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CFC Model Pledge Form


April 26, 2007


This memorandum transmits the 2007 CFC Model Pledge Form and accompanying guidance for use by all local campaigns. Changes from the 2006 Model Pledge Form are detailed below. Unless otherwise stated, these changes must appear on all local campaign pledge forms, according to the CFC regulations at 5 CFR § 950.402. Other modifications, except those noted, may not be made without prior approval from OPM.

  • The phrase "Use the New FIVE-DIGIT CFC Codes Only" replaces the "Four Digit Charity Code" header above the fill-in boxes. It is required on all local pledge forms. Campaigns may also use color, bold, watermarks or other printing styles; cover pages; and inserts on the pledge form that are suitable to conveying the new code message, according to local needs, CFC regulations and this guidance.
  • An additional fill-able box has been added to accommodate the additional code digit.
  • The box formerly labeled "Payroll Provider (optional)" has been replaced with the Social Security Number box. This change was made in response to campaign feedback to return the social security number to the top of the form. Campaigns with pledge formats that are of sufficient size that they can retain the "Payroll Provider" (Optional) box may do so without approval from OPM.
  • The first five digits of the social security number appearing on pages two and three of the model pledge form are blocked-out.
  • In accordance with the Privacy Act Notice on the last page of the model pledge form, the use of social security numbers is voluntary. However, payroll offices have advised, if the social security number is not provided by the donor, the payroll deduction may not be processed.
  • The "Recognition Options" box is modified to conform to current CFC regulations that donors will have the voluntary option to have their identity, home contact information and the amount of their pledge released to their designated charities. The donor is not required to check a box to indicate his/her desire to release identity or home contact information. It is the responsibility of the PCFO to forward any information entered in this section by the donor to the charity(ies) designated on the form.
  • The payroll authorization dates have been changed from 2007 to 2008.
  • The checkbox and statement indicating interest in being a CFC volunteer has been removed. Campaigns that wish to collect this information may voluntarily add it without further approval from OPM.

There is no requirement on the size of the pledge form. This is a decision that may be made by the local campaign.

Each campaign should take steps to clearly indicate the campaign name, local campaign four-digit control number (not to be confused with the new five-digit charity codes), and contact information on the face of the form. This will help to reduce errors in data entry at the payroll office level.

Campaigns may add their local giving levels and award recognition options to the pledge form without approval by OPM.

Requests for modifications can be sent to Requests must specify each specific modification (additions or deletions) that is being requested and include a review copy of the pledge form in its proposed format.

Questions and comments on this guidance should be directed to Cherlynn Stevens, Operations Specialist at

2007 CFC Model Pledge Form

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