1647-e Cfc Fsya

PENDING OMB APPROVAL

No. 3206-0131

Combined Federal Campaign

2017 Application Instructions for

Family Support and Youth Activities

Background

Enclosed is the model application for use by Family Support and Youth Activities (FSYA) and Family Support and Youth Programs (FSYP) organizations, also known as Morale, Welfare and Recreation (MWR) organizations, applying to participate in the Combined Federal Campaign (CFC). An FSYA/FSYP is an organization that operates on a military installation for the benefit of the members of the military who work or live on that installation. The following instructions and form are intended to assist an FSYA/FSYP 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.

The application deadline for FSYA/FSYP organizations seeking eligibility is [TBD], 2017.

All applications must be submitted electronically through the application module of the CFC Charity System (CFC-CS). Applications sent through any other means will not be processed.

OPM will not accept late applications. It is the applicant’s responsibility to ensure that its application and all required supplemental information and fees are received by the scheduled deadline. Requests for consideration after the deadline will not be granted.

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.

Applicants whose applications do not contain required documents or who submit incomplete or out-of-date documents will not be permitted to correct their applications during the appeal process. Organizations that are found ineligible will have only one opportunity to appeal to the Director of OPM. The Director's decision is final for administrative purposes. Therefore, appellants should ensure that their appeals are complete and responsive to the actual reasons for the LFCC denial decision.

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

Fees

A fee schedule is posted at www.opm.gov/cfc. All charities applying for participation in the CFC must pay a non-refundable Application Fee, which is due at the time the application is submitted. Applications that do not include payment at the time of submission will not be processed. Charities that are denied or withdraw will not have their fees refunded.

Charities that are approved for participation must pay a Listing Fee which is due no later than June 1, 2017. Approved organizations that have not paid the fee by that date will not be listed in the 2017 CFC Charity List. There are no waivers of the fee and requests for reconsideration will not be considered.

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 Arts, Culture, and Humanities

B Education

C Environment

D Animal Related

E Health Care

F Mental Health & Crisis Intervention

G Voluntary Health Associations & Medical 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

DEFINITIONS

Organization Legal name of the applicant organization.

Employer Identification Number (EIN) The nine-digit EIN that has been assigned to the organization by the IRS.

CFC Code The five-digit number assigned to the organization by the CFC. Organizations that did not previously participate in the CFC should leave this field blank.

Mailing Address A physical mailing address must be provided - Post Office Boxes or other mail service addressesmay not be used.

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.

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.

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

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. Participation decision letters and other CFC communications will be sent to this 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. Links to social media pages are not accepted.

Disbursement Address List the address where paper checks will be sent, if different from mailing address. Post office boxes may be used for the disbursement address.

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.

Certifying Official The certifying official is the individual who has the authority to affirm that all statements in the application are accurate. For FSYAs/FSYPs, the certifying official must be commander of the military installation or the head of the Federal facility where the organization is located.

INSTRUCTIONS

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

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.

Item 1

Each FSYA/FSYP 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 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 CFR§950.202(a)(4).

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:

1. Be a nonprofit, tax-exempt organization that provides family service programs or youth activity programs to personnel in the Command and be a Non-Appropriated Fund Instrumentality that supports the installation MWR/FSYA/FSYP program. The activity must not receive a majority of its financial support from appropriated funds.

2. Have a high degree of integrity and responsibility in the conduct of their affairs. Contributions received must be used effectively for the announced purposes of the organization.

3. Be directed by the base Non-Appropriated Fund Council or an active voluntary board of directors which serves without compensation and holds regular meetings.

4. Conduct 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 acceptable to an installation auditor and the inspector general.

5. Have a policy and practice of nondiscrimination on the basis of race, color, religion, sex, sexual orientation, gender identity or national origin applicable to persons served by the organization.

6. Prepare an annual report which includes a full description of the organization's activities and accomplishments. These reports must be made available to the public upon request.

APPLICANTS SHOULD BE AWARE THAT A FALSE RESPONSE TO ANY CERTIFICATION IN THIS APPLICATION MAY BE GROUNDS FOR DENIAL OF THE APPLICATION AND MAY BE PUNISHABLE BY FINE OR IMPRISONMENT (18 U.S.C. 1001).  ALL STATEMENTS AND INFORMATION PROVIDED ARE SUBJECT TO INVESTIGATION, INCLUDING CONFIRMATION THROUGH THIRD PARTIES AND OTHER GOVERNMENT AGENCIES.

Any information in your application may be subject to public disclosure under the Freedom of Information Act (FOIA). If your application is the subject of a FOIA request, you will be notified and given the opportunity to identify each item in the application that you believe is exempt from disclosure under the FOIA, specify which exemption you believe applies to that item, in accord with 5 U.S.C. Section 552, and give full justification for your belief that the justification(s) applies.  In making our decision on the disclosure, we will consider your justification for nondisclosure.  If we decide that an item of information that you believe is exempt is not exempt from disclosure, we will so inform you before it is disclosed.

REQUIRED ATTACHMENTS (failure to provide any of these documents may result in a denial)

• Attachment A – Letter of Certification from Commanding Officer

THE APPLICATION AND SUPPORTING DOCUMENTATION MUST BE SUBMITTED BY 11:59:59PM (EST), [TBD], 2017. LATE APPLICATIONS WILL NOT BE ACCEPTED.

OMB APPROVED

NO. 3206-0131

Combined Federal Campaign

2016 Application for

Family Support and Youth Activities

CFC Application System Account Registration:

Name:

Email Address:

CFC Charity Application:

Organization:

Employer Identification Number (EIN): ___ ___ - ___ ___ ___ ___ ___ ___ ___

CFC Code (If a previous participant in the CFC): ___ ___ ___ ___ ___

Telephone: ( )___________________ Website Address:

Organization Address:

(PO Box addresses are not accepted and may result in automatic disqualification.)

Contact Person:

Contact Title:

Contact Address:

(If different from the above address - Post Office Box Addresses are acceptable for the Contact Address.. All OPM correspondence will be sent to this address.)

Contact Telephone: ( )_________________ Fax: ( )_____________________

Contact Email Address(es):

Disbursement Address: _________________________________________________________________

(This is the address where paper checks will be sent.)

Electronic Fund Transfer (EFT):

Financial Institution:

Routing Number (nine digits): ___ ___ - ___ ___ ___ ___ ___ ___ ___

Account Number:

CFC Auto-Response Element (CARE) Statement:

The CFC Pledge System will immediately acknowledge donors’ gifts with a statement expressing thanks and an organization-specific explanation of what the donors’ gift will be used to fund. You may enter that statement here (optional; limited to 1,000 characters, including spaces, carriage returns, and line breaks.)

CFC Volunteerism:

Yes No

  Please indicate if your organization provides volunteer opportunities.

  If “yes”, please indicate if your organization would like to solicit volunteer time from federal employees.

$ . If yes, what is the estimated monetary value to your organization per hour of volunteer time.

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 immediately notify OPM's Office of CFC.

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 CFR §950.202(a)(4) (see application instructions for a list of the eligibility criteria).

Certifying Official

I, ____________________________________, am the duly appointed representative

(Print Name)

of ____________________________________ authorized to certify and affirm all statements

(Print Organization Name)

included 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 ______________________ ______________________________

The application must be submitted through the online CFC application module by 11:59:59PM (EST) [TBD], 2017. Applications submitted after that date, or sent via any means other than the online application module, will not be accepted.

APPLICANTS SHOULD BE AWARE THAT A FALSE RESPONSE TO ANY CERTIFICATION IN THIS APPLICATION MAY BE GROUNDS FOR DENIAL OF THE APPLICATION AND MAY BE PUNISHABLE BY FINE OR IMPRISONMENT (18 U.S.C. 1001).  ALL STATEMENTS AND INFORMATION PROVIDED ARE SUBJECT TO INVESTIGATION, INCLUDING CONFIRMATION THROUGH THIRD PARTIES AND OTHER GOVERNMENT AGENCIES.

Any information in your application may be subject to public disclosure under the Freedom of Information Act (FOIA). If your application is the subject of a FOIA request, you will be notified and given the opportunity to identify each item in the application that you believe is exempt from disclosure under the FOIA, specify which exemption you believe applies to that item, in accord with 5 U.S.C. Section 552, and give full justification for your belief that the justification(s) applies.  In making our decision on the disclosure, we will consider your justification for nondisclosure.  If we decide that an item of information that you believe is exempt is not exempt from disclosure, we will so inform you before it is disclosed.

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.

13

OPM Form 1647-E

Rev. June 2016