CFC Family Support and Youth Activities

OMB APPROVED
No. 3206-0131

COMBINED FEDERAL CAMPAIGN
2016 Application Instructions for
Family Support and Youth Activities
to the Director of the Office of Personnel
Management (OPM). The Director's decision is
final for administrative purposes. Appellants
should ensure that their appeals are complete and
responsive to the actual reasons for the LFCC
denial decision.

BACKGROUND
Enclosed is the model application for use Family
Support and Youth Activities (FSYA), also known
as Morale, Welfare and Recreation (MWR)
organizations, applying to participate in the
Combined Federal Campaign (CFC). An FSYA is
an organization that operates on a military base for
the benefit of the members of the military who
work or live on that. The following instructions
and form are intended to assist an FSYA in
applying for participation in the CFC. All aspects
of the CFC, including eligibility for participation,
are strictly governed by Federal regulation. The
current CFC regulations can be viewed on our
website at www.opm.gov/cfc. Additional copies of
the application can also be downloaded from the
website.

Each LFCC determines the application deadline
for organizations seeking local eligibility. Since
local dates will vary, please check with the local
CFC for local application deadlines and filing
information. Local campaign contact information
can be found on the CFC website at
www.opm.gov/cfc/Search/Locator.asp.
If a local application form is available, OPM
suggests that organizations use the local
application provided when applying to the CFC.
The CFC will not accept application forms with
modifications to any of the certification statements.

All required documents and attachments must be
complete and submitted before the application
deadline each year. The CFC will not accept late
applications. It is the applicant’s responsibility to
ensure that its application and all required
information is received by the scheduled
deadline. Requests for consideration after the
deadline will not be considered.

In order to determine whether an organization may
participate in the campaign, the LFCC may request
evidence of corrective action regarding any prior
violation of regulation or directive, sanction, or
penalty, as appropriate. The LFCC will decide
whether the organization has demonstrated, to the
LFCC’s satisfaction, that the organization has
taken appropriate corrective action. Failure to
demonstrate satisfactory corrective action or to
respond to the LFCC’s request for information
within 10 business days of the date of the request
may result in a recommendation to OPM that the
organization will not be included in the Charity
List. The Director’s decision will be communicated in writing to the organization.

Applicants whose applications do not contain
required documents or who submit incomplete or
out-of-date documents will not be permitted to
correct their applications during the appeals
process. Organizations that apply for local
eligibility and are found ineligible will have an
opportunity to appeal to the Local Federal
Coordinating Committee (LFCC) for reconsideration. If found ineligible on appeal by the LFCC,
the organization may appeal the LFCC’s decision

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OPM Form 1647-E
Rev. September 2015

address. Post office boxes may be used for the
disbursement address.

DEFINITIONS
Organization
organization.

Legal name of the applicant
Electronic Funds Transfer (EFT) Information
List the Routing and Account numbers, along with
the name of the financial institution, where funds
should be disbursed. This is an optional method
for receipt of CFC contributions. NOTE: Some
campaigns may elect not to disburse funds
electronically.

Employer Identification Number (EIN) The
nine-digit EIN that has been assigned to the
organization by the IRS.
5 Digit CFC Number
The 5 digit number
assigned to the organization by the CFC.
Organizations that did not previously participate in
the CFC should leave this field blank.

Certifying Official The certifying official is the
individual who has the authority to affirm that all
statements in the application are accurate. For
FSYAs, the certifying official must be

Mailing Address A physical mailing address
must be provided - Post Office Box addresses will
not be accepted.

commander of the military installation or the
head of the Federal facility where the
organization is located.

Telephone Organization’s telephone number.
Contact Person The contact person is the individual to whom the CFC will direct communications. This may be any individual in the organization.

INSTRUCTIONS
For details regarding CFC eligibility requirements
for FSYAs, refer to CFC regulations at 5 CFR §
950.204(c)
on
the
CFC
website
at
www.opm.gov/cfc.

Contact Title Self-explanatory
Contact Address
Contact person’s physical
mailing address if different than the organization's
address. Post Office Boxes may be used.
Participation decision letters and other CFC
communications will be sent to the contact person
at this address.

Applicants must check the box next to certification
statement #1 to demonstrate agreement to comply
with the statement and to certify that it meets the
requirement. Failure to provide a check mark for
the statements will be considered a refusal to
certify and will result in the denial of the
application.

Contact Telephone Contact person’s telephone
number, if different than the organization’s telephone number.

Item 1
Each FSYA applying to participate in the CFC
must, as a condition of participation, certify that it
is in compliance with all statutes, Executive
Orders, and regulations restricting or prohibiting
U.S. persons from engaging in transactions and
dealings with countries, entities, and individuals
subject to economic sanctions administered by the
U.S. Department of the Treasury’s Office of
Foreign Assets Control (OFAC). The programs
administered by OFAC restrict or prohibit U.S.
persons from engaging in transactions and dealings
with targeted countries, entities, and individuals.
OFAC publishes a list of Specially Designated
Nationals and Blocked Persons (SDN List). The
persons on the SDN List are subject to economic

Fax Contact person’s fax number.
Contact E-Mail Contact person’s electronic mail
address. Applicants are encouraged to provide
more than one email address.
Website Address
List one complete Internet
address of the applicant organization (no e-mail
addresses). This information is required, if the
organization has an Internet address.
Disbursement Address List the address where
paper checks will be sent, if different from mailing

2

OPM Form 1647-E
Rev. September 2015

sanctions. The SDN List and additional information relating to the economic sanctions
programs that OFAC administers are available at
http://www.treas.gov/ofac. A link to the SDN List
is
available
on
the
CFC
website
(www.opm.gov/cfc). For further information,
please see CFC Memo 2005-13.

•

Item 2
Include as Attachment A a copy of the letter
from the commanding officer of the military
installation certifying that the organization
meets the criteria in 5 C.F.R. §950.204(d).

Item 3
Include as Attachment B, a statement in 25
words or less that describes the organization’s
program activities. The statement should not
repeat the organization's name. The organization
must also provide the legal name as registered with
the IRS if the organization does business under a
different name. All organizations must include
their IRS Employee Identification Number (EIN)
regardless of whether or not they are operating
under a "dba" (“doing business as”). The
organization must also include a telephone number
that can be reached from any location in the U.S.
and the organization’s administrative and
fundraising rate. The legal name, telephone
number, EIN, taxonomy codes (see below), and
administrative and fundraising rate will NOT count
as part of the 25-word statement. An Internet
address where information on the organization can
be obtained may be included and will not count
toward the 25 words. OPM will not be responsible
for incorrect Internet addresses. E-mail addresses
are not accepted.

This certification letter must be completed
annually and dated on or after January 1 of the
campaign year to which the organization is
applying. The letter must certify that the organization meets the following criteria:
•

•
•

•

•

•

religion, sex or national origin applicable to
persons served by the organization.
The organization prepares an annual report
which includes a full description of the
organization’s activities and accomplishments.
These reports are made available to the public
upon request.

The organization is a nonprofit, tax-exempt
organization that provides family service
programs or youth activity programs to
personnel in the Command or in the Federal
facility where the organization is located. The
activity does not receive a majority of its
financial support from appropriated funds.
The organization is a Non-Appropriated Fund
Instrumentality that supports the installation
MWR/FSYA program.
The organization has a high degree of integrity
and responsibility in the conduct of its affairs.
Contributions received are used effectively for
the announced purposes of the organization.
The organization is directed by the base NonAppropriated Fund Council or an active
voluntary board of directors which serves
without compensation and holds regular
meetings.
The organization conducts its fiscal operations
in accordance with a detailed annual budget,
prepared and approved at the beginning of the
fiscal year. Any significant variations from the
approved budget must have prior authorization
from the Non-Appropriated Fund Council or
the directors. The family support and youth
activities must have accounting procedures
available to an installation auditor and the
inspector general.
The organization has a policy and practice of
nondiscrimination on the basis of race, color,

Taxonomy Codes
Each organization can
identify up to three categories, in priority order,
which most closely identify the type of mission,
services, and activities provided. The corresponding letters will be printed in your organization’s
listing in the CFC charity list (see example below)
to assist donors in identifying charities by type of
service provided. Categories are derived from the
National Taxonomy of Exempt Entities (NTEE)
classification system developed by the National
Center for Charitable Statistics. The 26 categories
are:
A
B
C
D
E
F
G

3

Arts, Culture, and Humanities
Education
Environment
Animal Related
Health Care
Mental Health & Crisis Intervention
Voluntary Health Associations & Medical
OPM Form 1647-E
Rev. September 2015

Disciplines
H Medical Research
I Crime & Legal Related
J Employment
K Food, Agriculture & Nutrition
L Housing & Shelter
M Public Safety, Disaster Preparedness & Relief
N Recreation & Sports
O Youth Development
P Human Services
Q International, Foreign Affairs & National Security
R Civil Rights, Social Action, & Advocacy
S Community Improvement & Capacity Building
T Philanthropy, Voluntarism & Grantmaking
Foundations
U Science & Technology Research Institutes,
Services
V Social Science Research Institutes, Services
W Public & Societal Benefit
X Religion-Related
Y Mutual & Membership Benefit
Z Unknown

Special design text used to draw attention to an
organization title, such as special fonts, capitalization, quotations, and underlining, are not accepted.
Any statement that uses special features, or
exceeds 25 words will be edited by the LFCC.
Organizations will be listed by their legal IRS
recognized name as it appears on the IRS
determination letter only unless the appropriate
legal documentation permitting otherwise is
provided with the application. See Item 2. The
format is as follows:
00000 Name of Organization (legal name of
organization, if applicable) (202) 555-1234
www.opm.gov/cfc
EIN#12-3456789
The
description will contain no more than 25 words. It
should be worded so the donor understands the
program services provided. B,V,O

Local CFC applications must be sent to the local campaign office. Do not send applications to the U.S.
Office of Personnel Management. Note that each campaign area sets its own application deadline. For
more information on the local application deadlines and addresses, please contact the Principal
Combined Fund Organization (PCFO) representative in your area. Contact information can be found
at www.opm.gov/cfc/Search/Locator.asp.

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OPM Form 1647-E
Rev. September 2015

OMB APPROVED
NO. 3206-0131

COMBINED FEDERAL CAMPAIGN
2016 APPLICATION FOR
FAMILY SUPPORT AND YOUTH ACTIVITIES
Organization:
Employer Identification Number (EIN): __ __ - __ __ __ __ __ __ __ __ __
5 Digit CFC Number (If a previous participant in the CFC):

___ ___ ___ ___ ___

Organization Address:
____________________________________________________________
(Post Office Box addresses are not accepted and may result in automatic disqualification.)

Telephone:

( ___ ) _________________________________________

Contact Person:
Contact Title:

_________________________________________________________

Contact Address:
(If different from the above address – Post Office Boxes are acceptable for the Contact Address. All CFC
correspondence will be sent to this address.)

Contact Telephone:

( ___ )________________

Contact E-Mail Address:

Fax: ( ___ )_____________________

_________________________________________________________

Website Address (required, if available):

________________________________________

Disbursement Address: _________________________________________________________________
(This is the address where paper checks will be sent.)
Electronic Funds Transfer (EFT) information (Optional):
Routing Number (9 digits): __ __ __ __ __ __ __ __ __
ACCT: ___________________________________________
Financial Institution: _________________________________

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OPM Form 1647-E
Rev. September 2015

1)

I certify that the organization named in this application is in compliance with all statutes,
Executive orders, and regulations restricting or prohibiting U.S. persons from engaging in
transactions and dealings with countries, entities, or individuals subject to economic
sanctions administered by the U.S. Department of the Treasury’s Office of Foreign Assets
Control. The organization named in this application is aware that a list of countries subject
to such sanctions, a list of Specially Designated Nationals and Blocked Persons subject to
such sanctions, and overviews and guidelines for each such sanctions program can be found
at http://www.treas.gov/ofac. Should any change in circumstances pertaining to this
certification occur at any time, the organization will notify OPM's Office of CFC
immediately.

2)

Include as ATTACHMENT A the letter from the commander of the military installation or
the head of the Federal facility where the organization is located certifying that the
organization meets the eligibility criteria outlined in 5 C.F.R. §950.204(d) (see application
instructions for a list of the eligibility criteria).

3)

Include as ATTACHMENT B a 25-word statement for listing in the campaign charity list.
(See Instructions Item 3 for additional required information on the optional taxonomy codes.)

CERTIFYING OFFICIAL
I, ____________________________________, am the duly appointed representative
(Print Name)
of ____________________________________ authorized to certify and affirm all statements
(Print Organization Name)
enclosed in this application. I certify that I have read all the certifications set forth in this document
and affirm their accuracy. In addition, by checking the box next to the certification, the organization
named in this application acknowledges and agrees to comply with that certification.

______________________________
(Signature)
______________________________
(Typed or Printed Name)
______________________________
(Title)
Date Completed ______________________

______________________________
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OPM Form 1647-E
Rev. September 2015

Public Burden Statement
We think this form takes an average of 3 hours to complete, including the time for getting the needed data and reviewing
both the instructions and completing the form. Send comments regarding our estimate or any other aspects of this form,
including for reducing completion time to Office of Personnel Management (OPM), CFC Operations (3206-0131),
Washington, DC 20415-7900. The OMB number 3206-0131 is currently valid. OPM may not collect this information,
and you are not required to respond, unless this number is displayed.

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OPM Form 1647-E
Rev. September 2015