Form 201508 - 2 201508 - 2 Certification Amendment Form

Certification Amendment Form

Certification Amendment Form

The following Certification Amendment Form to the Annual Certification and Data Collection Report Form must be submitted in order to update the information submitted in an organization’s certification application. If the response to any of the questions in Part II. Verification of CDFI Re-Certification Eligibility was “No,” or if the organization’s EIN changed, please submit updated information for the corresponding questions below.

Note that changes to documentation or Legal Entity will not be accepted unless as indicated below. A summary of required verification documentation follows the Certification Amendment Form.

Part I. Organizational Information

Eligibility Questions			Entry Type
1b.		Has the organization EIN changed?	Drop Down (Yes/No)
	If so, what is the new Employer Identification Number (EIN)?		Text Box
	Is the required EIN verification documentation attached?		Drop Down (Yes/No)
	Has any other organizational information changed (e.g., organization name, fiscal year end, or primary line of business)? Please explain.		Text Box

Part II. Verification of CDFI Re-Certification Eligibility

CDFI Certification Criteria			Entry Type
Legal Entity
1a.		The organization continues to be the same legal entity, duly formed and in good standing, since it was certified by the CDFI Fund.	Drop Down (Yes/No)
	If response is “No” please explain.		Text Box
1b.	The organization has not amended its organizational documentation (e.g., articles of incorporation, bylaws, charter) since the organization’s CDFI certification was last approved by the CDFI Fund.			Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
	Is necessary documentation attached for review?		Drop Down (Yes/No)
Primary Mission
2.	The Primary Mission of the organization, as evidenced in board- approved organizational documents, has not changed since the organization’s CDFI certification was last approved by the CDFI Fund.		Drop Down (Yes/No)
	If the Primary Mission changed since its certification was last affirmed by the CDFI Fund, please provide the updated Primary Mission.		Text Box
Financing Entity
3a.		The organization continues to be an entity whose predominant business activity is the provision, in Arms-Length Transactions, of Financial Products, as reflected on its financial statements and executed notes.			Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
3b.		The organization continues to maintain Sufficient Capital to continue Financing Activities that support the provision of Financial Products for at least three months from the end of the organization’s fiscal year.			Drop Down (Yes/No)
		If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.			Text Box
3c.		The organization continues to dedicate a Predominance of its Assets to Financial Products.			Drop Down (Yes/No)
		If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.			Text Box
3d.		The organization continues to dedicate a Predominance of staff time to the provision to Financial Products.			Drop Down (Yes/No)
		If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.			Text Box
Development Services
4a.		The organization, directly or through an Affiliate, or through a contract with another provider, continues to meet the Development Services criteria requirements.	Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
Target Market
5a.	At least 60% of the organization’s Transactions are directed towards serving their approved Target Market(s).		Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
5b.	The organization reviewed its approved Target Market maps in CIMS and verified that its Target Market(s) have not changed since its CDFI certification was last approved by the CDFI Fund.		Drop Down (Yes/No)
	If the Target Market(s) have changed, please describe the changes.		Text Box
	Are the updated Target Market maps attached to be submitted for review?		Drop Down (Yes/No)
Accountability Criteria
6a.	The organization continues to maintain Accountability to clients in its approved Target Market through representation on its governing board, or otherwise, since the Respondent’s CDFI certification was last approved by the CDFI Fund.		Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
6b.	The organization maintained the same method or set of methods for providing Accountability to the organization’s approved Target Market since the organization’s CDFI certification was last approved by the CDFI Fund.		Drop Down (Yes/No)
	If response is “No” please explain. Please attach updated documentation and submit with this amendment for review.		Text Box
Non-Governmental Entity
7.	The organization continues to not be an agency or instrumentality of the United States, or any state or political subdivision thereof, and that such has not changed since the organization’s CDFI certification was last approved by the CDFI Fund.		Drop Down (Yes/No)
	If the organization experienced a change in circumstances relative to the Non-Government Entity criteria since the Respondent’s CDFI certification was last affirmed, please explain.		Text Box
Other Eligibility Information Changes
	Has any other eligibility information changed since the original certification application was approved?		Drop Down (Yes/No)
	If “Yes” please explain and attach any relevant documentation for review.		Text Box

Summary of Documentation Required to Update Certification Eligibility Criteria

Requirement to be updated	Documentation accepted for verification of changes submitted	Notes
EIN	Official letter form the IRS providing EIN Confirmation fax from local IRS office with the organization’s EIN (must also include the online confirmation receipt)	IRS documentation required
Legal Entity	Articles of Incorporation Certificate of Incorporation Organization Certificate Regulatory Charter Certificate of Incorporation
Primary Mission	Articles of Incorporation Bylaws Board Resolution	Include the board-approved organizational document containing the revised primary mission.
Target Market	CIMS 3 Target Market Map	Updated map(s) corresponding to the list of newly proposed Target Market(s) is required

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