2015 PLEDGE CARD. WHY: Help people in military communities, across the nation, and around the world

Transcription

1 2015 PLEDGE CARD WHY: Help people in military communities, across the nation, and around the world WHO: DoD employees serving in the five overseas unified combatant commands WHAT: Annual workplace opportunity for federal employees to make charitable contributions HOW: Choose the charities of your choice, then either go to cfcoverseas.org to donate through egiving or mypay, or fill out this Pledge Card WHEN: 21 September to 20 November

2 Separate this page and submit it to your unit s Campaign Representative. FEEDBACK Help us maintain campaign accountability by providing information below. Check all that apply: q I was contacted by a Campaign Representative and offered the chance to give through the 2015 CFC-O. q I gave online this year. q I gave using the paper Pledge Card. q My gift was 150 or more and I would like to receive a 2015 CFC-O Contributor Coin. Please print your name and unit: q I chose not to give this year. q I make charitable donations elsewhere. q I cannot afford to make a charitable donation. q Other: ONLINE GIVING Pledging online is a safe, convenient, confidential and effective way to support your favorite charities through the CFC-O. Online donations also reduce operating costs and processing errors. To pledge online, follow these instructions: Step 1: Visit cfcoverseas.org and click the Donate button. Step 2: Choose DFAS mypay or CFC-O egiving. DFAS mypay Pledge via a monthly payroll allotment (National Guard and Reserves ineligible for this method). Step 3: Log in to mypay and select CFC from the menu. CFC-O egiving Pledge via credit card, debit card or ACH directly from a bank account. Choose from a onetime or monthly/recurring gift over the course of the year. Step 3: Establish an account or log in to your existing account. CONTRIBUTOR RECOGNITION In appreciation of your pledge, all contributors will receive an I GAVE wristband. Contributors making a pledge of 150 or more will receive a 2015 CFC-O Contributor Coin.* Limited quantities available. Pledge early to receive your recognition. *designed by Mitsuaki Fujimoto, Yokota Air Base, Japan Step 4: Enter 0995 as the campaign number. Step 5: Search for and select charities.* Enter designations. Step 6: Enter your 7 digit CFC-O Unit Reporting number in the work address, command/unit name field. Your CFC-O unit reporting number is: *Tip: mypay times out after 20 minutes and does not save your work! Choose your charities in advance using the paper Charity Listing or the online search at cfcoverseas.org to save time. Step 4: Find and select your unit by typing into the search feature. Step 5: Search for and select charities. Step 6: Choose your contribution type and designation amounts. Step 7: Enter your contact and financial information.

3 COPY #1 PAYROLL OFFICE COPY To Finance Office for Allotment Processing FALL 2015 COMBINED FEDERAL CAMPAIGN-OVERSEAS P.O. Box 64789, Virginia Beach, VA CFC Campaign No PRINT NAME Last First Middle Initial Pay Grade (Optional) ATTENTION PAYROLL OFFICES Use only this number to identify the local campaign. Unit Reporting # Organization or Military Address (Include APO or FPO AE, AA or AP number) Unit/Organization Name Work Phone (DSN or Civilian) PLEASE USE BLUE/BLACK BALL POINT PEN & WRITE FIRMLY PAYROLL DEDUCTION AUTHORIZATION I hereby authorize any agency of the United States Government by which I may be employed during 2016 to deduct the amount(s) shown above from my pay each pay period during the calendar year 2016 starting with the first pay period that begins in January and ending with the last pay period that begins in December, and to pay the amounts so deducted to the Combined Federal Campaign shown above. I understand that this authorization may be revoked by me in writing at any time before it expires. SIGNATURE SOCIAL SECURITY NUMBER NOTE: National Guard/Reserves are ineligible for payroll deduction. Active Duty Military Payroll x 12 months = x 12 months = x 12 months = x 12 months = 1, x 12 months = 2,400 Other x 12 = Note: Minimum 1 per pay period. Civilian Payroll DATE ACTIVE DUTY RESERVES NATIONAL GUARD CIVILIAN NAF AGR AIR FORCE ARMY COAST GUARD MARINES NAVY DODEA OTHER DOD AGENCY 6 x 26 pay periods = x 26 pay periods = x 26 pay periods = x 26 pay periods = 1, x 26 pay periods = 2,600 Other x 26 = Note: Minimum 1 per pay period. CASH (U.S. dollars only) or CHECK Number (Payable to the Combined Federal Campaign) AMOUNT DATE OF CONTRIBUTION DESIGNATED GIFTS: To designate one or more charities or federated groups, fill in the charity code(s) and the dollar amount(s) below. UNDESIGNATED GIFTS: In the CFC-O, undesignated gifts are distributed to Family Support and Youth Programs (FSYP). For more information on FSYP, please see the 2015 Charity Listing or visit cfcoverseas.org. Charity Code TOTAL INFORMATION RELEASE (OPTIONAL) Annual Amount Any information you enter below will be released, along with your name, to the charity(ies) to which you made a pledge. Do not enter your work address or . Home address: Personal address: In addition to my contact information, I authorize the CFC to release the amount of my pledge to the charity(ies) I designated above. CFC organizations do not provide goods or services in whole or partial consideration for any contributions made to the organizations via this Pledge Card. OPM 1654 Rev. Jun 2015 City/State Code:

4 COPY COPY #1 PAYROLL #2 AUDIT OFFICE COPY COPY To Finance To Supporting Office for Allotment CFC-O Office Processing FALL 2015 COMBINED FEDERAL CAMPAIGN-OVERSEAS P.O. Box 64789, Virginia Beach, VA CFC Campaign No PRINT NAME Last First Middle Initial Pay Grade (Optional) ATTENTION PAYROLL OFFICES Use only this number to identify the local campaign. Unit Reporting # Organization or Military Address (Include APO or FPO AE, AA or AP number) Unit/Organization Name Work Phone (DSN or Civilian) PLEASE USE BLUE/BLACK BALL POINT PEN & WRITE FIRMLY PAYROLL DEDUCTION AUTHORIZATION I hereby authorize any agency of the United States Government by which I may be employed during 2016 to deduct the amount(s) shown above from my pay each pay period during the calendar year 2016 starting with the first pay period that begins in January and ending with the last pay period that begins in December, and to pay the amounts so deducted to the Combined Federal Campaign shown above. I understand that this authorization may be revoked by me in writing at any time before it expires. SIGNATURE SOCIAL SECURITY NUMBER NOTE: National Guard/Reserves are ineligible for payroll deduction. Active Duty Military Payroll x 12 months = x 12 months = x 12 months = x 12 months = 1, x 12 months = 2,400 Other x 12 = Note: Minimum 1 per pay period. Civilian Payroll DATE ACTIVE DUTY RESERVES NATIONAL GUARD CIVILIAN NAF AGR AIR FORCE ARMY COAST GUARD MARINES NAVY DODEA OTHER DOD AGENCY 6 x 26 pay periods = x 26 pay periods = x 26 pay periods = x 26 pay periods = 1, x 26 pay periods = 2,600 Other x 26 = Note: Minimum 1 per pay period. CASH (U.S. dollars only) or CHECK Number (Payable to the Combined Federal Campaign) AMOUNT DATE OF CONTRIBUTION DESIGNATED GIFTS: To designate one or more charities or federated groups, fill in the charity code(s) and the dollar amount(s) below. UNDESIGNATED GIFTS: In the CFC-O, undesignated gifts are distributed to Family Support and Youth Programs (FSYP). For more information on FSYP, please see the 2015 Charity Listing or visit cfcoverseas.org. Charity Code TOTAL INFORMATION RELEASE (OPTIONAL) Annual Amount Any information you enter below will be released, along with your name, to the charity(ies) to which you made a pledge. Do not enter your work address or . Home address: Personal address: In addition to my contact information, I authorize the CFC to release the amount of my pledge to the charity(ies) I designated above. CFC organizations do not provide goods or services in whole or partial consideration for any contributions made to the organizations via this Pledge Card. OPM 1654 Rev. Jun 2015 City/State Code:

5 COPY COPY #3#1 DONOR PAYROLL COPY OFFICE THANK COPYOU To Finance Keep Office for Personal for Allotment Tax Records Processing FALL 2015 COMBINED FEDERAL CAMPAIGN-OVERSEAS P.O. Box 64789, Virginia Beach, VA CFC Campaign No PRINT NAME Last First Middle Initial Pay Grade (Optional) ATTENTION PAYROLL OFFICES Use only this number to identify the local campaign. Unit Reporting # Organization or Military Address (Include APO or FPO AE, AA or AP number) Unit/Organization Name Work Phone (DSN or Civilian) PLEASE USE BLUE/BLACK BALL POINT PEN & WRITE FIRMLY PAYROLL DEDUCTION AUTHORIZATION I hereby authorize any agency of the United States Government by which I may be employed during 2016 to deduct the amount(s) shown above from my pay each pay period during the calendar year 2016 starting with the first pay period that begins in January and ending with the last pay period that begins in December, and to pay the amounts so deducted to the Combined Federal Campaign shown above. I understand that this authorization may be revoked by me in writing at any time before it expires. SIGNATURE SOCIAL SECURITY NUMBER NOTE: National Guard/Reserves are ineligible for payroll deduction. Active Duty Military Payroll x 12 months = x 12 months = x 12 months = x 12 months = 1, x 12 months = 2,400 Other x 12 = Note: Minimum 1 per pay period. Civilian Payroll DATE ACTIVE DUTY RESERVES NATIONAL GUARD CIVILIAN NAF AGR AIR FORCE ARMY COAST GUARD MARINES NAVY DODEA OTHER DOD AGENCY 6 x 26 pay periods = x 26 pay periods = x 26 pay periods = x 26 pay periods = 1, x 26 pay periods = 2,600 Other x 26 = Note: Minimum 1 per pay period. CASH (U.S. dollars only) or CHECK Number (Payable to the Combined Federal Campaign) AMOUNT DATE OF CONTRIBUTION DESIGNATED GIFTS: To designate one or more charities or federated groups, fill in the charity code(s) and the dollar amount(s) below. UNDESIGNATED GIFTS: In the CFC-O, undesignated gifts are distributed to Family Support and Youth Programs (FSYP). For more information on FSYP, please see the 2015 Charity Listing or visit cfcoverseas.org. Charity Code TOTAL INFORMATION RELEASE (OPTIONAL) Annual Amount Any information you enter below will be released, along with your name, to the charity(ies) to which you made a pledge. Do not enter your work address or . Home address: Personal address: In addition to my contact information, I authorize the CFC to release the amount of my pledge to the charity(ies) I designated above. CFC organizations do not provide goods or services in whole or partial consideration for any contributions made to the organizations via this Pledge Card. OPM 1654 Rev. Jun 2015 City/State Code:

6 PRIVACY ACT NOTICE Executive Order No authorizes the U.S. Office of Personnel Management to conduct fundraising activities and to establish procedures for collecting information related to such activities. Executive Order 9397 (November 22, 1943) authorizes the use of the Social Security Number (SSN). This collected information will be disclosed to organizations maintaining the accounting of contributions and to your payroll office. Additional disclosure may be made to the Department of Treasury to make proper financial adjustments to a court or another agency when the government is party to a suit; and to the Internal Revenue Service and state and local taxing authorities regarding income tax returns. The furnishing of the SSN, along with other data requested, is voluntary. However, failure to furnish any of the requested information may result in errors or noncompliance with your request for a payroll deduction by your agency. If you are making a one-time, lump-sum gift and, therefore, not using the payroll deduction method of payment, you are not required to furnish your SSN. CFCOVERSEAS.ORG