Skip to page navigation
U.S. flag

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

You have reached a collection of archived material.

The content available is no longer being updated and as a result you may encounter hyperlinks which no longer function. You should also bear in mind that this content may contain text and references which are no longer applicable as a result of changes in law, regulation and/or administration.

2005 CFC Model Pledge Form

CFC Memorandum 2005-6

June 11, 2005


The 2005 CFC Model Pledge Form issued with this memorandum has two modifications that must be included in all local 2005-pledge forms. The donors' recognition option box is revised to provide greater clarity to donors and PCFOs. A volunteer checkbox located beneath the recognition options box is added to assist in the recruitment of workplace CFC volunteers. Campaigns will need to establish a process for collecting and contacting prospective volunteers with their agency coordinators and key workers.

The following text revisions must also be included in local 2005 pledge forms:

  1. The Unit/Division and Payroll Office box is now "optional". However, OPM still encourages campaigns to require keyworkers or agency coordinators to include this data on every pledge form. This information can be a valuable tool in tracking receipts from each of the Federal agencies especially in cases where the agency is part of a payroll center that serves multiple agencies. The information can be referenced to identify the amounts being transmitted from each agency.

    If the campaign chooses to use this tool, it may wish to include the Agency's Locator Code (ALC) assigned by the Department of Treasury. This information appears on the attached Department of Treasury Payroll Office Identifier/ ALC by Department/Agency Name list. Another option would be to list the actual payroll provider for the donor's agency. For example, GSA pays OPM. Therefore, OPM employees would put GSA in that box. A list of each of the major payroll providers and the agencies it services is attached. (Agencies not appearing on this list perform their own payroll.)

    Note: Most Federal agencies are migrating to one of the four major payroll providers: The National Finance Center (NFC), the Defense Financial Accounting System (DFAS), The National Business Center (NBC), and General Services Administration (GSA). As a result, campaigns can expect to receive fewer disbursements from Federal agencies as each of the four payroll providers is responsible for consolidating payments from all of the Federal agencies that it serves and disbursing it to the PCFO. CFC Operations is working with the providers to develop standardized reports that will itemize the amount disbursed from each of the agencies the payroll provider services. We will notify campaigns of any future changes to this information.

  2. The "Contribution" column heading is changed to "Allotment Source."
  3. The "Four Digit Agency Code" column heading is changed to "Four Digit Charity Code".
  4. The Designated Gifts instruction is changed from "fill in the charity or federation identification number(s) and dollar amounts here:" to "fill in the charity or federation codes(s) and dollar amounts above."
  5. The third paragraph of the Privacy Act Notice is changed from "to a court of another agency" to "a court or another agency".
  6. The title: "Privacy Act Notice" is included.
  7. The Social Security Number box is blocked out on pages two and three on the model but this remains an option at the discretion of the LFCC. See CFC Memorandum 2003-6 for reference.
  8. The Payroll Authorization date is changed from 2005 to 2006.

Please be advised that in accordance with CFC Regulations 5 CFR §950. 402 this pledge form may not be modified without prior approval from OPM. There is one exception. Campaigns may add their local giving levels and award recognition options to the pledge form without approval by OPM. All other modifications must be reviewed and approved in advance. Submit a Word or PDF file that shows the modifications requested along with an itemization of the changes by email to for review. Please direct follow-up inquiries to your regional CFC staff representative. For information on your CFC staff contact, please go to our CFC Contact Us webpage.

The CFC pledge form is made available to campaigns from our website for the sole purpose of downloading and printing the document to make the hard copy pledge forms for the annual campaign.

Back to Top

Control Panel