Certification Of Material Events Form

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CERTIFICATION OF MATERIAL EVENTS FORM
Organization Name
EIN #:
Certification Control
number (if available):
Definition:
A “Material Event” is an occurrence that affects an organization’s strategic direction,
mission, or business operation and, thereby, its status as a certified Community
Development Entity (CDE) and/or Community Development Financial Institution
(CDFI), and/or its compliance with the terms and conditions of its assistance/allocation
agreement. For additional guidance on what constitutes a Material Event, refer to the
“Frequently Asked Questions (FAQ): Material Event Occurrence and Reporting”
document available on the Fund’s website.
Instructions:
This form is to be used by CDFI Fund Awardees, applicants, and certified CDEs and
CDFIs, to report potential Material Events to the CDFI Fund. The Certification of
Material Events form must be signed by the organization’s Authorized Representative.
The completed form should be addressed to the attention of the Certification, Compliance
Monitoring and Evaluation Manager and emailed to
ccme@cdfi.treas.gov
or faxed to
(202) 622-7754. Please attach additional pages if necessary.
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PAPERWORK REDUCTION ACT NOTICE
CDFI - 0036
OMB Control Number 1559-0037
This submission requirement is provided to CDFI Fund Awardees, applicants, and certified CDEs
and CDFIs, to report potential Material Events to the CDFI Fund.
CDFI Fund Awardees,
applicants, and certified CDEs and CDFIs, are not required to respond to this collection of
information unless it displays a currently valid OMB number. The estimated average burden
associated with this collection of information is 0.25 hours. Comments concerning the accuracy of
this burden estimate and suggestions for reducing this burden should be directed to the CDFI
Fund, Department of the Treasury, Community Development Financial Institutions Fund, 601 13th
Street, NW, Suite 200 South, Washington, DC 20005.
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