2023 Federation Certification Application Post April 19, 2023 - 6:00am - May 31, 2023 - 5:00pm 2023 Federation Certification Application Conditions for Approval By signing this application, the federation agrees to the following conditions: 1) This application form must be complete and submitted no later than the May 31st, 2023 filing date. A timely submission is necessary to ensure that the organization will, if approved by the Department of General Services (DGS), be included by name in the 2023 Our Promise: California State Employees Giving at Work Initiative (2023 OP Campaign) literature distributed to State officers and employees. 2) If DGS or its designee requests information supporting a certification of eligibility, the information must be furnished within two business days. The burden of demonstrating eligibility shall rest with the applicant. 3) The administrative fee for the 2023 OP Campaign is as follows: a) $.51 cent per transaction fee as set by the State Controller’s Office (SCO). This fee is subject to change. b) 13.5% administrative set rate: 8% allocated to United Way California Capital Region (UWCCR) to manage and process the campaign year round 5.5% for reimbursement to the local Principal Combined Fund Drive (PCFD) for fundraising expenses. This fee structure is subject to change. You will be informed of any changes made prior to the 2023 Our Promise Campaign. c) The overall DGS approved percentage rate and SCO per transaction fee will be published in the 2023 OP Initiative literature distributed and on the website. 4) To hold harmless the State of California, including but not limited to its officers and employees, from any liability that may result from requesting, canceling or changing any payroll deduction, in consideration for and as a condition of the SCO withholding and transmitting payroll deductions, as authorized by California Government Code section 1151(f). 5) To immediately send notification by email to opcertification@uwccr.org of any changes to the information provided in or in connection with this application. Any changes to our application will be reviewed by the DGS’s designee to determine if we still comply with all applicable requirements. 6) DGS may elect to disqualify or remove an organization that makes a false certification and/or engages in illegal activity. 7) All applicants must be a 501(c)(3) organization and in good standing with the IRS and FTB. Additionally, a status of Current or Exempt-Active with the California Department of Justice is required for any organization who is seeking donations within the State of California. 8) To retain a copy of this digitally signed application and produce it to DGS or its designee within two business days of request for the original application. Statements of compliance: * The charitable federation named in the application has member organizations. Please enter the number at the bottom of this webform. The charitable federation and member organizations are currently a charitable organization qualified as “exempt” under Section 23701d of the California Revenue and Taxation Code and paragraph (3) of subsection (c) of section 501 of the Internal Revenue Code of 1954, in compliance with the provisions of the California Fair Employment and Housing Act, Part 2.8 (commencing with Government Code section 12900) and has a Current or Exempt-Active status with the California Department of Justice. It is the responsibility of the federation or PCFD to verify these statuses of its member organizations. The charitable federation and member organizations, its Board Members and Executive Officers are not in violation of any State of California or federal laws and regulations. The charitable federation is responsible to payout funds to all of their member organizations. The charitable federation is responsible to distribute reports and send communications to all of their member organizations. The charitable federation named in this application will not sell or lease OP Initiative contributor lists. The charitable federation named in this application conducts publicity and promotional activities based upon its actual programs and operations, and that these activities are truthful and non-deceptive, include all material facts, and make no exaggerated or misleading claims. The charitable federation named in this application effectively uses the funds contributed for its announced purposes. The charitable federation named in this application has supplied all information requested in the 2023 Certification Member Nonprofit Template attached to this submission. If any necessary information is not provided, this submission will be discarded and a corrected template must be submitted by the charitable federation. Submit your OP member organization listing: * Number of member organizations in your federation : * Latest date of nonprofit contact info update:: * MonthJanFebMarAprMayJunJulAugSepOctNovDec Day12345678910111213141516171819202122232425262728293031 Year20212022202320242025 Certifying Official: * I am the duly appointed representative for my charitable federation, authorized to certify and affirm all statements enclosed in this application. I certify that I have read all the conditions set forth in this document and affirm their accuracy. In addition, by checking the box next to the certification, the charitable federation named in this application acknowledges and agrees to comply with that certification. Name: * Title: * Name of Federation: * E-mail: * Date: * MonthJanFebMarAprMayJunJulAugSepOctNovDec Day12345678910111213141516171819202122232425262728293031 Year20212022202320242025 Signature: * By typing your name in the box above, you are providing a digital signature that affirms the accuracy of the information provided within this application.