**OMB APPROVED**

**No. 3206-0131**

> ![](media/image1.png)Combined Federal Campaign

**2008 Application Instructions for**

**Local Independent Organizations and Members of Federations**

#### Background

Enclosed is the model application for use by local independent
organizations applying to participate in the Combined Federal Campaign
(CFC) and for use by local federation members to submit to the local
federations to which they belong. The following instructions and form
are intended to assist charitable organizations in applying for
participation in the CFC. All aspects of the CFC, including eligibility
for par­ticipation, are strictly governed by Federal regula­tion. Copies
of current CFC regulations are avail­able in PDF and Word formats on our
website at www.opm.gov/cfc. Additional copies of the application can
also be downloaded from the website.

All required documents and attachments must be complete and submitted
before the application deadline each year. ***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**incomplete or out-of-date documents will not be permitted to correct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 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.

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.

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.

**FAXES OR ELECTRONIC SUBMISSIONS OF APPLICATIONS ARE NOT ACCEPTED**

##### DEFINITIONS

###### 

**Organization** Legal name of the applicant organization. If the name
of the organization differs from the name that appears on the IRS
determination letter, IRS Form 990, or audited financial statements,
official documentation from the IRS or state government authorizing use
of this name must accompany the application. The EIN must be included.

**Employer Identification Number (EIN)** The nine-digit EIN that appears
on the IRS determination letter and the IRS Form 990 submitted with this
application.

**5 Digit CFC Number** The 5 digit number assigned to the organization.
New 5 digit numbers were assigned to organizations that participated in
the 2007 CFC for use in that campaign and future campaigns.
Organizations that did not participate in the 2007 CFC should leave this
field blank.

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

**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 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.

**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.

**Website Address** List the 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 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.

***INSTRUCTIONS***

For details regarding CFC eligibility requirements for local independent
organizations and federation members, refer to CFC Guidance Memoranda on
the CFC website at [www.opm.gov/cfc](http://www.opm.gov/cfc).

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

**Item 1**

**Provide the hours and days per week of operation (a minimum of 15
hours per week is required) and the county and state where the applicant
organization's office is located.**

Check the one appropriate box. **Include as *Attachment A* supporting
statements and/or documentation demonstrating to the satis-faction of
the LFCC that the organization has a substantial local presence in the
geographical area covered by the local campaign, a substantial local
presence in the geographical area covered by an adjacent local campaign,
or substantial statewide presence.** ***Attachment A*** must also
include a description of the actual services, benefits, assistance, or
program activities. provided by the organization in calendar year 2007
and [how]{.underline} those programs, services, benefits, etc. affect
human health and welfare of the target population (see Certification
#4).

-   Substantial local presence is defined as a staffed facility, office
    or portion of a residence dedicated exclusively to that
    organization, available to members of the public seeking its
    services or benefits. The facility must be open at least 15 hours a
    week and have a telephone dedicated exclusively to the organization.
    The office may be staffed by volunteers. Substantial local presence
    cannot be met on the basis of services provided solely through an
    "800" telephone number or by disseminating information or
    publications via the U.S. Postal Service, the Internet, or a
    combination thereof.

OR

-   An adjacent local campaign is defined as a local campaign whose
    geographic border touches the geographic border of another local
    campaign. (Information on the geographic boundaries of local CFC
    Campaigns can be found on the CFC website at
    [www.opm.gov/cfc/Search/Locator.asp](http://www.opm.gov/cfc/Search/Locator.asp).)
    Partici-pation in a local campaign via an adjacency determination
    does not grant the organization a substantial local presence in the
    adjacent local campaign and participation via adjacency cannot be
    used to establish adjacency to local campaigns bordering the
    adjacent campaign area.

OR

-   Substantial statewide presence is defined as providing or conducting
    real services, benefits, assistance or program activities in the
    previous year (calendar year 2007) covering 30 percent of a state's
    geographic boundaries or providing or conducting real services,
    benefits, assistance or program activities affecting 30 percent of a
    state's population. Substantial statewide presence cannot be met on
    the basis of services provided solely through an "800" telephone
    number or by disseminating information and publications via the U.S.
    Postal Service, the Internet, or a combination thereof.

**Item 2**

**Include as *Attachment B* a copy of the organization's most recent IRS
determination letter.** If the name of the applicant organization
differs on the IRS determination letter, the IRS Form 990, or audited
financial statements, documentation from the IRS or state government
authorizing this name change must accompany the application.

Organizations that are part of an IRS group exemption must provide a
copy of the IRS letter granting the group exemption, as well as the list
of subordinates that are covered by the group exemption. If the
subordinate's EIN is different from the EIN on the group exemption
letter, EIN documentation from the IRS must be provided.

Bona-fide chapters or affiliates of a national organization that do not
have an IRS deter-mination letter for the local organization must
provide a certification signed by either the Chief Executive Officer
(CEO) or CEO equivalent of the national organization stating that the
local charitable organization operates as a bona-fide chapter or
affiliate in good standing of the national organization and it is
covered by the national organization's 501(c)(3) tax-exemption. A copy
of the national organization's 501(c)(3) letter must accompany the CEO's
certification.

Units of government are not eligible to participate in the CFC.

**Each applicant's 501(c)(3) status will be verified with the IRS.
Applicants whose current 501(c)(3) status cannot be confirmed by the IRS
will be denied participation. OPM encourages organizations to request
current letters from the IRS confirming the group's tax-exempt status.
This request can be made by contacting the IRS at (877) 829-5500.**

**Item 3**

Check the appropriate box.

Listing of a national organization, as well as its local affiliate
 organization, is permitted.  Each national or local organization must
individually meet all of the eligibility criteria and submit independent
documentation as required in 5 C.F.R. §950.202, §950.203 or §950.204 to
be included in the Charity List, except that a local affiliate of a
national organization that is not separately incorporated, in lieu of
its own 26 USC 501(c)(3) tax exemption letter and, to the extent
required by §950.204(b)(2)(ii), audited financial statements, may submit
the national organization's 26 USC 501(c)(3) tax exemption letter and
audited financial statements, but must provide its own pro forma IRS
Form 990, page 1 and Part V only, for CFC purposes.  The local
organization must submit a certification from the Chief Executive
Officer (CEO) or CEO equivalent of the national organization stating
that it operates as a bona-fide chapter or affiliate in good standing of
the national organization and is covered by the national organization\'s
26 USC 501(c)(3) tax exemption, IRS Form 990 and audited financial
statements.

A national organization may waive its listing in the
National/International or International parts of the Charity List in
favor of its local affiliate by following the procedures set forth in 5
C.F.R. §950.201(c). 

**Item 4**

Self-explanatory. Human health and welfare services provided in calendar
year 2007 must be reflected in ***Attachment A***.

**Item 5**

Check the appropriate box.

-   **Organizations with \$250,000 or more in annual revenue, as
    reported on the IRS Form 990, are required to submit an annual audit
    of fiscal operations by an independent certified public accountant
    in accordance with Generally Accepted Auditing Standards (GAAS).**
    The audited financial statements and IRS Form 990 must be prepared
    using the accrual method of accounting and cover the same fiscal
    period that ended not more than 18 months prior to January 2008
    (i.e. ending on or after June 30, 2006). **Include as *Attachment C*
    a copy of the organization's audited annual financial statements.**
    The organization must certify that it accounts for its funds in
    accordance with Generally Accepted Accounting Principles (GAAP) and
    has an audit of its fiscal operations completed annually by an
    independent certified public accountant in accordance with GAAS.
    Note that GAAP requires the use of the accrual method of accounting.
    No other basis of accounting is acceptable under GAAP. The cash
    basis, modified cash basis, modified accrual, and any other methods
    are not acceptable.

OR

-   **Organizations with total revenue of at least \$100,000 but less
    than \$250,000: the certifying official must certify that the
    organization accounts for its funds in accordance with GAAP and has
    an audit of its fiscal operations completed annually by an
    independent certified public accountant in accordance with GAAS.**
    The organization is not required to submit a copy of the audited
    financial statements with the CFC application. However, the
    information must be provided to OPM or the LFCC upon request. Note
    that GAAP requires the use of the accrual method of accounting. No
    other basis of accounting is acceptable under GAAP. The cash basis,
    modified cash basis, modified accrual, and any other methods are not
    acceptable.

OR

-   **Organizations with total revenue of less than \$100,000: the
    certifying official must certify that the organization has controls
    in place to ensure funds are properly accounted for and that it can
    provide accurate timely financial information to interested
    parties.** It is not required to submit financial documentation with
    the CFC application. However, the information must be provided to
    OPM or the LFCC upon request.

Bona-fide chapters or local affiliates of a national organization that
are not separately incorporated whose pro forma IRS Form 990 reports
revenues over \$250,000 and whose financial operations are covered by an
audit of the national organization may submit the national
organization's audited financial statements together with a
certification from the national organization's Chief Executive Officer
(CEO) or CEO equivalent stating that it operates as a bona-fide
affiliate in good standing of the national organization and is covered
by the national organization's 26 U.S.C. 501(c)(3) tax exemption, IRS
Form 990 and audited financial statements. (See requirements under Item
#2 for bona-fide chapters or local affiliates.)

Bona-fide chapters of a national organization that are not separately
incorporated whose pro forma IRS Form 990 reports revenues of at least
\$100,000 but less than \$250,000 and whose financial operations are
covered by an audit of the national organization may certify that it has
an audit of its fiscal operations completed annually if it, at the time
of the certification, is in good standing of the national organization
and is covered by the national organization's 26 U.S.C. 501(c)(3) tax
exemption, IRS Form 990 and audited financial statements. This
organization is not required to submit with its application the national
organization's audited financial statements or CEO statement evidencing
proof of good standing and coverage by the national organization's
documentation. However, it must be able to supply this documentation to
the LFCC or OPM upon request. (See requirements under Item #2 for
bona-fide chapters or local affiliates.)

**Item 6**

Check the appropriate box. **Include as *Attachment D* a copy of the
[complete, signed]{.underline} IRS Form 990 for a period ended not more
than 18 months prior to January 2008.** The IRS Form 990 must include a
signature in the block marked "Signature of officer"; the preparer's
signature alone is not sufficient.

A complete IRS Form 990 is required, including all supplemental
state­ments and Schedule A, if applicable, to be eligible for the CFC. If
the Internal Revenue Service does not require the organization to file
the Form 990 it must complete and submit a pro forma IRS Form 990, page
1 and Part V only. IRS Forms 990EZ, 990PF, and comparable forms will not
be accepted. However, smaller organizations that file Form 990EZ may
submit it with page 1 and Part V of the Form 990 attached in lieu of a
complete IRS Form 990.

The audited financial statements and IRS Form 990 must be prepared using
the accrual method of accounting and cover the same fiscal period ended
not more than 18 months prior to January 2008 (i.e. ending on or after
June 30, 2006).

**Item 7**

**Calculate and enter the organization's annual per­centage for
administrative and fundraising expenses.** This percentage is computed
from the IRS Form 990 by adding the amount reported as \"management and
general\" (line 14) to \"fundraising\" (line 15) and dividing the
resulting total by \"total revenue\" (line 12). No other method may be
used to calculate this percentage.

**Item 8**

Self-explanatory

### Item 9 

Self-explanatory

**Item 10**

Self-explanatory

### Item 11 

Self-explanatory

**Item 12**

Each federation and independent organization 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](http://www.opm.gov/cfc)).  For further
information, please see CFC Memo 2005-13.

**Item 13**

**Include as *Attachment E*, 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.

**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 Educational Institutions & Related Activities

C Envir. Quality, Protection & Beautification

D Animal Related

E Health -- General and Rehabilitative

F Mental Health, Crisis Intervention

G Disease, Disorders, Medicinal Disciplines

H Medical Research

I Crime, Legal Related

J Employment, Job Related

K Food, Agriculture, and Nutrition

L Housing, Shelter

M Public Safety, Disaster Preparedness & Relief

N Recreation, Sports, Leisure, Athletics

O Youth Development

P Human Services -- Multipurpose and Other

Q International, Foreign Affairs, National Security

R Civil Rights, Social Action, Advocacy

S Community Improvement, Capacity Building

T Philanthropy, Voluntarism & Foundations

U Science & Technology Research Institutes,

Services

V Social Science Research Institutes, Services

W Public, Social Benefit: Multipurpose, Other

X Religion Related, Spiritual Development

Y Mutual/Membership Benefit Orgs., Other

Z Other

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:

# 0000 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. 4.2% B,V,O

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

-   **Attachment A -- Documentation of local presence, adjacent
    presence, or statewide presence (See Item 1)**

-   **Attachment B -- IRS determination letter (See Item 2)**

-   **Attachment C -- Audited Financial Statements (if total revenues
    are \$250,000 or greater) (See Item 5)**

-   **Attachment D -- IRS Form 990 (See Item 6)**

-   **Attachment E -- 25-word statement (See Item 13)**

> OMB APPROVED
>
> NO. 3206-0131

Combined Federal Campaign

**[2008 Application for]{.smallcaps}**

**[Local Independent Organizations and]{.smallcaps}**

**[Members of Federations]{.smallcaps}**

Organization:

Employer Identification Number (EIN): \_\_ \_\_ - \_\_ \_\_ \_\_ \_\_
\_\_ \_\_ \_\_ \_\_ \_\_

5 Digit CFC Number (If a participant in the last year\'s CFC): **\_\_\_
\_\_\_ \_\_\_ \_\_\_ \_\_\_**

Organization Address:

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> *(Post Office Box addresses are not accepted and may result in
> automatic disqualification.)*

Telephone: [( )]{.underline}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contact Person:

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: [( )\_\_\_\_\_\_\_\_\_\_\_\_ \_\_]{.underline} Fax:
[( )]{.underline}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contact E-Mail Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1)  **Hours of Operation Per Each Day of the Week (*Example:
    Monday-Friday, 9AM-5PM; Saturday, 10AM -- 3PM; Sunday, Closed*):**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**County and State Where Office is Located:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Place a check in the ***one*** appropriate box:

I certify that the organization named in the application has a
substantial [local presence]{.underline} in the geographical area
covered by the local campaign. *(Substantial local presence is defined
in the Instructions as Item 1.)* **Include as *ATTACHMENT A* supporting
statements and/or documentation of substantial local presence in the
geographical area covered by the local campaign and a description of the
programs, services, benefits, etc. provided by the organization in
calendar year 2007 and [how]{.underline} those programs, services,
benefits, etc. affect human health and welfare of the target
population*.***

> **-OR-**

I certify that the applicant organization named in the application has a
substantial [local pres­ence]{.underline} in the geographical area
covered by an adjacent local campaign. *(Substantial adjacent presence
is defined in the Instructions as Item 1.)* **Include as *ATTACHMENT A*
supporting state­ments and/or documentation of substantial presence in
the geographical area covered by an adjacent campaign and a description
of the programs, services, benefits, etc. provided by the organization
in calendar year 2007 and [how]{.underline} those programs, services,
benefits, etc. affect human health and welfare of the target
population*.***

**-OR-**

I certify that the organization named in the application has a
substantial [statewide presence]{.underline}. *(Substantial statewide
presence is defined in the Instructions as Item 1.)* **Include as
*ATTACHMENT A* supporting state­ments and/or documentation of substantial
statewide presence and a description of the programs, services,
benefits, etc. provided by the organization in calendar year 2007 and
[how]{.underline} those programs, services, benefits, etc. affect human
health and welfare of the target population*.***

2\) I certify that the Internal Revenue Service (IRS) recognizes the
organization named in this

application as tax-exempt under 26 U.S.C. 501(c)(3) and to which
contributions are tax deducti­ble pursuant to 26 U.S.C. 170(c)(2).
**Include as *ATTACHMENT B* a copy of the most recent IRS determination
letter.** *See instructions for additional information.*

3\) Place a check in the ***one*** appropriate box:

I certify that the organization named in this application is not part of
a group exemption.

> \- OR -

I certify that the organization named in this application is part of a
group exemption.

> \- OR -

I certify that the organization named in this application is a bona-fide
chapter or affiliate that operates under a national organization's
single corporation tax-exemption.

4\) I certify that the organization named in this application is a human
health and welfare

organization providing services, benefits, or assistance to, or
conducting activities affecting human health and welfare. The services,
benefits, assistance, or program activities affecting human health and
welfare provided in 2007 are reflected in ***ATTACHMENT A***.

5\) Place a check in the ***one*** appropriate box:

I certify that the organization named in this application reports total
revenue of \$250,000 or more on its IRS Form 990 (or pro forma IRS Form
990) covering a period ending not more than 18 months prior to January
2008 and meets *both* of the following two conditions:

-   accounts for its funds on the accrual basis in accordance with
    generally accepted accounting principles (GAAP); and,

-   has an audit of its fiscal operations completed annually by an
    independent certified public accountant in accordance with generally
    accepted auditing standards (GAAS). **(Include as *ATTACHMENT C***
    **a copy of the organization's most recent audited financial
    statements for a fiscal period ending not more than 18 months prior
    to January 2008.)**

> \- OR -

I certify that the organization named in this application reports total
revenue of at least \$100,000 but less than \$250,000 on its IRS Form
990 (or pro forma IRS Form 990) covering a period ending not more than
18 months prior to January 2008 and meets *both* of the following two
conditions:

-   accounts for its funds on an accrual basis in accordance with
    generally accepted accounting principles (GAAP); and,

-   has an audit of its fiscal operations completed annually by an
    independent certified public accountant in accordance with generally
    accepted auditing standards (GAAS).

> \- OR -

I certify that the organization named in this application reports total
revenue of less than \$100,000 on its IRS Form 990 (or pro forma IRS
Form 990) covering a period ending not more than 18 months prior to
January 2008 and has controls in place to ensure funds are properly
accounted for and that it can provide accurate timely financial
information to interested parties.

6\) Check the ***one*** appropriate box:

I certify that the organization named in this application prepares and
submits to the IRS a complete copy of the organization's IRS Form 990.
**(Include as *ATTACHMENT D* a copy of the complete IRS Form 990 for a
period ending not more than 18 months prior to January 2008**, including
signatures in the box marked "Signature of Officer". The preparer's
signature alone is not sufficient. IRS Forms 990EZ, 990PF, and
comparable forms are not acceptable substitutes.)

> \- OR -

I certify that the organization named in this application is not
required to prepare and submit an IRS Form 990 to the IRS. (**Include as
*ATTACHMENT D* a pro forma IRS Form 990 page 1 and Part V only** **for a
period ending not more than 18 months prior to January 2008.** IRS Forms
990 EZ, 990PF, and comparable forms are not acceptable substitutes.)

7\) I certify that the administrative and fundraising rate for the
organization named in this

application is \_\_ \_\_.\_\_%. This percentage has been computed from
information on the IRS Form 990 submitted with this application by
adding the amount spent on \"management and general\" (line 14) to
\"fund-raising\" (line 15) and divid­ing the resulting total by \"total
revenue\" (line 12). No other method may be used to calculate this
percentage. All percentages must be listed to the tenth of a percent
(i.e. 10.0% or 15.5%).

8\) I certify that an active and responsible governing body, whose
members have no material

conflict of interest and a majority of whom serves without compensation,
directs the organization named in this application.

9\) I certify that the organization named in this application prohibits
the sale or lease of CFC

contributor lists.

10\) I certify that the organization named in this application conducts
publicity and promotional

activities based upon its actual program and operations, and that these
activities are truthful and non-deceptive, include all material facts,
and make no exaggerated or misleading claims.

11\) I certify that the organization named in this application
effectively uses the funds contributed

for its announced purposes.

12\) 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 Operations immediately.

13\) Include as ***ATTACHMENT E*** a 25-word statement for listing in
the campaign charity list. **(See Instructions Item 13 for additional
required information on the optional taxonomy codes.)**

**[Certifying Official]{.smallcaps}**

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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**NOTE: Applications will not be accepted if submitted electronically or
by facsimile. The certifying official's signature must be original.
Automatic pens and/or signature stamps may not be used.**

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