CDFI Fund Community Development Entity Certification App

Community
Development
Financial
Institutions
Fund

CDE Certification
Application
(R e v .

Sept

2015)

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
PAPERWORK REDUCTION ACT NOTICE
CDFI -0019
OMB Control Number CDFI -1559-0014
This submission requirements package is provided to applicants for Community Development Entity (CDE) certification under the
New Markets Tax Credit (NMTC) Program. Applicants are not required to respond to this collection of information unless it
displays a currently valid OMB number. The estimated average burden associated with this collection of information is 3.75
hours per applicant. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be directed to the Certification, Compliance Monitoring and Evaluation Program Manager, Department of the Treasury,
Community Development Financial Institutions Fund, 1500 Pennsylvania Avenue, Washington, DC 20220.

(REVISED SEPTEMBER 2015) PAGE 2 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
CDFI FUND MISSION
The mission of the Community Development Financial Institutions Fund (the CDFI Fund) is to expand the
capacity of financial institutions to provide credit, capital, and financial services to underserved
populations and communities in the United States.

WHAT IS A COMMUNITY DEVELOPMENT ENTITY (CDE)?
A Community Development Entity (CDE) is a domestic corporation or partnership that is an intermediary
vehicle for the provision of loans, investments, or financial counseling in Low-Income Communities (LICs),
under the New Markets Tax Credit (NMTC) Program.

CDE CERTIFICATION DESIGNATION
An entity seeking CDE certification must submit a CDE Certification Application to the CDFI Fund as
directed herein. To qualify as a CDE, an Applicant CDE must at the time of application submission:


Be a legally established entity and a domestic corporation or partnership for Federal tax
purposes;



Have a primary mission of serving or providing investment capital to LICs or Low-Income
Persons; and



Establish accountability to LICs through representation on its governing or advisory board.

Through the CDE Certification Application, an entity may apply for certification solely on its own behalf, or
on behalf of itself and one or more Subsidiary Applicants, provided that each applicant entity is legally
established at the time of application. Each entity and subsidiary entity seeking CDE certification must
have a valid Employer Identification Number (EIN) at the time the CDE Certification Application is
submitted.
NOTE: Community Development Financial Institutions (CDFIs) and Specialized Small Business
Investment Companies (SSBICs) seeking CDE certification automatically qualify as CDEs and do not
need to complete this Certification Application. Such entities should register electronically for CDE
certification on the CDFI Fund’s website.
NOTE: Subsidiaries and Affiliates of certified CDEs, CDFIs, and SSBICs do not automatically qualify as
CDEs. The parent CDE must submit this CDE Certification Application to have its Subsidiary entities
certified as CDEs.
NOTE: Section 7701(a)(4) of the Internal Revenue Code defines "domestic" when applied to a
corporation or partnership to mean created or organized in the United States or under the law of the
United States or of any State unless, in the case of a partnership, the Secretary provides otherwise by
regulations.


Organizations incorporated in US territories are not considered "domestic" corporations or
partnerships for the purpose of this definition.

(REVISED SEPTEMBER 2015) PAGE 3 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
CDE CERTIFICATION BENEFIT
Benefits of being certified as a CDE include being able to apply to the CDFI Fund to receive a New
Markets Tax Credit (NMTC) allocation to offer its investors in exchange for equity investments in the CDE
and/or its subsidiaries; or to receive loans or investments from other CDEs that have received NMTC
allocations.
New Market Tax Credit Program
Under the NMTC Program, taxpayers may claim a credit against Federal income taxes for Qualified
Equity Investments made to acquire stock or other capital interests in designated CDEs. Substantially
all of the Qualified Equity Investments must be used by the CDE to, among other things, make loans
to, or equity investments in, qualified businesses or CDEs operating in Low-Income Communities.
The investor (either the original purchaser or a subsequent holder) receives a tax credit for a sevenyear period equal to five percent of the total amount paid for the stock or capital interest, at the time of
purchase, for each of the first three years, and six percent annually for the remaining four years.
Applying for NMTC Allocations
The CDFI Fund allocates NMTC authority to for-profit and non-profit CDEs through a competitive
application process pursuant to a Notice of Allocation Availability (NOAA) published in the Federal
Register. NMTC Allocation Application materials and guidance are available from the CDFI Fund’s
website. For-profit CDE NMTC Allocation awardees can provide their investors the tax credit in
exchange for stock or capital interests. A Non-profit CDE NMTC Allocation awardee must
demonstrate to the CDFI Fund, prior to receiving an Allocation Agreement, that: 1) it controls one or
more for-profit Subsidiary CDE(s); and 2) it intends to transfer the entire NMTC Allocation to its forprofit Subsidiary CDE(s).
For-profit and non-profit entities that do not apply to the CDFI Fund for NMTC Allocations may obtain
CDE certification in order to receive Qualified Low-Income Community Investments from for-profit
CDE NMTC Allocation recipients.

MAINTAINING CDE CERTIFICATION
Each CDE NMTC Allocation awardee, as well as CDEs that are recipients of Qualified Low-Income
Community Investments (QLICIs) from other CDEs, may be required to annually certify to the Fund that it
continues to meet the Primary Mission and Accountability requirements by providing the information
below. The Fund may revoke a CDE’s certification if it fails to provide the requested information.


Information indicating that the entity remains accountable to the LIC(s) it is serving; and



A certification statement certifying that no material changes have occurred to affect their current
status as a CDE.

(REVISED SEPTEMBER 2015) PAGE 4 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
APPLICATION PROCESS OVERVIEW
Note: Each Applicant CDE and each Subsidiary Applicant must have its own valid Employer Identification
Number (EIN) prior to submission of the Certification Application. Failure to include this information for
any entity will result in the rejection of the entire application. For more guidance on obtaining an EIN, refer
to the CDFI Fund’s CDE Certification Frequently Asked Questions document.
Additional Questions and Resources: Please contact the CDFI Fund staff if you have questions
regarding the CDE Certification application. CDFI Fund staff can be contacted by telephone at
(202) 653-0423 and by e-mail at [email protected]. Information regarding the CDE Certification
application and process can also be obtained by visiting the CDFI Fund’s CDE Certification webpage.
Application Completion Steps:
•

Carefully review the following documents from the CDFI Fund’s CDE Certification webpage:
 The CDE Certification Guidance as published in the Federal Register; and
 The CDE Certification Frequently Asked Questions document.

•

Create a (or access an existing) customized web portal “myCDFI Fund” user account located at
the CDFI Fund’s homepage. Account holders can then access the CDFI Fund Information and
Mapping System (CIMS) program, which helps determine the eligibility of geographic areas under
the NMTC Program.

•

Complete the CDE Certification Application. Failure to properly complete the appropriate sections
of the Application may result in the CDFI Fund’s rejection of the entire Certification Application.

•

Provide the required Document Attachments, including legal entity establishment documents,
Internal Revenue Service (IRS) assignment of EIN, and additional documents demonstrating the
entity’s Primary Mission as directed. Copy the Documentation Attachments double-sided (front
and back) to minimize the Certification Application package.

•

Mail one original and one copy of the Certification Application, including documentation
attachments, to the address indicated below. Both the original and the copy should be secured
with a binder clip and without staples, tabbed dividers, or other forms of binding.

ATTN: CDE Certification Application
U.S. Department of the Treasury
Community Development Financial Institutions Fund
1500 Pennsylvania Avenue, NW
Washington, DC 20220

Telephone: 1-202-653-0300 (used on shipping labels for overnight delivery services) Faxed or
E-mailed Certification Applications WILL NOT be accepted

(REVISED SEPTEMBER 2015) PAGE 5 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
BASIC INFORMATION – APPLICANT CDE
Select the Application Type being submitted (check one):
 Type A: An Applicant CDE that is applying for initial CDE certification only on behalf of itself.
 Type B: An Applicant CDE that is applying for initial CDE certification on behalf of itself and one
or more subsidiary entities.
 Type C: An Applicant CDE, which is already certified, that is applying for CDE certification on
behalf of one or more subsidiary entities.
Enter Name of Applicant CDE: __________________________________________________________
Is the Applicant CDE already certified as a CDE?


 YES

✔ NO


If yes, provide the CDE Certification Application Control Number of the Applicant CDE:
_________________________

Enter the number of Subsidiary Applicant(s) submitted under this application, if applicable: ___________
For Type B and Type C Applications, complete the table below for all subsidiaries submitted under this
Application:

Name of Subsidiary
(Application Type B &
C Only)

Employer
Identification
Number
(EIN)

EXPRESS OPTIONS (See page 10)
[All boxes must be checked to utilize the Express Option]
 This subsidiary has the same Primary Mission as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Accountability.
 This subsidiary has the same Primary Mission as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant CDE and
there have been no unapproved material changes to the Applicant
CDE’s Accountability.

(REVISED SEPTEMBER 2015) PAGE 6 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Additional Subsidiary Applicants
(Copy this page as necessary.)

Name of Subsidiary
(Application Type B &
C Only)

Employer
Identification
Number (EIN)

EXPRESS OPTIONS (See page 10)
[All boxes must be checked to utilize the Express Option]
 This subsidiary has the same Primary Mission as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Accountability.
 This subsidiary has the same Primary Mission as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Accountability.
 This subsidiary has the same Primary Mission as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Accountability.
 This subsidiary has the same Primary Mission as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Primary Mission.
 This subsidiary has the same Service Area as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Service Area.
 This subsidiary has the same Accountability as the Applicant
CDE and there have been no unapproved material changes to
the Applicant CDE’s Accountability.

(REVISED SEPTEMBER 2015) PAGE 7 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Enter structure of the Applicant CDE (check all that apply)








For-profit
Publicly traded company
Thrift, Bank or bank holding company
Small Business Investment Company (SBIC)
Specialized Small Business Investment Company (SSBIC)
Certified Community Development Financial Institution
New Markets Venture Capital Company









Non-profit
Faith-Based Institution
Credit Union
Government-controlled entity
Minority Owned or Controlled
Tribal Entity
Real Estate Development Company

Products and Services that are, or will be, offered by the Applicant CDE (check all that apply)







Real estate Financing (Check only one accompanying sub-category
 Retail
 Industrial/Manufacturing
 Community Facilities
 Hospital/Tourism
 Office Space
 For Sale Housing
 Business Financing
 Mixed-use (housing commercial, retail)
Microenterprise Financing
Financing other CDEs
Loan purchase from other CDEs
Financial Counseling and Other Services.

Structure of the Applicant CDE’s Controlling Entity (check all that apply)









For-profit
Publicly traded company
Thrift, Bank or bank holding company
Small Business Investment Company (SBIC)
Specialized Small Business Investment Company (SSBIC)
Certified Community Development Financial Institution
New Markets Venture Capital Company
Not Applicable – Applicant CDE does not have a Controlling
Entity









Non-profit
Faith-Based Institution
Credit Union
Government-controlled entity
Minority Owned or Controlled
Tribal Entity
Real Estate Development Company

(REVISED SEPTEMBER 2015) PAGE 8 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Market Served and Estimated % of Total Activities (should total 100 percent)

_____ percent - Major urban areas (Counties in Metropolitan Area with a population equal to or greater
than 1 million include both central city and surrounding suburbs)
_____ percent - Minor urban areas (Counties in Metropolitan Area with a population of less than 1
million include both central city and surrounding suburbs)
_____ percent - Rural areas

Applicant Organizational Address(es):
Mailing Address

Shipping Address (if different, for overnight deliveries)

Applicant Contact Information
Authorized Representative:
Name

Applicant Contact (if different than AR):
Name

Phone

Phone

Fax

Fax

E-mail

E-mail

I hereby certify that all of the information provided in connection with the above-named Applicant CDE’s
certification as a CDE is true, accurate and complete. The submission of such information has been duly
authorized by the above-named Applicant CDE’s governing body.
Authorized Representative Signature:

Date:

Estimate how long this Certification Application form took to complete: ________ hours

(REVISED SEPTEMBER 2015) PAGE 9 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Certifications and Signature
REQUIRED:
I. I certify, on behalf of the Applicant CDE and, if applicable, its Subsidiary Applicants, that it/they will, at
all times during the course of its/their designation as a CDE, direct a minimum of sixty percent of
its/their activities (including loans, investments and related technical assistance) to Low-Income
Persons, to persons or organizations located in Low-Income Communities, or to other organizations
that principally serve Low-Income Persons or residents of Low-Income Communities.
II. I further certify that the Applicant CDE and, if applicable, its Subsidiary Applicant(s), will maintain
accountability to the Low-Income Communities that it/they serve, through their representation on the
governing board or on an advisory board(s) to the Applicant CDE (and, if applicable Subsidiary
Applicants), at all times during the course of its/their designation as a CDE.
III. The Applicant CDE and, if applicable, its Subsidiary Applicant(s) acknowledges that it may be
required to periodically certify to the Fund that it continues to comply with the above certification
requirements, and to notify the Fund if the Applicant CDE and, if applicable, its Subsidiary
Applicant(s) fails to comply with these requirements. The Applicant CDE and, if applicable, its
Subsidiary Applicant(s) acknowledges further that a failure to comply with these requirements may
result in the Applicant CDE and, if applicable, its Subsidiary Applicant(s) losing its designation as a
CDE, as well as the revocation of NMTC Allocations provided to the Applicant CDE or Subsidiary
Applicants and/or the recapture of NMTCs claimed by investors for making Qualified Equity
Investments in the Applicant CDE or Subsidiary Applicants.
OPTIONAL FOR APPLICANT CDE’S APPYING FOR CERTIFICATION ON BEHALF OF ONE OR
MORE SUBSIDIARY CDE APPLICANTS:
EXPRESS OPTION - Applicant CDEs (Type B or C) seeking to certify Subsidiary Applicants as CDEs that
have the same Primary Mission, Service Area, and Board(s) as the Applicant CDE, may make the
following certification by checking the following box below:

 I certify, on behalf of Applicant CDE, that the designated Subsidiary Applicant CDE(s) listed in this
application, for which all three boxes were checked in the Basic Information Section, are legal entities
(having filed the necessary paperwork with the appropriate state agencies), have valid EINs, and
• have the same Primary Mission as the Applicant CDE and there have been no unapproved
material changes to the Applicant CDE’s Primary Mission; and
• have the same Service Area as the Applicant CDE and there have been no unapproved material
changes to the Applicant CDE’s Service Area; and
• have the same Accountability as the Applicant CDE and there have been no unapproved material
changes to the Applicant CDE’s Accountability.
Selecting the option above requires that no further application materials be submitted for those
subsidiary CDEs listed on the Applicant’s Basic Information page and for which all three boxes
under the EXPRESS OPTION have been checked; EXCEPT LEGAL ENTITY DOCUMENTATION.
Authorized Representative Signature:

Date:

(REVISED SEPTEMBER 2015) PAGE 10 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
BASIC INFORMATION
Name of Subsidiary CDE
Subsidiary CDE Employer Identification Number
Contact Name
Contact Telephone
Contact Email
Mailing Address

Market Served and Estimated % of Total Activities (should total 100 percent)

_____ percent - Major urban areas in a Metropolitan Area with a population equal to or greater than 1
million (include both central city and surrounding suburbs).
_____ percent - Minor urban areas in a Metropolitan Area with a population of less than 1 million
(include both central city and surrounding suburbs).
_____ percent - Rural areas

Type of Entity (check all that apply)








For-profit
Publicly traded company
Thrift, Bank or bank holding company
Small Business Investment Company (SBIC)
Specialized Small Business Investment Company (SSBIC)
Certified Community Development Financial Institution
New Markets Venture Capital Company









Non-profit
Faith-Based Institution
Credit Union
Government-controlled entity
Minority Owned or Controlled
Tribal Entity
Real Estate Development Company

Products and Services that are, or will be, offered by the Subsidiary CDE (check all that apply)







Real estate Financing (Check only one accompanying sub-category
 Retail
 Industrial/Manufacturing
 Community Facilities
 Hospital/Tourism
 Office Space
 For Sale Housing
 Business Financing
 Mixed-use (housing commercial, retail)
Microenterprise Financing
Financing other CDEs
Loan purchase from other CDEs
Financial Counseling and Other Services

(REVISED SEPTEMBER 2015) PAGE 11 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type A & B Only

Criteria: LEGAL ENTITY
As of the date its CDE Certification Application is submitted (signed by Authorized Representative), the
Applicant, and relevant subsidiaries, must be duly organized and validly exist under the laws of the state
jurisdiction in which it is incorporated or established AND be a domestic corporation or partnership for
federal tax purposes. Legal documents must be submitted for the Applicant and all subsidiaries,
INCLUDING subsidiaries using the EXPRESS OPTION)
APPLICANT CDE: ______________________________________________________________
EVIDENCE OF LEGAL ENTITY STATUS
✔ NO
Is the Applicant CDE a domestic corporation or partnership for federal tax purposes?  YES

If no, the applicant is not eligible to apply for certification as a CDE and therefore should not submit a
CDE Certification Application.

NOTE: Section 7701(a)(4) of the Internal Revenue Code defines "domestic" when applied to a
corporation or partnership to mean created or organized in the United States or under the law of the
United States or of any State unless, in the case of a partnership, the Secretary provides otherwise by
regulations.
 Organizations incorporated in US territories are not considered "domestic" corporations or
partnerships for the purpose of this definition.
If the Applicant CDE is an LLC:
✔ NO
 Does the LLC have more than one Member?  YES 


If “NO” to the question above, has the LLC elected to be treated as a corporation for federal tax
✔ NO
purposes?
YES 

* Attach, if the Applicant is a single member LLC, a copy of the Applicant’s official IRS Documentation of
tax classification election as a corporation (e.g. submitted IRS Form 8832 or IRS acceptance of Form
8832.)
Enter the Applicant CDE’s date of incorporation/organization/establishment (month/day/year):_________
Enter the Applicant CDE’s total assets as of the date of this application: $______________

* Attach a copy of one of the following (documents must be signed, stamped, and filed with the
appropriate state agency):





Articles of Incorporation
Certificate of Formation
Organization Certificate
Other:_____________________

* Attach any amendments to attached organizing documents, (documents must be signed, stamped, and
filed with the appropriate state agency).

EMPLOYER IDENTIFICATION NUMBER (EIN)

(REVISED SEPTEMBER 2015) PAGE 12 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Enter CDE’s Employer Identification Number: _____________________________

* Attach one of the following for the Applicant CDE (documentation must clearly identify both the entity’s
legal name and its EIN):
-

Official letter from IRS providing EIN;
Confirmation fax from local IRS office with the organization’s name and EIN; or
A printout of completed and submitted online SS-4 (with organization’s EIN in upper right hand
corner) from IRS’ website, accompanied by a printout of the online confirmation of receipt of EIN
from IRS’ website.

(REVISED SEPTEMBER 2015) PAGE 13 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type B & C Only

Criteria: LEGAL ENTITY
As of the date its CDE Certification Application is submitted (signed and mailed by Authorized
Representative), the Applicant, and relevant subsidiaries, must be duly organized and validly exist under
the laws of the state jurisdiction in which it is incorporated or established AND be a domestic corporation
or partnership for federal tax purposes. Legal documents must be submitted for the Applicant and all
subsidiaries, INCLUDING subsidiaries using the EXPRESS OPTION.
SUBSIDIARY CDE Name: ____________________________________________________
EVIDENCE OF LEGAL ENTITY STATUS
✔ NO
Is the Subsidiary CDE a domestic corporation or partnership for federal tax purposes?  YES 
If no, the applicant is not eligible to apply for certification as a CDE and therefore should not submit a
CDE Certification Application.

NOTE: Section 7701(a)(4) of the Internal Revenue Code defines "domestic" when applied to a
corporation or partnership to mean created or organized in the United States or under the law of the
United States or of any State unless, in the case of a partnership, the Secretary provides otherwise by
regulations.
 Organizations incorporated in US territories are not considered "domestic" corporations or
partnerships for the purpose of this definition.
If the Subsidiary CDE is an LLC:
✔ NO
 Does the LLC have more than one Member?  YES 


If “NO” to the question above, has the LLC elected to be treated as a corporation for federal tax
✔ NO
purposes?
 YES 

* Attach, if the Subsidiary CDE is a single member LLC, a copy of the Subsidiary CDE’s official IRS
Documentation of tax classification election as a corporation (e.g. submitted IRS Form 8832 or IRS
acceptance of Form 8832.)
Enter the Subsidiary CDE’s date of incorporation/organization/establishment (month/day/year):________
Enter the Subsidiary CDE’s total assets as of the date of this application: $ _____________

* Attach a copy of one of the following (documents must be signed, stamped, and filed with the
appropriate state agency). Indicate which document is submitted below:
 Articles of Incorporation
 Certificate of Formation
 Organization Certificate
 Other:_____________________

* Attach any amendments to attached organizing documents, (documents must be signed, stamped, and
filed with the appropriate state agency).

EMPLOYER IDENTIFICATION NUMBER (EIN)

(REVISED SEPTEMBER 2015) PAGE 14 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Enter CDE’s Employer Identification Number: ____________________________

* Attach one of the following for each Subsidiary Applicant (documentation must clearly identify both the
entity’s legal name and its EIN):
-

Official letter from IRS providing EIN;
Confirmation fax from local IRS office with the organization’s name and EIN; or
A printout of completed and submitted online SS-4 (with organization’s EIN in upper right hand
corner) from IRS’ website, accompanied by a printout of the online confirmation of receipt of EIN
from IRS’ website.

(REVISED SEPTEMBER 2015) PAGE 15 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type A & B Only

Criteria: PRIMARY MISSION
A CDE must demonstrate that it has a primary mission of serving, or providing investment capital for LICs
or low income persons, and that at least 60 percent of its activities (e.g., loans and investments) are
targeted to low income persons or LICs.

APPLICANT CDE: ___________________________________________________________
Indicate type of board-approved organizational document that provides evidence of Applicant’s primary
mission of promoting community development:
 Articles of Incorporation, Organization, or Formation (signed and filed with appropriate state
agency)
 Bylaws (board-approved)
 Board approved resolution
 Annual report containing a signed letter from the Board Chairperson
 Board-approved, one-page narrative that specifically states how the organization’s collective
activities and products evidence the primary mission certification criteria
 Other similar board-approved documents
* Attach: Copy of the Applicant’s organizational documents, as indicated above, that provide evidence of
a primary mission of promoting community development.
Enter primary mission of Applicant (as stated in board approved document(s) indicated above):

(REVISED SEPTEMBER 2015) PAGE 16 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type B & C Only

Criteria: PRIMARY MISSION
A CDE must demonstrate that it has a primary mission of serving, or providing investment capital for LICs
or low income persons, and that at least 60 percent of its activities (e.g., loans and investments) are
targeted to low income persons or LICs.

SUBSIDIARY CDE Name: _______________________________________________________
(Complete and submit requested information for each Subsidiary seeking certification, except those for which the
EXPRESS OPTION is selected. Reproduce additional copies of the form as needed.)
Indicate type of board-approved organizational document that provide evidence of Applicant’s primary
mission of promoting community development:
 Articles of Incorporation, Organization, or Formation (signed and filed with appropriate state
agency)
 Bylaws (board-approved)
 Board approved resolution
 Annual report containing a signed letter from the Board Chairperson
 Board-approved, one-page narrative that specifically states how the organization’s collective
activities and products evidence the primary mission certification criteria
 Other similar board-approved documents
* Attach: Copy of the Applicant’s organizational documents, as indicated above, that provide evidence of
a primary mission of promoting community development.

Enter primary mission of Applicant (as stated in board approved document(s) indicated above):

(REVISED SEPTEMBER 2015) PAGE 17 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type A & B Only

Criteria: ACCOUNTABILITY & SERVICE AREA
A CDE Applicant must identify the service area that it serves or intends to serve; and demonstrate that it
maintains accountability to the LICs in those areas.
APPLICANT CDE:
1. Select one and identify the service area geography the entity currently serves or intends to serve:
 Local service area [e.g., county(ies); PMSA(s)]: _______________________________________
 State-wide or territory-wide service area: ____________________________________________
 Multi-state service area: __________________________________________________________
 National service area: ___________________________________________________________
2. Select and identify the method of accountability maintained to the residents of LICs (check all that
apply):
 Governing Board of the Applicant CDE
 Governing Board of the Applicant CDE’s Controlling Entity
 Governing Board of the Subsidiary Applicant
 Advisory Board(s)


Enter the number of Advisory Boards used to maintain accountability __________



Enter the names of the Advisory Boards used to maintain accountability
o

#1 ________________________________________________

o

#2 ________________________________________________

o

#3 ________________________________________________

(REVISED SEPTEMBER 2015) PAGE 18 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
APPLICANT CDE:
3. Complete one Board Table for each governing and/or advisory board listed.

For governing and advisory boards, the options for how board members may be representative of a
Service Area are as follows:
Categories for
Board Members:

Board members may:

A

Reside within a NMTC qualified census tract within the designated service area.

B

Own, control, or manage a business located in a NMTC qualified census tract within the
designated service area(s) that principally employs or provides goods and services to area
LIC residents.

C

Be an employee or board officer of a non-affiliated community-based or charitable
organization providing more than 50% of its program activities and services to LICs within the
designated area.

D

Be a religious leader whose congregation is located in a NMTC qualified census tract.

E

Be an employee of a governmental agency or department that primarily serves LICs, or whose
job responsibilities primarily involve serving LICs.

F

Be, or work for, an elected official whose constituency is comprised principally of, or are
residents of, qualified NMTC census tracts.

(REVISED SEPTEMBER 2015) PAGE 19 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
BOARD TABLE
BOARD TYPE:  Governing: (Name)___________________  Advisory: (Name)________________________
BOARD COMPOSITION DATE (as of): ____________________

Name
(List all board member’s
names)

LIC
Representative
(yes or no)?

Category
(Choose
from
category
listed
above)

1.

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

2.
3.
4.
5.
6.
7.
8.
9.
10.

Total # of board members

Geographic
Area(s)
Serve

Conflict of Interest Certification:
Check here to certify that neither
board member, nor any of his/her
family members, is (are) principal(s)
or staff member(s) of the Applicant
CDE (or Subsidiary Applicant), its
affiliated entities, or its investors.

 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.

%of LIC Reps

a) For each board member designated as a LIC Representative, complete an LIC Representative
Form, have the LIC Representative sign the form and submit with the application.

(REVISED SEPTEMBER 2015) PAGE 20 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
b) If the applicant entity intends to maintain accountability to the residents of its LIC through their
representation on Advisory Board(s), provide a narrative statement, detailing the following for
each Advisory Board named above:
♦

The process by which members are selected for the Advisory Board;

♦

How often the Advisory Board meets (to be accountable, a board must meet at least
annually);

♦

How the Advisory Board solicits, or intends to solicit, feedback from LIC residents, and how
often this information is, or will be, collected (e.g., feedback collected semi-annually at
community meetings, feedback collected annually through surveys, etc.); and

♦

How the information is used, or will be used, to influence the Governing Board’s actions in
developing the organization’s policies (e.g., an Advisory Board representative sits on the
Governing Board; a member of the Advisory Board presents reports to the Governing Board,
etc.).

(REVISED SEPTEMBER 2015) PAGE 21 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
Type B & C Only

Criteria: ACCOUNTABILITY & SERVICE AREA
A CDE Applicant must identify the service area that it serves or intends to serve; and demonstrate that it
maintains accountability to the LICs in those areas.

SUBSIDIARY CDE Name: ________________________________________________________
(Complete and submit requested information for each Subsidiary seeking certification, except those for which the
EXPRESS OPTION is selected. Reproduce additional copies of the form as needed.)
1. Select one and identify the service area geography the entity currently serves or intends to serves:
✔

Local service area [e.g., county(ies); PMSA(s)]: _______________________________________

 State-wide or territory-wide service area: ____________________________________________
 Multi-state service area: __________________________________________________________
 National service area: ___________________________________________________________
2. Select and identify the method of accountability maintained to the residents of LICs (check all that
apply):
 Governing Board of the Applicant CDE
 Governing Board of the Applicant CDE’s Controlling Entity
 Governing Board of the Subsidiary Applicant
 Advisory Board(s)


Enter the number of Advisory Boards used to maintain accountability __________



Enter the names of the Advisory Boards used to maintain accountability
o

#1 ________________________________________________

o

#2 ________________________________________________

o

#3 ________________________________________________

(REVISED SEPTEMBER 2015) PAGE 22 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
SUBSIDIARY CDE Name: ________________________________________________________
3. Complete one Board Table for each governing and/or advisory board listed.

For governing and advisory boards, the options for how board members may be representative of a
Service Area are as follows:
Categories for
Board Members:

Board members may:

A

Reside within a NMTC qualified census tract within the designated service area.

B

Own, control, or manage a business located in a NMTC qualified census tract within the
designated service area(s) that principally employs or provides goods and services to area
LIC residents.

C

Be an employee or board officer of a non-affiliated community-based or charitable
organization providing more than 50% of its program activities and services to LICs within the
designated area.

D

Be a religious leader whose congregation is located in a NMTC qualified census tract.

E

Be an employee of a governmental agency or department that primarily serves LICs, or whose
job responsibilities primarily involve serving LICs.

F

Be, or work for, an elected official whose constituency is comprised principally of, or are
residents of, qualified NMTC census tracts.

(REVISED SEPTEMBER 2015) PAGE 23 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
BOARD TABLE
BOARD TYPE:  Governing:(Name)___________________  Advisory: (Name)________________________
BOARD COMPOSITION DATE (as of): ____________________

Name
(List all board member’s
names)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Category
(Choose
from
category
listed
above)

Geographic
Area(s)
Serve

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

No

NA

NA

LIC
Representative
(yes or no)?

Conflict of Interest Certification:
Check here to certify that neither
board member, nor any of his/her
family members, is (are) principal(s)
or staff member(s) of the Applicant
CDE (or Subsidiary Applicant), its
affiliated entities, or its investors.

 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.
 There is no conflict of interest.

0%
Total # of board members

%of LIC Reps

a) For each board member designated as a LIC Representative, complete an LIC Representative
Form, have the LIC Representative sign the form and submit with the application.

(REVISED SEPTEMBER 2015) PAGE 24 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
c) If the applicant entity intends to maintain accountability to the residents of its LIC through their
representation on Advisory Board(s), provide a narrative statement, detailing of the following for
each Advisory Board named above:
♦

The process by which members are selected for the Advisory Board;

♦

How often the Advisory Board meets (to be accountable, a board must meet at least
annually);

♦

How the Advisory Board solicits, or intends to solicit, feedback from LIC residents, and how
often this information is, or will be, collected (e.g., feedback collected semi-annually at
community meetings, feedback collected annually through surveys, etc.); and

♦

How the information is used, or will be used, to influence the Governing Board’s actions in
developing the organization’s policies (e.g., an Advisory Board representative sits on the
Governing Board; a member of the Advisory Board presents reports to the Governing Board,
etc.).

(REVISED SEPTEMBER 2015) PAGE 25 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________
LOW INCOME REPRESENTATIVE FORM
(Complete and submit requested information for each proposed LIC representative. Reproduce additional copies of
the form as needed.)
1. Board Member’s Name: ______________________________________________
2. Service Area BOARD MEMBER (not Applicant) represents (e.g. County(ies), (P)MSA, State(s),
National): _______________________________________________
3. How is the Board Member representative of LICs? (Check and complete information in only one
category below)

✔
 A. Is a resident of a LIC. Provide the information below.
Board Member’s Complete Home
Address:
Census Tract (11 digit FIPS code):

Attach the “Address Geocoder Report” from The Fund’s CIMS mapping program.

 B. Is a small business owner who controls, operates or manages a business located in a LIC that:
a) provides goods and services to LIC residents; or b) principally employs LIC residents.
Business Name:
Business’ Complete Street Address:

Census Tract (11 digit FIPS code):

Attach the “Address Geocoder Report” from The Fund’s CIMS mapping program.
Provide a clear and concise description of the goods and/or services the business provides to
the LIC, and/or how it was determined that the business principally employs LIC residents.
Description
services:

of

goods

and/or

Explain how and what percentage
of LIC residents the business
employs:

(REVISED SEPTEMBER 2015) PAGE 26 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________


C. Is an employee or board member of a non-affiliated community-based or charitable
organization that provides more than 50 percent of its activities or services to Low-Income Persons
and/or LICs. Provide ALL of the information below.
Board Member Title:
Charitable organization name:
Organization Website Address:

Geographic area organization
serves (County(ies), State, or
Metropolitan Statistical Areas):
Describe the organization’s primary
activities and services that directly
benefit Low-Income Persons and/or
Communities:
Primary Low-Income Mission
Certification:

The organization named above has a primary mission to
serve low-income persons and/or communities, and
more than 50% of the organization’s program activities
and services are directed to benefiting low-income
persons and/or communities.

 D. Is a religious leader whose congregation is based in an LIC.
Board Member Title:
Religious Entity Name:
Religious Entity’s Complete Street
Address:
Census Tract (11 digit FIPS code):

Attach the “Address Geocoder Report” from The Fund’s CIMS mapping program.

(REVISED SEPTEMBER 2015) PAGE 27 OF 28

Community Development Financial Institutions Fund

CDE Certification Application
______________________________________________


E. Is a governmental agency/department employee that primarily serves LICs, or is a
governmental agency/department employee whose job responsibilities primarily involve serving LICs.
Board Member Title:
Agency/Department Name:
Agency/Department Website:
Geographic area
agency/\department Serves
(County(ies), state, or Metropolitan
Statistical Areas):
Describe the Agency/Department’s
primary activities and services, or
the Board Member’s primary job
responsibilities, that benefit LowIncome Persons and/or
Communities:
Primary Low-Income Mission
Certification:

The agency/department has a primary mission, or the
Board Member has primary responsibilities, to serve
low-income persons and/or communities, and more than
50% of the agency/department’s program activities and
services, or more than 50% of the Board Member’s
responsibilities, are directed to benefiting low-income
persons and/or communities.

 F. Is, or works for, an elected official whose constituency is comprised primarily of LICs or
residents of LICs. Provide information below.
Board Member organization title:
Elected Official Name:
Elected Official’s Geographic
Jurisdiction:
Explain how it was determined that
the elected official’s constituency is
comprised primarily of LICs or LIC
residents:
Attach the “Address Geocoder Report” from The Fund’s CIMS mapping program.
The LIC representative identified above certifies that all of the information provided by the Applicant
CDE is true and accurate.
LIC Representative Signature:

Date:

(REVISED SEPTEMBER 2015) PAGE 28 OF 28