Standards of Conduct for Department of the Army · PDF file · 2006-09-29Standards...
Transcript of Standards of Conduct for Department of the Army · PDF file · 2006-09-29Standards...
Army Regulation 600-501@'m pJ)
Personnel-GeneralI-'RQPER-KY OF ti. S. ARMY THE JUDGE ADVOCATE GENERAL'S SCHOOL LlBRARY Standards of
Conduct for Department of the
Headquarters Department of the Army Washington, DC 25 September 1986
AR 600-50 ' Standards of conhuct for
Department of the Army Personnel
This change--
o Substitutes "Senior Ethics Counselor" and "Ethics Counselor" for "Standards of Conduct Counselor" and "Deputy Standards of Conduct Counselor" throughout the regulation.
o Consolidates punitive language into paragraph 1-1, Purpose.
o Adds a requirement in paragraph 1-6 to regularly evaluate ethics training programs; requires counseling on nego- tiating for employment and postemployment restrictions for departing employees.
o Restructures paragraph 2-1 to clearly set out guidance regarding conflicts resulting from outside employment.
o Adds the requirement to paragraph 2-lj for Reservists to disclose information necessary to ensure that no conflict exists between their duty assignment and private interests.
o Revises paragraph 2-111, Negotiating for employment, con- sistent with changes to 10 USC 2397.
o Restructures paragraph 2-2 into three topic areas: gra- tuities, reimbursements, and other benefits from outside sources.
o Raises the value for acceptance of unsolicited advertising or promotional items from $5 to $10 in paragraph 2-2a(2)(a).
o Adds as paragraph 2-2a(2)(k) an exception to allow the receipt of coffee, donuts, and similar refreshments.
o Adds paragraph 2-2c(8) providing specific guidance con- cerning the receipt of benefits incident to official tra- vel, including participation in airline frequent traveler programs.
o Adds guidance to paragraph 2-3a extending the prohibitions concerning gifts and donations to solicitations on behalf of immediate family members.
o Restructures paragraph 2-6 to include language advising commanders to consider requiring personnel in sensitive positions to obtain approval prior to engaging in outside employment.
o Revises procedures in paragraph 2-10 for reporting suspected violations of the standards of conduct. -
o Adds a summary of the 2-year post-Government-service employment limitation on Presidential appointees to appendix B.
o Adds definitions of "Affiliation," "DOD Contractor," "Employment," "Nominal value," "Procurement official," and "Procurement function" to the Glossary.
Headquarters Department of the Army Washington, DC 20 November 1984
Army Regulation 600-50
Effective 20 November 1984
Personnel-General
Standards of Conduct for Department of the Army Personnel
The original form of this regulation was first This UPDATE printing publishes a new change By Order of the Secretary of the Army: published on 20 November 1984. 1 which is effective24 October 1986. The por- JOHN JR.tions of the text that are revised by Change 1 UnitedStatesArmyare highlighted in this printing. Chief of Staff
Official:
R. L. DILWORTH Brigadier General, United States Army The Adjutant General
Summary. This regulation prescribes stan-dards of conduct required of all Department of the Army (DA) personnel, regardless of assienment. It is intended to reeulate the in-divGual conduct of DA pers&nel and to define only the minimum standards of con-duct required of DA personnel. These stan-dards are designed t b m a t z k p m a m r d t o provide notice of conduct required of D x personnel and to enable them to avoid con-flicts of interest and the appearance of con-flicts of interest between their private interests and their official duties.
Applicability. a This regulation applies to all DA per-
sonnel, military and civilian (including those employed by nonappropriated fund instrumentalities (NAFIs)). Chapters 4 and 5 and portions of chapter 2 apply to retired DA personnel.
b. Chapters 1 and 2 of this regulation also apply to all officers and enlisted personnel of the US Army Reserve and of the Army National Guard of the United States when they are performing Federal duties or en-gaging in any activity directly related to the performance of a Federal duty or function.
c. Penalties for violations of these stan-dards apply to military and civilian person-nel and include the full range of statutory and regulatory sanctions, both criminal and administrative.
Impact on New Manning System. This regulation does not contain information that affects the New Manning System.
Internal control svstems. This resula-tion is subject to the requirements of AR 11-2. It contains internal control provisions but does not contain checklists for con-ducting internal control reviews. These w
checklists are being developed and will be published at a later date.
Supplementation. Local supplementation of this regulation is prohibited without prior approval from HQDA (DAJA-ALG), WASH DC '20310-2212.
Interim Changes. Interim changes to this regulation are not official unless they are au-thenticated by The Adjutant General. Users will destroy interim changes on their expira-tion dates unless sooner superseded or re-scinded.
Suggested Improvements. The propo-nent agency of this regulation is the Office of The Judge Advocate General. Users are invited to send comments and suggested im-provements on DA Form 2028 (Recom-mended Changes to Publications and Blank Forms) directly to HQDA (DAJA-ALG), WASH DC 203 1C-2212.
Distribution. -, 'vTS,tft; MW€+4zDistribution of this issue has been made in accordance with DA Form 12-9A-R reauirements for 600-series ~ubl i -cations or by subscription card for users that have submitted a subscription card for, this regulation. AR 600-50 distribution is A for Active Army, ARNG, and USAR.
Changes. Changes to the basic publication are shown using the strikethrough and un-derscore method (when material that is be-ing deleted or changed is crossed out, and new material that is being entered is under-scored) and the tint method (when new or greatly reorganized material appears tinted erav).
Contents (Listed by paragraph number)
Chapter 1 Standards of Conduct Purpose 1-1 References 1-2 Explanation of abbreviations and
terms 1-3 General policy on proper conduct of official
activities 1 4 Governing directives 1-5 Information to personnel 1-6 Display of the Code of Ethics for
Government Service 1-7 Report fo rm 1-8
Chapter 2 Conflicts of Interest and General
Prohibitions Conflicts of interest 2-1 Gratuities, reimbursements, and other
benefits from outside sources 2-2 Prohibitions concerning gifts and
donations 2-3 Use of Government facilities, property, and
personnel 2-4 Use of civilian and military titles in
connection with a commercial enterprise 2-5
Outside employment and other activities of DA personnel 2-6
Gambling, betting, and lotteries * 2-7 Indebtedness 2-8 ,
-Ethics -Counselors 2-9
Reporting suspected violations 2-10 Resolution of a conflict or appearance of
conflict of interest 2-1 1 Restrictions on enlisted personnel 2-12
Chapter 3 Statement of Affiliations and Financial
Interests (DD Form 1555) DA personnel required to file
statements 3-1 Review of positions 3-2 Submission and review 3-3 Excusable delay 3-4 Special Government employees 3-5 Exemptions to specific appointees 3-6
25 SEPTEMBER 1986 UPDATE AR 600-50 1
Contents-Continued
Statements required 3-7 Interests of relatives of DA
personnel 3-8 Information not known by DA
personnel 3-9 Information not required to be
submitted 3-10 Confidentiality of statements of DA
personnel 3-1 1 Effect of statements on other
requirements 3-12 Processing DD Forms 1555 3-13 DD Form 1555 Status Report (RCS
JAG-74) 3-14
Chapter 4 Financial Disclosure Reports (SF 278) DA personnel required to file SF 278
(covered positions) 4- 1 Reporting responsibility 4-2 Reports required 4-3 Contents of reports 4-4 Submitting assumption, annual, and
termination reports 4-5 Preliminary review 4-6 Review at Headquarters, Department of
the Army 4 7 Public disclosure 4-8 Penalties 4-9
Chapter 5 Laws Governing Former Government
Employees Former officers or employees 5-1 Enforcement responsibility 5-2 Postemployment restrictions 5-3 Additional restrictions pertaining to senior
employees 5 - 4 Consultation exception to postemployment
restrictions 5-5 Exemption for persons with special
qualifications in a technical discipline 5-6
Postemployment violations and administrative enforcement proceedings 5-7
Retired Regular Army officers 5-8 Employment in DOD 5-9 Report of DOD and defense-related
employment 5-10
Appendixes
A. Related Publications
0. Digest of Conflict of Interest Laws
C. Executive Order No. 11222, May 8, 1965
D. Code of Ethics for Government Service
E. Examples of Conflicts of Interest Situatiohs
Glossary
25 SEPTEMBER 1986 UPDATE AR 600-50
Chapter 1 Standards of Conduct
1-1. Purpose This regulation prescribes standards of con-duct required of all DA personnel, regard-less of assignment, to avoid conflicts arid the appearance of conflicts between private in-terests and official duties. Personnel subject to the Uniform Code of Militarv Justice (UCMJ) who fail to comply witi the re-quirements of this regulation are subject to punishment under the UCMJ, as well as to adverse administrative action and other ad-verse action authorized by applicable Unit-ed States code sections o r Federal regulations. Personnel not subject to the UCMJ who fail to comply with the provi-sions of this regulation are subject to ad-verse administrative action or criminal prosecution as authorized by applicable sec-tions of the United States Code or Federal regulation.
1-2. References Related publications are listed in appendix A.
1-3. Explanation of abbreviations and terms Abbreviations and special terms used in this regulation are explained in the glossary.
1-4. General policy on proper conduct of official activities
a. DA personnel will become familiar with the scope, authority for, and the limi-tations of the activities for which they are responsible. Further, DA personnel will gain a working knowledge of appropriate statutory prohibitions on standards of con-duct. A digest of these provisions is at ap-pendix B.
b. Government service or employment, as a public trust, requires
, ~1 1c g h t k m s o l d i e r s and Army civilians to act with integrity and abide bv the values of the Professional Army Ethic (FM 100-1). These values of loyalty to the Nation, Army, and unit; per-sonal responsibility; and selfless service lead one to serve the Nation and other people-before versonal interest.
b.1. DA personnel place loyalty to coun-try, ethieal principles, and law above private gain and other interests. DA personnel will not make or recommend any expenditureo$ funds or take or recommend anv action known or believed to be in violation of U.S.~~ ~ ~ - - ~ ~
laws, Executive orders, or applicable direc-tives, instructipns, or regulations.
c. If the propriety of a vrovosed action or- -decision in terms of the regulation or law is doubtful, DA personnel will consult legal counsel or, if appropriate, the ! hdadsd
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p a p p r o -priate Ethics Counselor for guidance. This will ensure the proper and lawful conduct of DA programs.
d. DA personnel will strictly adhere to the DA program of equal opportunity re-gardless of race, color, religion, sex, age, marital status, physical handicap, or nation-al origin, in accordance with AR 600-21 and CPR 713.
e. DA personnel will avoid any action, whether or not specifically prohibited by this regulation, that might result in or rea-sonably be expected to create the appear-ance of-
(1) Using public office for private gain. (2) Giving preferential treatment to any
person or entity. (3) Impeding Government efficiency or
economv. (4) Lbsing independence or impartiality. (5) Making a Government decision
outside official channels. (6) Affecting adversely the confidence of
the public in the in tegr i ty of t h e Government. f:L
W+Rescinded.
1-5. Governing directives a. Executive Order 11222, 8 May 1965.
This directive, which prescribes standards of ethical conduct for Government officers and employees is at appendix C.
b. DODD 5500.7. c. Federal Personnel Manual, chapters
734, -Financial isc closure Re-quirements, chapter 735, Employee Respon-sibilities and Conduct.. and c h a ~ t e r737. Post Employment ,conflicts of interests; supplemented by AR 690-700, chapter 735, subchapters 1, 2, and 3.
d. The Ethics in Government Act of 1978 (PL 95-5 2 : . as a m m d d M as
,L
amended), Pub.L. ~o.'95-521 (1978). e. Parts 734 and 737, title 5, Code of
Federal Regulations.
1-6. Information to personnel a. Initial orientation. All new DA per-
sonnel, except enlisted personnel not reauired to file a DD Form 1555. will be of= k k - e q q + g i v e n an opportunity to re-view this regulation and will be given an-oral standards of conduct briefing not later than 760 days after initial employment, as-sumpti; of duties, or entry on active duty. Enlisted personnel not required to file the statement will be given standards of con-duct briefings. ,These briefings may be given at the same time as the explanations required by 10 USC 937 and other statutes or regulations.
(1) The US Army Training and Doctrine Command (TRADOC) or the appropriate service school will conduct initial briefings
5 SEPTEMBER 1986 UPDATE AR 600-50
for military personnel. The employing man-agement/supervisory official will brief new civilian personnel. An entry will be made on personnel records to show military person-nel have received the initial briefing. For ci-vilian personnel, an entry will be made on the civilian personnel orientation checklist after the initial briefing. This requirement is not retroactive.
(2) These briefings will be conducted in such a way as to make DA personnel aware of the standards of conduct that apply to their prospective duties. Appropriate meth-ods may include-
(a) An orientation packet directed to all pertinent standards of conduct documents.
(b) An explanation of sections of the Standards of Conduct regulation rather than simple notice of their existence.
(c) An information summary of the stan-dards designed to alert personnel to poten-tial conflicts and areas in which they should seek advice.
(d) Use of videotapes or training films. b. Semiannual reminder. Commanders in-~ - - - - - - ~ - -~~
conjunction with Ethics Counselors will evaluate command ethics training programs on a regular basis to ensure that appropriate emphasis is being given to identified prob-lem areas and that the t o ~ i cas a whole is adequately covered. All DA personnel will be reminded at least semiannually of their duty to comply with required standards of conduct. This may be accomplished through notices printed in command bulletins, let-ters, or similar publications of wide dissemi-nation, or through live presentations, videotapes, training, films, or other media. Copies of this regulation will be provided upon request and may be circulated in read-ing files. Commanders or supervisors must be able to show by some written method (e.g., training schedule, memorandum) that the semiannual requirement has been met. . .
c.
Departing personnel. Commanders will es-tablish procedures to ensure that-
(1) Officers and civilian employees who have indicated that they will be separating from service will be counseled concernine negotiating for employment (para 2-ln) an; postemployment restrictions (paras 5-3, 5-4, and 5-8) 4 to 6 months (or as soon as possible thereafter) before their proposed se~arationdate.
(2) All officers and civilian employees ending service with the Army will be given a copy of the summary of Post Employment Restrictions (fig 1-1). They also will be pro-vided a copy of this regulation for review during their outprocessing. Those who re-quest additional information will be referred to the local Ethics Counselor or legal office as appropriate.
1-7. Display of the Code of Ethics for Government Service H+96dEkPub.L. No. 96-303 (1980) re-quires the Army.t o display copies of the Code of Ethics for Government Service (app D) in appropriate areas of Federally
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owned or leased office space. Army activi-ties must display the Code at all military in-stallations and other facilities where at least 20 persons are regularly employed as civil-ian employees. The Code may be displayed in lobbies, conference rooms, reception ar-eas, auditoriums, cafeterias, and other high traffic areas. (Code of Ethics posters are self-service supply items and may be pro-cured under National Stock Number 769041499-8 167.)
1-8. Report forms The following forms, which may be ob-tained from the sources cited, will be used in complying with this regulation:
a. DD Form 1357, Statement of Employ-ment (Regular Retired Officers), is stocked and issued by the Cdr, US Army Finance and Accounting Center (USAFAC), ATTN: FINCM-T, Indianapolis, I N 46249-1501. See figure 1 4 2 for a sample of a completed DD Form 1357.
b. DD Form 1555, Confidential State-ment of Affiliations and Financial Interests, is available through normal publications supply channels. See figure 1-93 for a sam-ple of a completed DD Form 1555.
c. Standard Form 278, Financial Disclo-sure Report, is available through publica-tion supply channels from the US Army AG Publications Center, Baltimore, MD 21220-2896. See figure 1-34- for a sample of a completed SF 278.
d. DA Form 4971-R, Certificate of Pre-liminary Review of SF 278, is located at the back of this regulation. It may be repro-duced locally on 8%-X 1I-inch paper, printed head to head.
e. DD Form 1787, Report of DOD and Defense Related Employment as Required by -10 USC 2397, is available as prescribed in AR 600-47. See figure 1-45 for a sample of a completed DD Form 1787.
Chapter 2 Conflicts of Interest and General Prohibitions
2-1. Conflicts of interest a. General. DA personnel should place
loyalty to country, ethical principles, and law above private gain and other interests. The performance of their duties should be in keeping with the highest tradition of the military service and civilian service to the US Government.
b. Afiliations and financial interests. In performing their duties and responsibilities, DA personnel maptfl avoid engaging in any personal business or professional activ-ity, or having or retaining any direct or in-direct financial interest, that places them in a position in which there is a conflict or the appearance of a conflict between their pri-vate interests or affiliations and the public interests of the United States as it relates to their duties and responsibilities as DA per-sonnel. For the purpose of this prohibition,
the private interests of a spouse, dependent child, and any household members are treated as private interests of DA personnel. Therefore, if such a family member is re-ceiving anything of value from any organi-zation, the Government employee will have a financial interest in that entity.
c. Avoiding actual or apparent conflicts of interest. Direct or indirect financial interest in a defense-related contractor, in any amount and in any form (e.g., common or preferred stock, bonds, options), may give rise to an impermissible actual or apparent conflict of interest. Outside employment or other outside activity, either with or with-out compensation, or seeking future em-ployment may also create a conflict or the avvearance of a conflict of interest. Before
A A
any negotiations for employment, DA per-sonnel (militarv and civilian) are en-couraged to consult with their'^^^^ to determine whether a disqualification is required. This applies to all negotiations for employment conducted while the individual is on active duty or currently employed with the Government. Examples of circum-stances or situations that may result in actu-al or apparent conflicts of interest because of financial interests or outside activities are provided in appendix E. These examples are not inclusive; they merely illustrate a few situations in which conflicts arise. These ex-amples demonstrate that conflicts of interest arise more often in situations that are more indirect than when a contracting officer ad-ministers a contract held bv a comDanv in which he holdi stock. DA Grdnnelimiiita-ry and civilian) with holdings .in defense re-lated contractors that could lead to an actual or apparent conflict of interest should seek guidance from their Ethics Counselor.
c.1. Conflicts of interest resulting from outside employment. Outside employment or other outside activity, either with 'or with-out compensation; may also create a conflict or the appearance of a conflict of interest. Before anv neeotiations for em~lovment. w
DA personnel (military and civilian) are en-couraged to consult with their Ethics Counselor to determine whether a disquali-fication is required. This applies to all nego-tiations for em~lovmentconducted while the individual is' on-active duty or currently employed with the Government.
d. Using "inside information." DA per--sonnel will not engage in any personal busi-ness or professional activity, or enter into any financial transaction, that involves or appears to involve the direct or indirect use of "inside information" to further a private gain for themselves or others.
e. Using oficial positions. DA personnel are prohibited from using their official posi-tions to induce, coerce, or in any way influ-ence any person, including subordinates, to provide any unauthorized benefits, financial or otherwise, to themselves or others. (See 18 USC 1905)
f: Unauthorized release of acquisition in-formation. -Ex- -cept as provided herein, DA personnel are prohibited from releasing to an individual
or business concern or its representatives any knowledge such persons may possess or have acquired in any way concerning pro-posed acquisition or purchases by any con-tracting activity of DA. Such information will be released to all potential contractors as nearly simultaneously as possible. These releases will be made only through duly des-ignated agencies, so that one potential source of supply may not be given an ad-vantage over another. Such information will be provided in accordance with existing authorized procedures and only in connec-tion with the necessary and proper dis-charge of official duties.
g. Unauthorized statements or commit-ments with respect to award of contracts. On-ly contracting officers and their duly authorized representatives acting within their authority are authorized to commit the Government with respect to award of contracts. Unauthorized discussion and commitments may place DA in the position of not acting in good faith. Unauthorized- -personnel -re prohibited from makine anv commitment or ~romiserelat-" . ing to award of contract and will make no respresentation that would be construed as . such a commitment. atmpDA personnel will never advise a businessrepresentative that an attempt will be made to influence another person or agency to give preferen-tial treatment to his or her concern in the award of future contracts. Persons request-ing preferential treatment will be informed by official letter that DA contracts are awarded only in accordance with estab-lished contracting procedures.
h. Membership in associations. DA per-@)
sonnel who are members or officers of non-Government associations or orgatlizations must avoid activitieson behalf of the associ-ation or organization that are incompatible with their official Government positions. (See AR 1-210 and AR 1-211.) (See also app E, para f.)
i. Commercial dealings and other solicita-tion. To eliminate the appearance of coer-cion, intimidation, or pressure from rank, grade, or position, DA personnel, except special Government employees, will not make personal commercial solicitations or sales to DOD personnel who are junior in rank, grade, or position at any time, on or off duty. "Personal commercial solicitation" refers to those situations where DA person-nel are employed as sales agent on commis-sion or salary, or conduct business, and have contact with prospective purchasers concerning the commodity, real or intangi-ble, that is being offered for sale.
(1) This prohibition includes, but is not limited to, the solicitation and sale of insur-ance, stocks, mutual funds, real estate, and any other commodities, goods, or services. (See also AR 210-7 and AR 210-10.)
(2) This prohibition does not apply to the sale or lease, by a person, ,of a privately owned former residence; nor does it apply to the sale of personal property not held for commercial or business purposes. It also does not apply to the off-duty employment
25 SEPTEMBER 1986 UPDATE AR 600-50
25 SEPTEMBER 1986 UPDATE AR 600-51
units should be discouraged. On appropriate occasions, however, military organizations may wish to demonstrate their unit pride and esprit de corps by presenting distinctive mementos to such official visitors. Accord-ingly, appropriate mementos may be presented on such occasions provided the other conditions of this paragraph are ob-served (i.e., voluntariness of contributions, minimal value of contributions, and nomi-nal value of mementos).
c. DA personnel will not act as a conduit to give any foreign recipient any gift that has been provided by a private US citizen or business firm.
d. Guidance on the acceptance by DA ~ersonnelof eifts and mementos from for--eign governmentsis in AR 672-5-1, chapter 7, section 111.
e. The presentation of mementos to dis-tinguished foreign visitors is governed by AR 37-47.
2-4. Use of Government facilities, property, and personnel Government facilities, property, and work assistance will be used only for official Gov-ernment business. This includes but is not limited to stationery, stenographic services, typing assistance, duplication and chauffer . . .services-. DA per- . sonnel will not directly or indirectly use, or allow the use of, Government property of any kind, including property leased to the Government, for other than official pur-poses. These provisions do not prevent the limited use of Government facilities for ap-proved activities to further authorized DOD community relations; howeve3 the activities must not interfere with military missions or Government business.
2-5. Use of civilian and military titles in connection with a commercial enterprise
a. DA personnel, other than special Gov-ernment employees, may not use their titles or positioni in connection with any com-mercial enterprise or to endorse any com-mercial product. The foregoing does not prevent such personnel from publishing books or articles which identify them as au-thors by reference to their title or position, provided that publication of such material has been cleared under DOD procedures prescribed in AR 360-5.
b. Retired military personnel and mem-bers of Reserve Components, not on active duty, may use their military titles in connec-tion with commercial enterprises, provided they indicate their Reserve or retired status. However, the use of military titles is prohib-ited if it in any way casts discredit on the Army or the Department of Defense or gives the appearance of sponsorship, sanc-tion, endorsement, or approval by the A m y or DOD. In addition, oversea commanders may further restrict the use of titles, includ-ing use by retired military personnel and members of Reserve Components not on ac-tive duty, in an oversea area.
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2-6. Outside employment and other activltles of DA personnel
a. DA personnel will not engage in outside employment, affiliations, or other outside activity, with or without compensa- tion, that-
(1) Interferes, or is not compatible, with the performance of their Government duties.
(2) May reasonably be expected to bring discredit upon the Government or DA.
(3) Is otherwise inconsistent with the re- quirements of this regulation. This includes the requirement to avoid actions that rea- sonably can be expected to create a conflict or the appearance of a conflict of interest.
a. 1. Outside employment activities and other business relationships present special problems for personnel who occupy sensi- tive positions involving classified informa- tion o r significant decision-making authority. Commanders should consider re- guiring such personnel to obtain approval prior to accepting any outside employment
contractor). b. No enlisted members of the armed
forces on active duty may be ordered or per- mitted to leave their post to engage in a ci- vilian-pursuit or business, or a professional activity in civil life, for emolument, hire, or otherwise if the pursuit, business,. or profes- sional activity interferes with the customary or regular employment of local civilians in their art, trade, or profession. (See 10 USC 974.) This provision will not normally pre- clude off-duty employment by enlisted members of the armed forces. When aues- tions arise, advice should be .sought from the Ethics Counselor concerning impact, if any, in the local area.
c. Off-duty employment of military per- sonnel by an entity involved in a strike is permissible if the person was on the the pay- roll of the entity before the strike began and if the employment is otherwise in conform- ance with the provisions of this regulation. After a strike begins and while it continues, no military personnel may accept employ- ment with the involved entity at 'the strike location.
d. DA personnel are encouraged to en- gage in teaching, lecturing, and writing. However, they will not, either with or with- out compensation, engage in activities that are dependent on information obtained as a result of their Government employment, ex- cept when-
(1) The information has been published or is generally available to the public; or
(2) It will be made generally available to the public and the Assistant Secretaries of the Army, heads of Army Staff (ARSTAF) agencies, or MACOM commanders give written authorization for the use of nonpub- lit information on the basis that the use is in the public interest. (See AR 360-5.) 8
Table 2-1 Reviewing officials
Assignment of reporting individual: Office, Secretary of De!ense (OSD) Reviewing official: Director for Personnel and Security, Washington Headquarters Services
Assignment of reporting individual: ~efense~ u c k a rAgency (DNA) Reviewina official: General Counsel. DNA-Assignment of reporting individual: Defense CommunicationsAgency (DCA) Reviewing official: General Counsel, DCA
Assignment of reporting individual: Defense Mapping Agency (DMA) Reviewing official: General Counsel, DMA
Assignment of reporting individual: Defense Logistics Agency (DM) Reviewlng official: General Counsel, D M
Assignment of reporting individual: ~efenseintelligence Agency (DIA) Reviewing offlclal: General Counsel, DIA
Assisnment of reporting individual: ~ationalsecurity Agency (NSA) Reviewing official: General Counsel, NSA
Assignment of reporting individual: Organization, Joint Chiefs of Staff (OJCS) Reviewing official: Through OJCS Legal Adviser to Director for Personnel and Security, Washington Headquarters,Service OSD
Assignment of reporting individual: Combined commands and agencies Reviewing official: Director for Personnel and Securitv. Washington Headquarters Services OSD
-
Assignment of reporting individual: Unified and specified commands Reviewing official: Director for Personnel and Security, Washington Headquarters Services OSD
Assignment of reporting individual: ~ationaisecurity Council Reviewlns official: Director for Personnel and ~ecuzty,Washington Headquarters Services OSD
Assignment of reporting individual: Central intelligence Agency (CIA) Reviewing official: General Counsel, CIA
Memorandum f o r : (Immediate superior) (Immediate subordinates)
SUBJECT: D i s q u a l i f i c a t i o n Statement
1. This i s t o n o t i f y y o u t h a t I h a v e f i n a n c i a l i n t e r e s t s i n t h e fo l l ow ing organizationsand, p u r s u a n t t o t h e p r o v i s i o n s ofAR600-50, I a m r e q u i r e d t o disqual i fymysel f fromoff ic ia l act ions re la ted to them:
* ( h tapplicable organizations)
2. Accordingly, Imay not p a r t i c i p a t e personal ly and subs tan t i a l l y i n any o f f i c i a l a c t i o n s a f f e c t i n g t h e s e o r g a n i z a t i o n s i f t h a t would c rea tea c o n f l i c t , o reven the appearance o f a c o n f l i c t , w i t h m y o f f i c i a l d u t i e s . M y par t i c i pa t i onwou ldbe "personaln whether Iactdirect lyorthroughothers . My pa r t i c i pa t i onwou ldbe msubstant ia lni n a n y case inwhichmy decis ion, approval, disapproval, recommendation, i nves t i ga t i on , advice, o r any other a c t i v i t y m a y c o n t r i b u t e t o o r in f luence the o f f i c i a l a c t i o n a f f e c t i n g a n organizat ion i n w h i c h I h a v e an i n te res t . Mypar t i c i pa t i onwou ld create a c o n f l i c t , o r a t l e a s t the appearance o f one.wheneveritappears reasonably p o s s i b l e t h a t m y o f f i c i a l f u n c t i o n s w i l l a f f e c t the organizat ion, whetherby actiononaparticularmatteraffectingthe s p e c i f i c organizat ions o r by act ions i n v o l v i n g p o l i c i e s , standards, ob jec t ives o r o thermat ters of general a p p l i c a t i o n t h a t may subs tan t i a l l y a f f e c t the organization.
@ 3. Any such matters i n our o f f i c e should be handled wi thout my knowledge o r pa r t i c i pa t i on .
Figure 2-1. Sample disqualification statement
25 SEPTEMBER 1986 UPDATE AR 600-50
Assignment of reporting individual: National Aeronautics and Space Administration (NASA) Reviewing official: Director for Personnel and Security, Washington Headquarters Services OSD
Assignment of reporting individual: Americarl Battle Monuments Commission Reviewing offlclal: Director for Personnel and Security, Washington Headquarters Services OSD
Assignment of reporting individual: US Arms Control and DisarmamentAgency Reviewlng official: Director for Personnal and Security, Washington Headquarters Services OSD
Assignment of reporting individual: Federal ~ m e r ~ e n c y~anagement-~genc~ Reviewing official: Director for Personnel and security, Washington Headquarters , Services OSD
Assignment of reporting individual: Army Secretariat Reviewing official: Army General Counsel
Assignment of reporting individual: Chief of Staff, US Army Reviewing official: Army General counsel
Assignment of reporting individual: Vice Chief of Staff, US Army Reviewing official: Army General Counsel
Assignment of reporting individual: Director of the Army Staff Reviewing official: Army General Counsel
Assignment of reporting individual: The Judge Advocate General, US Army Reviewing official: Army General Counsel
Assignment of reporting Individual: All other Army general officers and civilian employees Reviewing official: The Judge Advocate General, US Army
2-1 1. Resolution of a conflict or appearance of conflict of interest
a. When a real or apparent conflict of in-terest arises and is not a suspected violation of criminal statutes as set out i n paragraph 2-10 above, the superior, in consultation with the P 3WXEthics Counselor, will discuss the sit-uation wi th the person concerned. I f the conflict or appearance of conflict o f interest persists and is not resolvedas a result o f dis-cussion, the superior will consult the Sta-
Ethics Counseloq. The superior will prepare and give to the person concerned written notice that a conflict or apparent conflict ex-ists and point out the reasons for the con-flict. The person wi l l indorse the notice, explaining the conflict or appearance o f conflict.
b. On receiving the person's indorsement, the superior, if he or she concludes that the conflict or appearance of conflict is resolved, will forward the entire file with his or her indorsement to the
-Ethics Counselor. The Counselor or DSCC will file all the corre-spondence if the superiorls conclusion is accepted.
c. If either the su~erioror M€EEthics Counselor, after review of the employee's explanation, concludes that the conflict or appearance of conflict is not resolved, the superior at the next level will review the en-tire matter. If a conflict or appearance of conflict does exist, he or she will attempt to resolve it.
d. In any case arising at any echelon be-low HQDA level in which there is a conflict or appearance of conflict of interest that is not resolved, the commander will forward the entire file with detailed information and recommendations through command chan-nels to The Judge Advocate General (TJAG), HQDA (DAJA-ALG), for resolu-tion. Intermediate commands will attempt to resolve each case without forwarding it to HQDA. In anytcase arising at HQDA, the head of the ARSTAF agency will take the necessary action to resolve the conflict or appearance of conflict of interest. Un-resolved cases will be forwarded to TJAG for resolution.
e. TJAG will forward to the Army Gen-eral Counsel, any case involving a conflict or appearance of a conflict that is not re-solved by him or her or at a lower level. f: A conflict or apparent conflict of inter-
est, either on review at the local level or af-ter referral to HQDA, will be resolved promptly so that the conflict or appearance of conflict is ended. It will be resolved in ac-cordance with applicable laws, executive or-ders, and regulations. Resolution will be accomplished within 90 days after the writ-ten notice described in paragraph a above is issued or a shorter period as prescribed by appropriate authorities. One or more of the following steps will be used as appropriate:
(1) Exemption under 18 USC 208(b). (2) Disqualification in accordance with g
below. (3) Limitation of duties. (4) Divestiture. (5) Establishing a "qualified blind trust"
within the meaning of the Ethics in Govern-ment Act of 1978.
(6) Transfer or reassignment. (7) Resignation. (8) Other appropriate action as provided
by statute or administrative procedure. g. Disqualification procedures are stated
below. (1) Unless otherwise expressly authorized
by action taken under 18 USC 2Bfet208, all DA personnel who have affiliations or fi-nancial interests that create conflicts or ap-pearance of conflicts of interest with their official duties must disqualify themselves from any official activities that are related to those affiliations or interests or the entities involved. (See j below concerning nondis: qualifying financial interests.) A formal dis-qualification must be sent to a person's superior and immediate subordinates when-ever it appears reasonably possible that the
person's official functions will affect the af-filiations, interests, or entities involved. If such persons cannot adequately perform their official duties after such disqualifica-tion, they must divest or be removed from their position. The effectiveness of any dis-qualification will be evaluates periodically by an individual's superior. (A sample dis-qualification statement is at fig 2-1).
(2) For the purpose of this paragraph, the "Government official responsible for ap-pointment to his or her position," under 18 USC 208b(l), for purposes of granting ex-emptions, will be a supervisor of the person concerned. This supervisor must be serving in the grade of colonel or above or GS/_ GM-15 or above or be an installation com--mander. All cases involving determinations under 18 USC 208b(l) will be coordinated with the £%€€Ethics Counselor.
(3) When a superior thinks' a subordinate may have a disqualifying interest, the supe-rior will discussthe problem with the subor-dinate. If such an interest does exist, the superior will disqualify the subordinate for duty and responsibility in that particular matter.
(4) In cases of disqualification under this paragraph, the particular matter will be re-assigned for decision and action to someone else who is not subordinate to the disquali-fied person.
h. The order to divest will be in writing, indicate the specific interests and why they create a problem, and specify the time al-lowed for divestiture.
i. The immediate superior of the individ-ual and other authorities as appropriate will be informed in writing by the person in-volved when the necessary actions have been taken to resolve an identified conflict.
j. A conflict does not exist when DA per-sonnel hold shares of a widely held, diversi-fied mutual fund or regulated investment company. In accordance with the provisions of 18 USC 208b(2), such holdings are ex-empted as being too remote or inconsequen-tial to affect the integrity of the services of Government personnel. k A conflict of interest arises whenever
DA personnel have an affiliation or financial interest which may be affected by perfor-mance of their official duties. It is not neces-sary that such an interest be in a defense contractor; it may be in some other entity (e.g., a subcontractor) as long as there is a
2-12. Restrictions on enlisted personnel
a. Enlisted members of DA who occupy a position of trust and responsibility, as des-ignated below, will not-
(1) ~ x c e ~ tas otherwise authorized by law, act as attorney or agent for anyone, with or without compensation, before any court, Government agency, or officer in
connection with any contract, claim, con-troversy, or any matter in which the United States is a party or has an interest.
(2) Participate in his or her official capac-ity through decision, approval, disapproval, recommendation, advice, or otherwise in any contract, claim, controversy, or any other mattter in which he or she, or his or her spouse, minor child, partner, organiza-tion in which he or she is serving as officer, director, trustee, partner or employee, or any person or organization with whom he or she is negotiating or has an arrangement concerning prospective employment, has a financial interest.
(3) Receive any salary, or supplementa-tion of his or her Government salary, from a private source as a compensation for his or her services to the Government.
b. The following positions are designated as positions of trust and responsibility for the purposes of this paragraph:
(1) Codtracting officers. (2) Contracting officers' representatives. (3) Ordering officers. (4) Purchasing agents. (5) Persons otherwise involved in pro-
curement and related functions for appro-priated and nonappropriated fund activities.
c. The application of these specifically enumerated restrictions does'not relieve en-listed members of DA from the applicability of the other prohibitions contained in this regulation.
Chapter 3 Statement of Affiliations and Financial Interests (DD Form 1555)
3-1. DA personnel required to file statements
a. If not required to file a Financial Dis-closure Report (SF 278) under chapter 4, the following DA personnel must submit initial and annual Confidential Statements of Affiliations and Financial Interests (DD Form 1555) unless they are expressly exempted:
(1) Commanders a& deputy com-manders of major installations and activities (except general officers). For this purpose, major installations and activities are those authorized a commander in the grade of colonel or higher.
(2) DA personnel classified at GS-15 or below under 5 USC 5332 or at a comparable pay level under other authority (subject to b, below) and members of the military be-low the rankpay grade of 0-7, when the offi-cial responsibilities of such personnel require them to exercise judgment in mak-ing a Government decision or in taking Government action in regard to contracting or procurement, regulating or auditing pri-vate or other non-Federal enterprise, or oth-er activities in which the final decision or action may have an economic impact on the interests of any non-Federal entity. This in-cludes DA personnel whose duties require
25 SEPTEMBER 1986 UPDATE AR 600-50
them t~ make a finding or recommendation or to provide other advice involving the ex-ercise of judgement, that usually is adopted or followed in making the decision or taking, the action. Following are examples of filing decisions:
(a) Example 1. A is a voting member of a committee that exerts substantial influence on the Army materiel acquisition process. A should be required to file DD Form 1555.
(b) Example 2. Although having no deal-ings with Government contractors and not involved in the acquisition process, B rec-ommends the level of supply of items which must be obtained from contractors. B's rec-ommendations normally are followed. B should be required to file DD Form 1555.
(c) Example 3. C performs technical tests on equipment received from XYZ Corpora-tion to determine whether it meets contract specifications. C's findings almost always are adopted by his or her superior in decid-ing whether to accept the equipment. If C's findings involve the exercise of judgment, C should be required to file a DD Form 1555. However, if C's findings are made up entire-ly of objective mechanical or scientific ob-servations, not involving the exercise of judgment on his or her part, C need not file the form.
(d) Example 4. D assembles predeter-mined data and prepares preliminary posi-tion papers for R, D's superior, on matters that have an economic,impact on an Army contractor. However, R always makes a completely independent review of the data and forms his or her own conclusion that, as often as not, differs from D's. D need not be required to file DD Form 1555.
(e) Example 5. E is a procurement ana-lyst who conducts random reviews of com-pleted acquisition actions for quality and timeliness of accomplishment. E's analyses and recommendations focus on the local procurement office system and operation, but they are not likely to have a direct effect on any Government contractors. E need not be required to file DD Form 1555.
@ Example 6. F is editor of an Army magazine who @ecifies the printing meth-ods and processes needed and who performs technical coordination with the commercial printers and art firms engaged in printing the magazine. F provides advice as to the technical quality of the contractor's work, but F otherwise does not make effective rec-ommendations or decisions that could influ-ence the award of the printing costract. F need not be required to file DD Form 1555.
(g) Example 7. Dr. G, while not directly involved in the Drocurement Drocess. makes recommendations regarding what kind of medical supplies/equipment should be used in certain Army medical activities. Dr. G's recommendationsnormally are Ellowed and. in at least some cases. ado~tionof his recdmmendations means that t i e supplies/ equipment must be obtained from a particu-lar supplier/manufacturer. Dr. G. should be required to file DD Form 1555.
(3) Special Government employees (as defined in the glossary), except as stated in paragraph 3-5.
b. A decision that a yivilian position filled by an employee in a grade below GS 13 under 5 USC 5332 or a comparable grade under other authority necessitates the filing of a DD Form 1555 must be made by a general officer or a member of the senior executive service who is in the individual's chain of supervision. Position descriptions for all civilian positions determined to re-quire DD Form 1555 filing will reflect that requirement.
3-2. Revlew of positions a. All positions in the categories indicat-
ed in paragraph 3-la will be reviewed annu-ally by thd -upemisor in coordination with the appropriate per-sonnel officer and the EtHics Counselor.
(1) If, as a result of this review, a deter-mination is made that the incumbent of the position must file a DD Form 1555, he or she will be so informed and the requirement for such filing will be included in the appro-priate document describing the duties and responsibilities of the position. The review may be accomplished at the time that per-formance, efficiency, or effectiveness ratings are given or incident to other currently pre-scribed annual reviews.
(2) A person who believes that he or she has been improperly required to file (or de-leted from a filing requirement) may request a review of the decision through established grievance procedures of the Army. 'Griev-ances initiated by civilian employees will be processed under the procedures prescribed by FPM -hapter 771 and AR 690-700.77 1.
b. The Secretary of the Army (SA) or his or her designee may determine that the sub-mission of statements is not necessary for certain positions because of the remoteness of any impairment of the integrity of the Government and the degree of supervision and review of the incumbent's work. For purposes of this subparagraph, the SA dele-gates authority for such a determination (except in the case of the positions identified in para 3-la(1)) to MACOM commanders and heads of ARSTAF agencies. Authority may not be further delegated.
3-3. Submission and review a. Personnel in MACOMs or ARSTAF
agencies required to file will submit their statements in accordance with instructions issued by the agency or command to which assigned.
b. Statements required pursuant to re-views by MACOM commanders or heads of ARSTAF agencies under paragraph 3-2a will be submitted to and filed *with the BS€€Ethics Counselor of the MACOM or ARSTAF agency. c Army personnel assigned to the Office
of the Secretary of Defense (OSD) or the Organization of the Joint Chiefs of Staff
(OJCS) will submit their statements in ac-cordance with instructions issued by the agency to which assigned.
d. Personnel of the unified commands will submit their statements through their supervisors to the =Ethics Counselor of the unified command. Commanders who have a dual responsibility as commandersof both joint commands and Army compo-nents will submit their statements through Army channels.
e. Army officers assigned to Army ele-ments (excluding Army components listed in AR 10-5, chap 3) of joint commands or activities outside primary staff agencies of DA will submit their statements in accord-ance with instructions issued by the agency or command to which assigned.
$ Prior to the commencement of service or assumption of duties and annually there-after, as prescribed in paragraph 3-7, all statements will be reviewed and approved by the P -Ethics Counselor and the immediate superior.
3-4. Excusable delay An individual's BE€Ethics Counselor may grant an extension of time to file a DD Form 1555 in the unique case where the ex-tension is necessitated by either duty assign-ment or infirmity. An extension in excess of 30 days will not be given without the ap-proval of the Army General Counsel.
3-5. Special Government employees a. Except as provided in c below, each
special Government employee and each nowFederal member of any DOD or DA advisory cornmipee who is not required to file an SF 278 will) prior to appointment, file a DD Form 1555 statement with the of-ficer designated in paragraph 2-9.
b. Categories of special Government em-ployees who are not required to file D D Forms 1555 unless specifically requested to do so are as follows:
(1) Physicians, dentists, and allied medi-cal specialists engaged only in providing ser-vice to patients.
(2) Veterinarians providing only veteri-nary service.
(3) Lecturers participating in educational activities.
(4) Chaplains or clergymen performing only religious service.
(5) Individuals in the motion picture and television fields who are used only as narra-tors or actors in DOD productions.
(6) An employee who is not a "consult-ant" or "expert" as defined in chapter 304 of the FPM.
(7) Reservists on active duty for less than 30 consecutive days during the calendar year..
3-6. Exemptions to specific appointees The SA may grant an appointee an exemp-tion from the requirement of filing a state-ment upon a determination that such
25 SEPTEMBER 1986 UPDATE AR 600-50 11
information is not relevant in view of the duties the appointee is to perform.
3-7. Statements required DD Forms 1555 will be submitted in ac-cordance with paragraph 3-3 under the cir-cumstances described below.
a. Initial statements. Before the assump-tion of duties in a position that requires the filing of the DD Form 1555, the reporting individual must file the required disclosure statement with either his or her new super-visor or the TMXEthics Counselor affiliat-ed with this new position. (See para 3-3f.)
b, Annual statements. DD Forms 1555 will be filed by 31 October of each year for all affiliations and financial interests as of 30 September of that year. Even though no changes occur, a complete statement is required. Notwithstanding the filing of an-nual statements, DA personnel will at all times avoid acquiring a financial interest or affiliation or taking action that could result in a violation or apparent violation of the conflicts of interest provisions of 18 USC 208 or this regulation.
3-8. Interests of relatives of DA personnel The interest of a spouse, minor child, or any member of one's household will be reported in the same manner as an interest of the individual.
3-9. lnformation not known by DA personnel DA personnel will request submission on their behalf of required information known only to other persons. The submission may be made with a request for confidentiality that will be honored even if it includes a limitation on disclosure to the DA person-nel concerned.
3-10. lnformation not required to be submitted DA personnel are not required to submit on a statement any information relating to the employee's connection with or interest in a professional society or a charitable, reli-gious, social, fraternal, recreational, public service, civic, or political organization or similar organization not conducted as a business for profit. For the purpose of this regulation, educational and other institu-tions doing research and development or re-lated work involving grants of money from or contracts with the Government will be included in a person's statement.
3-1 1. Confidentiality of statements of DA personnel Each DD Form 1555 will be held in confi-dence. DA may not disclose information from a statement except for good cause, as determined by the Army General Counsel on behalf of the SA or by the Office of Gov-ernment Ethics. "Good cause" includes a determination that the record or any part of the record must be released under the Free-dom of Information Act (FOIA). Persons designated to review or process statements
are responsible for maintaining the state-ments in confidence. They will not allow ac-cess to or disclosure from the statements except to carry out the purpose of this regu-lation. Inspections by Government officials charged with the responsibility for deter-mining the proper operation of the financial disclosure reporting system fall within this exception.
3-12. Effect of statements on other requirements Submission of statements does not permit DA personnel to participate in matters in which their participation is prohibited by law, order, or regulation.
3-13. Processing DD Forms 1555 a. Each person required to file a DD
Form 1555 will forward the completed statement to his or her immediate supervi-sor for review and approval. Conflicts and apparent conflicts will be resolved in ac-cordance with paragraph 2-1 1. Statements will then be forwarded t o the !kmdmkd -Ethics Counselor for review and approval. If no appearance of a conflict of interest is present, the statement will be filed at that level.
b. Statements will be maintained in ac-cordance with AR 340-18, appendix E, for 6 years from the date of filing.
3-14. DD Form 1555 Status Report (RCS JAG 74)
a. Each year MACOM and ARSTAF H€€sEthics Counselor will prepare re-ports concerning the annual filing of DD Forms 1555.'These reports will be dis-patched to HQDA(DAJA-ALG), WASH DC 20310-2212, not later than 20 Novem-ber. The MACOM and Army Staff report will be a consolidated report from all subor-dinate elements. This'report will reflect the following data:
(1) The number of individuals required to file DD Forms 1555.
(2) The names of individuals who have not filed as of 15 November.
(3) The reason why individuals listed in (2) above have not filed.
(4) The anticipated date of fiiing for indi-viduals listed in (2) above.
b. Biweekly reports will be filed for those organizations that have not received reports from all individuals required to file, until all DD Forms 1555 have been received.
the provisions of Title 11, Ethics in Govern-ment Act of 1978, PlkPub.L. No. 95-521, as amended (5 USC app. I, sec. 201 et seq.)
(1) General officers. (2) Members of the Senior Executive Ser-
vice (SES). (3) General Schedule (GS) employees,
grade 16 and above. (4) Personnel (including special Govern-
ment employees) whose rate of pay is fixed, other than under the GS, at a rate equal to or greater than the minimum rate of pay for GS-16.
(5) Employees in the excepted service in positions that are of a confidential or policy-making character (Schedule C employees). This requirement does not apply to posi-tions that have been excluded by the Direc-tor of the Office of Government Ethics.
b. Individuals required to file an SF 278 are not required to file a DD Form 1555.
4-2. Reporting responsibility a. It is the responsibility of individuals
occupying covered positions to file the required SF 278. In certain cases (see para 4-3a), HQDA will notify individuals of fil-ing requirements. The requirement for filing SF 278 for covered civilian positions will be specified in the job description or other doc-ument that describes the duties and respon-sibilities assigned to the position.
b. SF 278 may be obtained through nor-mal publicati~nschannels from The Adju-tant ' ~ e n e r a lPublications Center, 2800 Eastern Blvd., Baltimore, MD 21220-2896. The servicing Staff Judge Advocate (SJA), Civilian Personnel Officer (CPO), or,BE€ Ethics Counselor should ensure that the forms are available in sufficient time to al-low the reporting individual to meet the required suspense dates.
4-3. Reports required SF 278 will be submitted in accordance with paragraph 4-5 under the circumstances shown below. Local submission dates may be adjusted by immediate supervisors as long as suspense dates to HQDA(DAAG-ZX) are met. The reviewing official (table 2-1) may, for good cause shown, grant an extension of up to 45 day2
a. Nomination reports. Except as indicat-ed in e below, a civilian nominated by the President to a position requiring Senate con-firmation will submit an SF 278. The Army General Counsel will notify such persons when to submit the report and of any addi-tional information required by the report. That office will attach a position descrip-tion, review the report, and forward a copy of it to the Office of Government Ethics
Chapter 4 (OGE), to arrive no later than 5 days after Financial Disclosure Reports (SF transmittal of the nomination to the Senate. 278) Brigadier general designees and general of-
ficers are not required to file a nomination 4-1. DA personnel requlred to file SF report with respect to their nomination for 278 (covered posltions) promotion to 0-7 and above. However,
a. The DA personnel listed below are brigadier generals will file assumption re-required under the circumstances shown in ports after promotion to 0-7 and assump-paragraph 6 3 to submit an SF 278 (fig 1-3 tion!of duties commensurate with their new 4). This requirement is in accordance with grade in accordance with b below.-
25 SEPTEMBER 1986 UPDATE AR 600-50
b. Assumption report. Except as indicated in e below, an individual will submit an SF 278 before assuming a covered position. This requirement does not apply if the indi-vidual has left another covered position within 30 days prior to assuming a new po-sition, or already has filed with respect to nomination for the new position.
(1) A civilian position is assumed on the effective date of the civilian personnel action involved. A civilian temporarily occupying a covered position (i.e., without a formal ci-vilian personnel action) will not be consid-ered to have assumed the position for purposes of this filing requirement.
(2) A military officer below the grade of 0-7 will not be considered to have assumed a general officer position unless frocked as a general officer.
(3) A newly appointed (or frocked) brig-adier general will submit an assumption re-port within 30 days after assuming the duties of a general officer position.
(4) When an individual assumes duties in a covered position but is not required to submit a new report, the individual will re-view his or her financial interests with that organization's -Ethics Counselor to ensure that the change of duties will not af-fect continued compliance with applicable conflict of interest laws and regulations. Such a review will also be conducted if the individual acquires additional duties or as-sumes a new covered position during the pe-riod before the annual report is required to be filed. This review will include the most recent report filed by the individual plus in-formation supplied informally by the indi-vidual as to any additional interests subsequently acquired or other significant changes.
c. Annual reports. (1) An SF 278 will be submitted by each
person, including special Government em-ployees who perform the duties of a covered position (para &la) for more than 60 days during a calendar year. The report covering that calendar year will be submitted to the immediate supervisor in accordance with paragraph 4-5 by 15 April of the next cal-endar year. The report will be reviewed and forwarded by the immediate supervisor to HQDA(DAAG-ZX) by 15 May. (RCS ex-empt, AR 335-15, para 5-2e(4))
(2) When an individual has filed an an-nual report; and subsequently either acquires additional duties or assumes a new covered position, new SF 278 does not need to be filed. The individu-al, however, will review his or her financial interests with that organization's 3%X?Eth-ics Counselor to ensure that the c h a n g z f duties will not affect continued compliance with applicable conflict of interest laws and regulations. This review will include the most recent report filed by the individual plus information supplied informally by the individual as to any additional interests sub-sequently acquired or other significant changes.
d. Termination reports. Except as indicat-ed in e below, an SF 278 will be submitted
in accordance with paragraph 4-5. The SF 278 will be submitted 15 days before the ef-fective date of termination of employment unless the persod has accepted employment in another covered position. The termina-tion report will cover the poqtion of the present calendar year up to the date of ter-mination and, if the annual report has not yet been filed, the preceding calendar year. Such reports must reach HQDA(DAAG-ZX) no later than 30 days after the last day of Federal employment.
e. Not more than 60 days in covered position.
(1) A person who is nominated to or as-sumes a covered position is not required to file a report if the appropriate appointing of-ficial (for civilian employees) or HQDA (DAPE-GO) (for USAR and ARNG gen-eral officers) determines after consultation with the organization's WE€Eth ics Counselor that such a person is not reasona-bly expected to perform the duties of the position for more than 60 days in the calen-dar year. However, if the person performs the duties of the office or position for more than 60 days in the calendar year, an as-sumption or nomipation report will be filed within 15 days after the 61st day of duty.
(2) A person who does not actually per-. form the duties o f a covered position for more than 60 days in the calendar year is not required to file an annual report or a termination report.
44..Contents of,reports Instructions for completing SF 278 are in-cluded as part of .the report forms. Addi-tional guidance for personnel in covered ~ositionsis available from local BE€sEth-Ics Counselor, SJAs, CPOs or c o m m a counsel.
4-5. Submitting assumption, annual, and termination reports
a. DA personnel required to file will sub-mit their SF 278 through their E3SXEthics Counselor (or persons fulfilling similar re-sponsibilities in the agency to which as-signed) to their immediate supervisor. Forms will not be submitted through com-mand channels.
(1) DA personnel assigned,to agencies and offices outside DOD will submit their SF 278 to HQDA(DAAG-ZX), WASH DC 20310-2101, in compliance with the suspenses listed in paragraph 4-3. A copy of the official position description and a com-pleted DA Form 4971-R (Certificate of Pre-liminary Review of SF 278) must be included.
(2) DA personnel of the unified com-mands will submit their reports through their 3WXEthics Counselor to their imme-diate superior and then to the E 3 S X B Codnselor (or persons fulfilling similar re-sponsibilities) of the unified command for submission to HQDA (DAAG-ZX).
b. Agreements with any other DOD component or Government agency involv-ing a loan of DA personnel in covered posi-tions (para &la) will contain a requirement
that the other DOD component or Govern-ment agency will review any SF 278 submit-ted by the loaned individual, attach a copy of the official position description, complete a DA Form 4971-R, and forward the re-ports with all attachments to HQDA (DA9G-ZX) in compliance with the filing dates prescribed in paragraph 4-3. A state-ment will be included concerning the resolu-tion of any conflict or apparent conflict of interest.
4-6. Preliminary review a. BSfXEthics Counselor of reporting
person. The reporting individual's EXXX Ethics Counselor will-
(1) Thoroughly review the SF 278. (2) Attach a copy of the official position
description. (3) Complete the applicable portions of
the DA Form 4971-R to include listing (at item 2c and/or 2d) those business entities in which an interest or affiliation has been re-ported that are doing business or attempting to do business with the reporting person's organization or activity.
(4) Forward the SF 278, with all attach-ments, to the reporting individual's supervisor. ,
b. Immediate supervisor of reporting per-son. The reporting person's immediate su-pervisor will thoroughly review the reported financial interests as they relate to the per-son's duties. Conflicts or the appearance of conflicts will be resolved in accordance with paragraph 2-1 1 of this regulation and item 2d of the DA Form,4971-R. If the immedi-ate supervisor is aware of any information that relates to a possible conflict of interest, the information will be included. The imme-diate supervisor will complete the applicable portions of the DA Form 4971-R and for-ward the report, with all attachments, to his or her 3WXEthics Counselor.
c. M E t h i c s Counselor of immediate supervisor. The 3%X?Ethics Counselor for the immediate supervisor of the reporting person will-
(1) Conduct a thorough preliminary re-view of the reported financial interests and positions disclosed on the form.
(2) Clarify and resolve discrepancies, conflicts, or apparent conflicts with the im-mediate supervisor in accordance with para-graph 2-1 1 of this regulation and item 2d of the DA Form 497 1-R.
(3) Complete the DA Form 4971-R. (4) Forward the SF 278, with attach-
ments (e.g., position description and com-pleted D A Form 49712R), to HQDA (DAAG-ZX), WASH DC 20310-2101 in compliance with the suspenses listed in par-agraph 4-3.
4-7. Review at Headquarters, Department of the Army
a. Filing authority. The official filing au-thority for all individuals occupying covered positions within the Department of the A r m y i s T h e A d j u t a n t G e n e r a l (DAAG-ZX). The date of receipt by HQDA (DAAG-EX) will be noted on the
5 SEPTEMBER 1986 UPDATE AR 600-50
SF 278 as required by law. Upon dating the report, HQDA(DAAG-ZX) will forward the SF 278 to the appropriate reviewing offi-cial for final review.
b. Reviewing official. Reviewing oficials are shown in table 2-1. When TJAG is the reviewing official, he or she will provide the General Counsel a copy of all correspond-ence referred to in e and f below. Review of an SF 278 is completed when the reviewing official has signed the SF 278, indicating that each item is completed and that the re-port discloses no unresolved conflict or ap-pearance of a conflict of interest under applicable laws and regulations. (Circum-stances or situations that have resulted in or may result in noncompliance with applica-ble laws and regulationsare listed at app E.)
c. Permanent filing. After signing the SF 278, the reviewing official will return it for permanent filing to HQDA(DAAG-ZX).
d. Additional information. If the review-ing official, after reviewing an SF 278, be-lieves additional information is required, the reporting individual will be notified of the additional information required and the date by which it must be submitted. The re-porting individual will submit the required information directly to the reviewing official.
e. Preliminary determination. If the re-viewing official, after reviewing the SF 278, is of the opinion, on the basis of information submitted, that the reporting person is not ip compliance with applicable laws and reg-ulations, the following steps will be taken:
(1) The person will be notified in writing of the preliminary determination.
(2) The person will be afforded a reason-able opportunity for a written or oral re-sponse. Written responses will be forwarded directly to the reviewing official by the sus-pense date specified in the notice.
f: Compliance or referral. After consider-ing the response provided by the reporting person, the reviewing official will determine whether the person is in compliance with applicable laws and regulations.
(1) If the person is in compliance, the re-viewing official will sign the SF 278. He or she will also send written notification of the determination to the person, including the addition of any comments written or at-tached to the SF 278.
(2) If the person is determined not to be in compliance, he or she will be notified in writing of that determination. After an op-portunity for personal consultation, if prac-ticable, the reviewing official will notify the person in writing of the remedial measures outlined in paragraph 2-1 1 that should be taken to bring the person into compliance. The notification will specify a date by which such measures must be taken.
(a) When the reviewing official deter-mines that a reporting person has fully com-plied with the remedial measures, a notation to that effect will be made in the comment section of the SF 278. The reviewing official will then sign and date the SF 278 and send written notice of that action to the person. 14
(b) If steps assuring compliance with ap-plicable laws and regulations are not taken by the date established, the reviewing offi-cial will report the matter to the SA for ac-tion. The OGE will also be notified.
4-8. ~ubli: disclosure By law, SFs 278 must be made available for public examination upon request, 15 days after the report is filed. Receipt of the report by HQDA(DAAG-ZX) constitutes official filing and establishes the date from which the 15 days will run. In most cases, this means the reports are available to the public before review at HQDA is completed. Re-porting persons are personally responsible for ensuring that their reports are accurate, complete, and timely.
4-9. Penalties Compliance with the financial disclosure provisions will be enforced by administra-tive, civil, o r criminal remedies, as appropriate. ,
a. Action within Department of the Army. The SA may take appropriate action, in-cluding a change in assigned duties or ad-verse action, in accordance with applicable law or regulation, against any person who is reported under paragraph 4-7f(2)(b), who fails to file an SF 278, 'or who falsifies or fails to report information required to be reported.
b. Action by the Attorney General. The SA is required by the Ethics in Government Act of 1978 to refer to the Attorney Gener-al the name of any person whom the SA has reasonable cause to believe has willfully failed to file an SF 278 on time or has will-fully falsified or failed to file information required to be reported. Such referral does not bar additional administrative or judicial enforcement. The Attorney General may bring a civil action in the US District Court against any person who knowingly and will-fully falsifies or fails to file or report any required information. The court may assess a civil penalty not to exceed $5,000. Know-ing or willful falsification of information required to be filed may also result in crimi-nal prosecution under 18 USC 1001 leading to a fine of not more than $10,000, or im-prisonment for not more than 5 years, or both.
c. Misuse of reports. (1) The Attorney General may bring a
civil action against a person who obtains or uses an SF 278 filed pursuant to the Ethics in Government Act for the reasons shown below.
(a) Any unlawful purpose. (b) Any commercial purpose, other than
by news and communicationsmedia for dis-semination to the general public.
(c) Determining or establishing the credit rating of any individual.
(d) Use, directly or indirectly, in the so-licitation of money for any political, charita-ble, or other purpose.
(2) The court in which such action is brought may assess against such person a penalty in any amount not to exceed $5,000.
25 SEPTEMBER 1986 UPDATE AR 600-50
This is in addition to any other legal remedy available.
Cha~ter5 . ~ a w sGoverning Former Government Employees
$1. Former officers or employees a. The term "former officer or employee"
includes the following personnel: (1) Full-time civilian officers or employ-
ees who have left Government service. (2) Special Government employees who
have left Government service. (3) Retired officers released from active
duty. (4) Reserve officers released from active
duty. (5) Officers discharged or dismissed from
active dutv. b. The term does not include enlisted
personnel.
5-2. Enforcement responsibility a. Each officer and employee, upon end-
ing service with the US Army, is obligated to review the postemployment restrictions imposed by law and regulation and deter-mine those that apply to future employment and dealings with the agencies of the Feder-al Government. This chapter and appendix B summarize the laws and regulations that apply to persons who have already left the Government or will do so in the future.
b. Persons ending service with the US Army will be furnished a copy of this regu-lation for review during their outprocessing. Personnel who request additional advice will be referred to the local DSCC or legal office as applicable. Such advice may be pro-vided before or during the outprocessing.
c. Administrative enforcement proce-dures are set forth in paragraph 5-7.
5r3. Postemployment restrictions a. Employment of retired DA personnel.
PJaExcept for former Presidential appoin-tees in Federal employment, no Federal law or regulation precludes retired or former ci-vilian or military personnel from being em-ployed by a domestic corporation or concern doing business with the Govern-ment. General professional knowledge ac-quired while in Government service eenerallv mav be used in connection with w . . the employment. However, the use of "in-side information" as well as the use of other. .activities- that reasonably give the appearance of making unfair use of pri-
'
or Government em~lovmentand affiliations is prohibited. he' statutory.postemploy-ment restrictions are not intended to dis-courage the movement of employees to and from positions in industry, research institu-tions, and universities. Instead, only certain acts that are detrimental to public confi-dence in the Government are prohibited. See appendix B for a digest of laws relating to conflict of interest.
~ ~ l - ~ ~ ~ ~ ~ ,
b. Permanent bar. The target of these re- the Director, Office of Government Ethics. %€€Ethics Counselor for the office to strictions is the former officer or employee To be eligible to be desigriated, a position which the communication is to be directed. who participates in a particular matter must involve significant decision-making or (See para 2-9.) while employed by the Government and lat- supervisory responsibility and be at a basic b. The subject matter of the communica-er "switches sides" by representing another rate of pay of GS-17 or above or within the tion must be limited to scientific and tech-
(@ person on the same matter. The restrictions SES. In the case of military members, the nological exchanges. These may include are directed at regulating representational position must be held by active duty officers discussions of feasibility, risk, cost, and activities, whether or not such activities in- at grades 0-7 or 0-8. speed of implementation. elude personal appearances by physical b. Two-year bar on assisting in represent- c. The office receiving the communica-Presence before the Government, and corn- ing by personal presence. For 2 years after tion or participating in the discussions must munications made with intent to influence. leaving Government service, a former senior maintain copies of the written communica-This includes promotional and contract employee may not assist in the representa- tions and written summaries of any discus-resentations3 whether by personal appear- tion of another person by personal presence sions for a period of 5 years. ante or by oral or written communication. at an appearance before the Government on
(1) All former officers or employees are any particular matter in which he or she 5 4 . Exemption for persons with permanently prohibited from knowingly personally and substantially participated special qualifications in a technical representing anyone other than the United while in Government service. While such disciplineStates in connection with a particular mat- employees could, for example, work on a uponapplication by the concerned,ter involving a Specific party or parties in contract with which they were involved the SA, in consultation with the under set-which the United States is a party or has a while in Government service, they may not of ~~f~~~~for ~~~~~~~hand ~ ~direct and substantial interest and in which render assistance while in attendance at any opment and with the ~ i ~OGE, maythe individual participated personally and meeting, negotiations, or proceedings with grant an exception to the postemp~oymentsubstantially for the Government (18 USC the Government. (See 18 USC 207(b)(ii), as rest,.ictions outlined in paragraphs 5-3 and207(a)). amended.) 5 4 if the conditions below are met.
(2) In addition to the restriction in Para- C. One-year bar on attempts to influence a. written applications for an exception graph above*former Or former agency. For 1 year after leaving will be submitted directly to HQDA ees who terminate after Government service, a former senior em- (SARDA), WASH DC 2031&0600. Justifi-
1979 are prohibited from making ployee may not represent another person or cation submitted with the application will Or written On per- himself or herself in attempting to influence include evidence that the person has out-sons than the United States with an his or her former agency in any matter standing qualifications in a scientific, tech-intent influence particular matters in pending before, or of substantial interest to, nological, or other technical discipline and which both conditions shown below occur. such agency. This provision does not re- the person is acting with respect to a partic-
(a) The United States is a party or has a quire that the former employee have had ular matter that requires such qualifications,direct and substantial interest. any prior involvement in the particular mat- and that the national interests will be served
(b) The individual participated personal- ter. The prohibition does not apply to com- by participation of the former officeror em-ly and substantially for the Government (18 munications made by a former senior ployee. The Assistant Secretary of the Army USC 207(b)(i) as amended). employee who is an elected official or em- (Research, Development, and Acquisition)
c. Two-year bar on representing. ployee of a State or local government, act- will forward the application through the (1) Former officersor employees who ter- ing On behalf of such government, or to Army General Counsel to the SA, together
minate Government service on or after 1 communications on behalf of a degree- with a recommendation on whether to ap-July 1979 are subject t~ a restriction which granting institution of higher learning, or prove the application and the basis for that lasts for 2 ye= after termination of service. nonprofit hospitals or medical institutions recommendation. If the application for an Such persons may not act as agent or attor- by a former senior employee who is princi- exception is approved, the SA will publish ney or otherwise represent others in formal P ~ U Yemployed by such institutions or med- appropriate certification in the Federal or informal appearances before the Govern- ical organizations. It also does not apply to Register. ment in connection with particular matters purely social or ir~f~rmational~ ~ m m u n i c a - b. The use of this exception will be limit-that were pending under the former employ- tions9 responses to requests from the former ed to instances in which the former Govern-eels official responsibility during the final agency, or to expressions of personal views ment employee's involvement is needed on year of service. This restriction includes oral when the former senior employee has no Pe- so continuous and comprehensive a basis or written communications as described in cuniary interest. The provision results in a 1 that compliance with the procedures adopt-b(2)above. Year "cooling of' period to Prevent the Pas- ed for the communication of technical infor-
(2) "Official responsibility" includes the sible use of personal ~nfluencebased on Past mation (para 5-5) or other actions to isolate direct administrative or operating authority, affiliations to facilitate the the former Government employeefrom 0th-whether intermediate or final, either exercis- business. (See l8 USC 207(c)9 er aspects of the matter would be burden-able alone or with others, and either person- amended.) some and impractical. ally or through subordinates, to approve, disapprove, or otherwise direct Government 5-5. ons suit at ion exception to 5-7. Postemploymentviolations and actions (18 USC 202(b)). Ordinarily, the PostemPlo~mentrestrictions administrative enforcement scope of an employee's official responsibility The postemployment restrictions outlined in proceedings is determined by reference to the pertinent paragraph 5-3 do not apply to communica- a. Basic procedures. The administrative statute, regulation, executive order, job tionsrmade solely for the purpose of furnish- enforcement of restrictions on postemploy-description, or delegation of authority. ing scientificor technological information in ment activities will be accomplished in ac-
accordance with the following procedures. cordance with DOD 5500.7, 5 CFR 737.27 5-4. Additional restrictionspertaining a. The office receiving the contact or (OPM Regulation, "Post-employment Con-to senior employees communication will be advised by the for- flict of Interest"), and chapter 5 of this
a. Senior employees and designated posi- mer officer or employee, or by the organiza- regulation. tions. A senior employee means a civilian tion represented by that individual, of the b. Delegation. The Army General Coun-employee at the executive level or a three- prior employment status of that individual sel will have authority to administer these or four-star general. It also means other and the general subject matter to be com- provisions within the DA. TJAG is delegat-persons holding positions that have been municated. Notice will be given in advance ed general authority to conduct the admin-designated as senior employee positions by of any communication, if possible, to the istrative enforcement functions described in
25 SEPTEMBER 1986 UPDATE AR 600-50 15
this paragraph. However, the Army Gener-al Counsel may reserve authority to act in any case by so notifying TJAG in writing.
c. Receipt of information concerning for-mer DA personnel. If an officer or employee of DA has reason to believe, or receives in-formation that, a former officer or employee has violated 18 USC 207(a), (b), or (c), or implementing regulations, he or she will promptly report the information to the Eth-ics Counselor. The Ethics Counselor will re-view the information and, if it appears that a violation of 18 USC 207 may have oc-curred, forward a written report to the IG, HQDA(DA1G-ZB), WASH DC 20310-1700. The report will not be forwarded through command channels. Other persons outside DA having information of such vio-lations may make a report to any DA per-sonnel. The privacy of former officers or employees will be protected by adequately safeguarding information concerning allega-tions made prior to a determination of suffi-cient cause to initiate an administrative disciplinary hearing.
d. Actions by The Inspector General (TIG). Upon receipt of a report alleging vio-lations of 18 USC 207(a), (b), or (c), or im-plement ing regula t ions , T I G will immediately provide a copy of the allega-tions to the TJAG and the Army General Counsel. The IG will have a preliminary in-vestigation conducted into the basis of the allegations. A memorandum will be pre-pared and forwarded to TJAG and, upon request, to the Army General Counsel.
e. Report to the Ofice of Government Ethics (OGE) and the Department of Justice (DOJ). On receipt of information regarding a possible violation of 18 USC 207(a), (b), or (c) or implementing regulations, and af-ter determining that the information ap-pears substantiated, TJAG (except in those cases in which the Army General Counsel has reserved authority to act) will provide such information to the Army General Counsel with appropriate comments. The Army General Counsel will evaluate the in-formation and forward it, along with any comments and applicable agency regula-tions, to the Director, OGE, and to the Criminal Division, DOJ. In cases where TJAG determines that such information does not appear substantiated, he or she will notify TIG and the Army General Counsel in writing of this determination. Until DOJ has formally declined to take action in a particular case, the Army General Counsel will coordinate any DA investigation or ad-ministrative action with DOJ. If, during the course of a criminal investigation, allega-tions of violations of 18 USC sections 207(a), (b), or (c), or implementing regula-tions are identified, an immediate report of these allegations will be made by the USACIDC to the TJAG and the Army General Counsel. The USACIDC shall con-duct an expeditious investigation into the al-legations and provide a report of the results thereof to the TJAG and, upon request, to the Army General Counsel.
f: Initiation of administrative disciplinary hearing. Whenever TJAG (or the Army General Counsel in cases in which he or she has reserved authority to act) has deter-mined that the information appears substan-t ia ted , he o r she may in i t ia te an administrative disciplinary proceeding.
g. Notice of hearing. (1) TJAG (or the Army General Counsel
in those cases in which he or she has re-served authority to act) will provide a for-mer officer or employee with notice of not less than 20 calendar days of an intention to institute a proceeding and an opportunity for a hearing.
(2) Notice must include-(a) A statement of allegations and the ba-
sis thereof, sufficiently detailed to enable the former officer or employee to prepare an ad-equate defense.
(b) Notice of the right to a hearing. (c) Procedure for requesting a hearing. (d) Notice of the right to waive the right
to appear at the hearing and the procedure to do so. (See h below.)
(e) Notice that the failure to appear at the hearing will constitute a constructive waiver of the right to appear.
Cf) Notice of the potential administrative sanctions that the SA could impose should the hearing result in a decision adverse to the former officer or employee.
h. Waiver procedure. A hearing under this paragraph is a condition precedent to the imposition of administrative sanctions by the SA. However, the required hearing may be conducted in the absence of the for-mer officer or employee if there has been a waiver of the individual's right to appear. The right to appear may be waived in either of the following ways:
(1) The former officer or employee may affirmatively waive his or her right to ap-pear at the hearing by executing a written waiver. Waiver statements should accompa-ny the notice of the hearing. The format of a waiver statement may vary provided the statement clearly informs the former officer or employee that his or her signature on the document constitutes a waiver of his or her right to appear at the hearing and notifies this individual of the potential administra-tive sanctions should the hearing result in a decision adverse to the interests of the for-mer officer or employee.
(2) The former officer's or employee's failure to appear at a scheduled hearing, af-ter due notice, will constitute a constructive waiver of the right to appear.
i. Hearing examiner. The presiding offi-cial will be a person to whom TJAG (or the Army General Counsel in those cases in which he or she has reserved authority to act) has delegated authority in writing to make an initial decision. (This person will hereafter be referred to as "examiner.")
(1) An examiner will be an attorney with not less than 3 years of experience subse-quent to admission to the bar.
25 SEPTEMBER 1986 UPDATE AR 600-50
(2) An examiner will be impartial. (An individual who has participated in any man-ner in the decision to initiate the proceed-ings may not serve as an examiner in those proceedings.)
j. Time, date, and place of hearing. (1) The hearing will be held at a reasona-
ble time, date, and place. (2) The date of the hearing will be speci-
fied by the examiner with due regard to the former officer's or employee's need for ade-quate time to prepare a defense properly and a need to resolve expeditiously allega-tions that may be damaging to his or her reputation.
k. Hearing rights. The subject of the hearing will have the following rights:
(1) The right to represent himself or her-self or be represented by counsel.
(2) The right to introduce and examine witnesses and submit evidence.
(3) The right to confront and cross-ex-amine adverse witnesses.
(4) The right to stipulate as to facts not in issue.
(5) The right to present oral argument. (6) The right to receive a transcript or a
recording of the proceedings upon request. I. Burden of proof: DA has the burden of
proof. A violation is established only by substantial evidence.
m. Decision. (1) The examiner will-(a) Make a determination that is based
exclusively on matters of record in the proceedings.
(b) Set forth in a written decision all find-ings of fact and conclusions of law relevant to the matters at issue.
.(c) Provide the SA (ATTN: Army Gen-era1 Counsel), TJAG, and the subject of the hearing a copy of the written decision.
(2) Within 20 days following receipt of a decision, either party may appeal the deci-sion to the SA. The SA will base his or her decision on such appeal solely on the record , of the proceedings or those portions thereof cited by the parties to limit the issues.
(3) If the SA modifies or reverses the ini-tial decision, such findings of fact and con-clusions of law as are different from those of the hearing examiner will be specified in writing.
(4) The decision will inform any person found in violation of 18 USC 207 (a), (b), or (c), or implementing regulations of his or her right to seek judicial review of the ad-ministrative determination.
n. Administrative sanctions. The SA will take appropriate action in the case of an in-dividual found in violation of 18 USC 207(a), (b), or (c), or implementing regula-tions. This action may be taken based upon a final administrative decision or a failure to request a hearing after receiving adequate notice. This action may i n c l u d e
(1) Prohibiting the individual from mak-ing, on behalf of any other person except the United States, any formal or informal appearance before, or, with the intent to in-
@/; fluence, any oral or written communication to, the DA on any matter of business for a
period not to exceed 5 years. This may be enforced by directing officers and employees of the DA to refuse to participate in any
will be reviewed by an Ethics Counselor on the staff of the Commanding General, USAFAC. to ensure com~liancewith a ~ ~ l i -
such appearance or to accept any such communication.
(2) Taking other appropriate disciplinary@ action. o. Judicial review. Any person against
whom the SA imposes an administrative sanction may seek judicial review of the ad-ministrative determination.
5-8. Retired Regular Army officers a. Prohibitions. Appendix B contains a
digest of laws relating to conflicts of inter-est. Many of these are applicable to retired Regular Army (RA) officers. In other words, as an officer whose employment has ceased, he or she may not-
(1) Engage in the prohibited activities listed in paragraph 5-3 (18 USC 207).
(2) At any time, assist in prosecuting a claim against the United States involving any subject matter with which he or she was directly connected while on active duty (18 USC 283).
(3) Within 2 years after retirement, assist in prosecuting a claim whichrinvolves the Department in whose service he holds a re-tired status (18 USC 283).
(4) At any time, sell anything other than his or her own services to the Department in whose service he or she holds a retired status (18 USC 281). This permanent re-striction extends to sales to NAF activities that are under the joint control of the Army and some other agency. An example of such an activity is the Army and Air Force Ex-change Service.
(5) Within 3 years after retirement, sell supplies or war materials to any agency of DOD (including NAF activities), theCoast Guard, the National Oceanic and Atmos-pheric Administration, or the Public Health Service. (See 37 USC 801(b), as amended 9 October 1962; P35Pub.L. No. 87-777.)
(6) Accept any present, emolument, of-fice, title, or employment from any foreign government without the consent of the Con-gress. (See Art 1, sec 9, cl 8 of the US Con-stitution.) Requests for approval of employment by a foreign government should be processed under AR 600-291. The penalty for a violation is loss of retired pay. This prohibition does not apply to em-ployment by international agencies such as the United Nations.
b. Required statement of employment. Each retired RA officer will file a DD Form 1357 (Statement of Employment) (fig 142)-with the Cdr, USAFAC, ATTN: FINCM-DB, Retired Pay Operations, Indi-ana~olis ,IN 4 6 2 4 9 - w
. . 1536
witiin 60 davs after retirement. DD F E 1357 will be ievised within 30 days after the information in the previous statement has ceased to be accurate. If the retiree is em-
@ ployed by the Federal Government, a copy of the SF 50. Notification of Personnel Ac-
5-9. Employment in DOD The Dual Compensation Act of 1964 pro-hibits the employment of any retired mem-ber of the Armed Forces in the DOD (including NAF instrumentalities (NAFIs)) within 180 days following retirement (5 USC 3326) unless-
a. The appointment is authorized by the Secretary of a military department or his designee and, if appropriate, by the OPM;
b. The minimum rate of basic pay for the position has been increased under 5 USC 5305; or,
c. A state of national emergency exists.
5-10. Report of DOD and defense-related employment
a. Requirements for reporting defense-re-lated employment are specified in AR 600-47. The report (DD Form 1787 (Re-port of DOD and Defense Related Employ-ment as Required by H+++H~10 USC 2397)) is required by certain former and re--tired military officers, former civilian of-ficers, and employees of DOD presently employed by defense contractors, and for-mer civilian officers and employees of De-fense contractors presently employed by DOD. Failure to file DD Form 1787 is pun-ishable by a maximum of 6 months impris-onment, or a fine of not more than $1,000, or both. DD Form 1787 should be filed with H Q D A (DACF-ISRV), ALEX VA 22331-0522.
b. These reporting requirements are in addition to-
(1) The DD Form 1357 required from re-tired RA officers (see para 5-86).
(2) The DD Form 1555 required of cer-tain DA personnel by chapter 3 of this regulation.
(3) The SF 278 required of certain DA personnel by chapter 4 of this regulation.
-tion, will be submitted with DD Form 1357. If the DD Form 1357 discloses that the re-tiree is employed by a DOD contractor, it
25 SEPTEMBER 1986 UPDATE AR 600-50
SUMMARY OF POSTEMPLOYMENTRESTRICTIONS
Applicable t o all officers and civilian employees:
If you were a Government officer or employee (including a special Government employee), you may not-
Duration Activities prohibited Governmentrepresentative Subject matter
Ever- represent another in any formal or any Government entity, officer, or any particular matter involving specific \
informal appearance before or, with employee regard~ng- parties in which you ever participated intent to influence, make any oral or personally and substantially for the written communication on behalf of Government (18 USC 207(a)). another to-
Within 2 years after represent another in any formal or any Government entity, officer, or any particular matter involving specific termination of Informal appearance before or, with employee regarding- parties which was pending under your official responsibili- intent to influence, make any oral or official respons~bilityin the last year of ty- written communication on behalf of Government employment (18 USC
another to- 207(b)(i)).
Applicable only t o "senior employees":
If you held an Executive Level position or a military grade above 0-8, or if your 0-7, 0-8, GS-1 7, GS-18, or SES position was specifically designated by the Office or Government Ethics (in 5 CFR 737.33) as having significant decision-making or supervisory responsibility, you may not-
Within 2 years after represent, aid, or assist in representing any Government entity, officer, or any particular matter involving specific ceasing to be a another by your personal presence at employee regarding- parties in which you participated "senior employ- any formal or informal appearance personally and substantially for the eel'- b e f o r e Government (18 USC 207(b)(ii)).
Within 1 year after represent anyone, even yourself, in any the Army or any Army officer or any particular matter pending before ceasing to be a formal or informal appearance before employee regarding- the Army or in which the Army has a "senior employ- or, with intent to influence, make any direct and substantial interest (18 USC eel'- oral or written communication to- 207(c)).
PENALTY FOR VIOLATION of any of these four restrictions is a $10,000 fine, 2 years in prison, or both
Exceptions:
1. These restrictions do not apply to communicat~onssolely for the purpose of furnishing scientific or technological information, or when the Secretary of the Army certifies that the former officer or employee has outstanding scientific or technological qualifications and that the national interest would be served by his or her participation in a particular matter.
2. The final (1 year) restriction does not apply to official contacts by an elected State or local official or by certain employees of State or local governments, universities, and hospitals.
Additional restriction on Presidential appointees:
; If, while a Presidentialappointee, you participate as "a primary Government representative" in the negotiation or settlement of a Government contract, then for the next 2 years, you may not accept employment with the contractor you dealt with (Pub. L. 99-145, 921).
PENALTY FOR VIOLATION of this restriction is a $5,000 fine, 1 year in prison, or both.
Report of DOD and Defense-related employment (DD Form 1787):
1. Any former or retired military officer who had at least 10 years of active service, held a grade of 0-4 or above, and who, within 2 years after leaving active duty, is employed at an annual pay rate of at least $25,000 by a defense contractor that was awarded at least $10 million in DOD contracts in the fiscal year in which employed, must file DD Form 1787 with HQDA (DDAG-LRA), Washington, D. C. 20310 (10 USC 2397).
2. Any former DOD civilian official or employee (including a consultant or part-time employee) whose pay rate at any time during the last 3 years of DOD employment was at least equal to the minimum rate for GS-13 and who, within 2 years after pcgforming civilian service for DOD, is employed at an annual pay rate of at least $25,000 by a defense contractor that was awarded at least $10 million in DOD contracts in the fiscal year in which employed, must file DD Form' 1787 with his last servicing civilian personnel office (10 USC 2397).
3. DD Form 1787 must be filed not later than 90 days after beginning the employment relationship with the contractor. Another report must be filed each time, during the 2-year period, that the person's job with the contractor significantly changes or he or she commences new employment with another affected contractor. These additional reports must be filed within 30 days of the change of employment. Failure to file is punishable by a $1,000 fine, 6 months in prison, or both.
Figure 1-1. Summary of postemployment restrictions
25 SEPTEMBER 1986 UPDATE AR 600-50
SUMMARY OF POSTEMPLOYMENT RESTRICTIONS-(Continued)
Additlonai restrictionsapplicable to Retired Regular Army officers:
If you are a Retired Regular Army Officer, you may not-
Duration
Ever-
Activities prohibited ~overnmentrepresentative Subject matter
Prosecuteor assist in prosecuting any any Government entity, officer, or any matter with which you were directly claim against the U.S. Government employee regarding- connected while on active duty (18 before-- USC 283).
Within 2 years-- Prosecuteor assist in prosecuting any claim against the U.S. Government involving the Army before--
Ever- Representanother in connectionwith selling t o -
Within 3 years after engage in selling, or contracting or retirement- negotiating in connection with the sale,
t o -
any Government entity, officer, or employee regarding-
the Army or an Army nonappropriated fund activity-
any Departmentof Defense agency, including the militaly departments and all DOD nonappropriatedfund activities-
any matter whatsoever (18 USC 283).
anything, either goods or services (18 USC 281).
any tangible property (but not personal or professional services) (37 USC 801(b)).
Penalty for violation of the first three restrictionsabove is a $10,000 fine, 2 years in prison, or both. Penalty for violation of the last restriction is forfeiture of retirement pay for the period of the violation or the duration of any resulting contract (but not more than 3 years after retirement).
Additional report required of all retired officers:
All retired Army officers are required to file DD Form 1357 (Statement of Employment) with CDR, USAFAC, ATTN: FINCM-DB, ~ndkina~olis,IN 46249-1536 within 60 days of retirement. See AR 600-50, para 5-8b for procedures.
Figure 1-1. Summary of postemployment restrictiondontinued
25 SEPTEMBER 1986 UPDATE AR 600-50
L
STATEMENT OF EMPLOYMENT (Regular Retired Officers)
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY : 37 U.S.C. 801 ( c ) and 5 U.S.C. 5532
PRINCIPAL PURPOSES: Information is required from retired regular officers to enable Department of Defense personnel t o determine whether such officers are engaged in activities prohibited by law or regulation. including those that could result in the loss of retired pay or a reduction in retired pay due t o other Federal employment.
IROUTINE USES : The information supplied on this form is forwarded t o the Military Department in which the individual holds a retired status and is appropriately reviewed t o assure compliance with applicable statutes and regulations. I
DISCLOSURE: Disclosure of the requested information is voluntary in the sense that no criminal penalties will follow from failure t o file. However, the information requested by this form 1s requlred t o enable the Depart-ment of Defense to implement 37 U.S.C. 801 (c) and 5 U.S.C. 5532. If the information is not provld-ed, further investigation will ensue whlch may lead to the withholding of retlred pay and the referral of the matter to the Comptroller General of the Un~tedStates o r other Federal agencies.
I
1. I am a regular retired officer of the US ARMY .and was retired on 2 N Y 1984 (Department) " (Date )
2. 1 am am not employed. (If employed. o r self employed. complete the rest of this item; if more than one employer,I list complete information for each employer on a separate sheet) I
I a. My employer's name and address is
FORD AEROSPACE, 2700 SKYLINE BLVD PAIX) ALTD, CA 80010
I b. My employer sells, o r offers for sale, t o agencies (including nonoppropriated fund actiuities) of the Department of Defense, the Coast Guard, the National Oceanlc and Atmospheric Administrat~on,or the Public Health Service. the follpwing types of products or services: 1 3. If item 2.b is answered in the affirmative, complete this item: 1
I a. My position title is CONSULTANT I I b. My duties are, briefly (a complete description of your job, a copy of your employment contract, or any other pertinent
information, may be attached): I 'IQ DETERMINE THE WEXPONS SYSTPiS NEEDED BY THE ARMY I N THE FUTURE.
c. My duties include one or more of the following activities in regard to an agency specified in item 2.b:
( 1 ) signing a bid, proposal, or contract. ( 2 ) negotiating a contract, ( 3 ) contacting an officer or employee of the agency for the purpose of (i) obtaining o r negotiating contracts, (ii) negotiating or discussing changes in specifications, price, cost allowances, or other terms of a contract, or (iii) settling disputes concerning performance of a contract, or ( 4 ) any other liaison activity with a view toward the ultimate consummation of a sale even though the actual contract therefor is subsequently negotiated by another person.
a No @ Yes (Ifanswered in the affirmative. attach explanatory details) -- ~-I 4 . I have received a copy o f DoD Directive 5500.7 or the regulation issued by my department implementing that D i r e c i r l
I 5. 1 will file a new Statement of Employment within 30 days after the information is this Statement has ceased t o be accurate. I understand that i f I have been retired for less than three years and have been employed by a defense contractor, I might also be subject to the requirement to file a Report o f DoD and Defense Related Employment (DD Form 1787) pursuant t o 5 0 USC 1436 and DoD Directive 7700.15. I
I I FORM 1357 REPLACES D D F O R M 1357, 1 M A Y 6 3 A N D D D F O R M 1357(PAS) , 2 6 SEP 75. W H I C H ARE OBSOLETE.DD 1 JAN 77
S I G N A T U R E P d s,N A M E (Typed or printed)
PAUL Q. JONES
Flgure I-*. Sample of a completed DD Form 1357
25 SEPTEMBER 1986 UPDATE AR 600-50
D A T E
4 MkY 1984 F I LE/SSN
345-67-8920
IF AODITIONAL WAC€ IS II€OUIRED. US& .LCAIIAT€ SUE€T AND INDICAT€ ITEM UUYO€II
I CONFIDENTIAL STATEMENT OF AFFILIATIONS AND f lNANClAL INTERESTS DEPARTMENT OF DEFENSE PERSONNEL
l lNCLUDlNC SPECIAL GOVERNMENT EMPLOYEES1
DATA REQUIRED mv THE CRIVACV ACT w n?r AVTHORITY ln formal~onIS w l ic i lcd ~n t h~aSla lcmml u n d n the aulhoroly of, E x t c u ~ ~ v eOrder 11222.
IPRINCIPAL PURPOSE Informatson IS requorrd l rom c a u # a a r o f DoD pcrwnnt l s p a ~ f i t dIn DoD D m c t l r r 5500 7. Srcllon XIX or ~mpl rmenl lngr t g u b l ~ o nl o en able suprrvors and other resporulblr DoD olfbcds l o dewrmone wht lhr r l h t r r I r e actual or apparent c o n f l ~ c uu l mntrrrsl I,rlwten lhe 6ndur1 dual's p r t u n l and prapectwr olf~cnmldu11.s and non Federal affil~ml~onsor lbnancnal l n l t r n u
1 ROUTINE USES Thts onform.lton ahall br treated as conf idcnt~de ~ c c p tu delermnncd by the component head conn rn rd or Lht Cbvzl Strvlcr Commtulon I
I 1 JUNE 1984 I USARMY 1
DISCLOSURE Fllong 1. voluntary un the acnu that no cr lm~nalp t n a l l t r w l l l o l l o r *om r t f i t u l to f ~ l r Howrvtr the r c fuv l l o provndc r t q u n l c d ~n lo rma tnon m y r a u l t ~n such m t u u r a a1 supenston o r conm~d~ra l~onfor appo~ntmtn l .rewbgnmtnt o f dut~rs.daactpl~naryactton or termlnallon of nnp loymrn l
CART I TO BE COWlETED I V SECTION XIX OF W D OIIIFCTIVI
5 NON FEDERAL AFFILIATIONS AND FINANCIAL INTERESTS I'hc In urn of apouv, mmor chlld. and an) member o f your h o ~ u h o l dshall b r repor l ld I n the u m e manner u your nnlcrrau L u t the namrr o f all corpora bonm, f i r m , parlntr.hop, and olher b w ~ n t vtnlerpnw8, n o n p m l ~ lor(.n#u Iaoru. and rducaloond, or olher ~n. t~ lu t~onr(a) with whlch you u c (or 81na lul foltnl r a t ) .ffiI~attd u an employee, olf tctr. owner, dnrrctor mcm brr. l r uaw . pu1n.r. a d r ~ u r .agent, r e p r e u n t a l ~ r ~ .or consullml. or u a per .on on 1r.v. l r om o r havtng m y undenlandung or plaru for future a f f~ l ra t~on. (b) In whlch you hare m y conunuons financsal ~ntrrtsla.such u lhroush a p M l O n or rrttrem.nl plan, rkamd Income, conttnuang t r rm~na t~onpaymtnu. or oUer uran#emtnl u a result o f any currcnl or prtor employnun1 or bual n * r or p ro l r u~ona lusocmtlon. or (c ) an whach you have any hnmnc8.l I n l t r al thmugh Ihc legal or benefic~al owner.h~p of stock stock opl~ona,honda. rcunlmrm, or o l h a anangtmcnts ~nc lud~ngl rusu Idcntafy any financnal
I NAY€ (-1 I an1 rnlddl, on#l- l l
ANDERSON, JOHN K 1 DATE OF APPOINTUINT TO PRESENT POSITION
THON 000 CERK*IN€L INDICATE0 IN 1 5600.7 OII IYLLYENTING REGULATlOll
m t c r a u tn cornmod~t~csrhoch you hare had '!"re lul fnlln( I 1 none. wblr1 "None"
I TITLE 01 POSITION
POST E N G I N W , 25th INFANTRY DIVISION 4 0 0 0 COMPONENT AN? MAJOR ORGANIZATIONAL SEGMENT
Assu~atnon. ~ 8 t h .or ~ n t t r a uIn. a proleutonal chantable, rcl~poua.-ml. fraurnal rccrralaonal. publlc urr lce. ctrsc, dr po l t l#cdorgan.zallon no1 con ductrd for prof11and whmh u no1 tngagtd ~no w n t n h ~ por conduct o f a buun.u for prof41 IS not rtquartd Educat~onaland other ~ n a l ~ l u l ~ o r udoan# revarch and dt*dopmcnl or rt latcd work ~nro l r [email protected] from or conwacu w ~ t ht h t Gorernmtnt mtt l o b t oncludtd un l h u report
Amounls of f~nancualnmcreau n e d not b t r cpw t td u n l t u aprrtfically r c q u d ed by the Slandmrds o f Conduct Counv lor o r Drpu ly Counwlor For rc qulrrd mnlormal~onnot known l o you but known lo anothrr pmon, you are r cqu~ r tdl o r r q u t a 11s submuanon on your b h a l f
.
6 CREDITORS Lmr all crtdators other than tho* provodnng arm* l t n l t h . cunvent~onalloans 18" rustornary runmrrcn.1 term. I f nun*. r r v l r "NONE " .---- -- -.--- .----- -.-
- -7- MATUII OF 0E.T 1I...-,d b r m - # , I # S I C I
NAN AND r l u o OF ORGANIZAIION
AT&T 1 NTiMYtRX, NEMYORK
POS1110N OR AFFILIATION tH~lll01 ~nl.nd..llADORES1
1 I I FORM R E P L A C E S D D F O R M S 1 5 5 5 A N D 1555-1, 1 M A R 66. O D F O R M S 1555 (PAS) A N D 1555*1(PAS). 26 SEP 75.
NATURE OF FINANCIAL INT€R€ST t \ I o c b p r ~ l rb u 0 l l . l lnco-.
"".,a" .b I
MBR, B D O F D I R
WIUIAM ANDERSON, CHICAGO IUINOIS
Figure 1-23. Sample of a completed DD Form 1555
25 SEPTEMBER 1986 UPDATE AR 600-50
SALARY, STOCK OWNER
PEXSONAL IDAN
Figure 142. Sample of a completed DD Form 1555--Continued
MATU~I oc I M T ~ ~ ~ * T (Om-@. mu-. I** ' u n l u a l m a , rc I
OWNER
25 SEPTEMBER 1986 UPDATE AR 600-50
rrm or r r o r t n r v la-" *.I*#. -(.rm.hm. .M*'vhl.d W .* I
APARTMENT BUILDING
AOWSU
4 3 2 C o y o t e A v e , Kil leen Texas
6 INFORMATION REQU-D PROM OTHER ?CRI)ONS I f any mf~orrmlnmr KI ht wppl rd hy 0th- pmm f r #. t w t n . attom,. r c a n m t . nbbu ) . I a k u M R ~md a d e r r of m~chpnon. d.U on r h k h m u raqwlcd mtt~rmat~am.and whpcl mallrr ~ n w l w d I f none, m w "NONC"
NAY* AN0 AOOIESS
NONE
-
OAT* 01 1lOUEST WUSCT YATTI1
PART I1 . A#HTIOIYAL INFOIIMATIOU TO BE FURNISMED ~ W L VaY 'WFiCIAL QOVERWYENT EYLOVEEI" (TenPonr* or put hne "dlunbr comlt*nla" u pnuntud m kcrlrrn 111C u l U I D fir SJOO 7 w rmpbmrn l~yr r y b t n n )
9. eembWE THC NUMBER OF DAYS ON WHICH SERVICES ARE EXFWTED '1D BE PERFORMED
warn r w ~ o v ~ m om o c o u m m r m ~
L NUYIS~ 01O A ~WOIRIO POI) 000 WIIMO THE aa* OATS *1~CLOINOOAT€ 01 WIIIENT ACPOINTUINT
b WIT* OTWEI VEOSIAL AOCNCI~S < WY 01 ANO 8
.NUYD~IQ01OAVS wonuto r o n EYLOTIMG m o c w m m t ~ ~WIING THE Y oAva CIIICIOIMO OAT@01 CUIlENT AUOINTYENT
10 n D E R A L OOVCRNMENT EMPLOYMENT l a 1 all u t lm DUD Compnrnb and P t d m l .(enem m r h ~ c hyou a n p m n l l y rmpluyd I f n a u m w "NONE"
COUCONINT 01A0ENCV AN0 LOCATION - TITLE 01 RIND 01 COIITION - -,
Id f y a 1 clu alaUn.nU Ih a n m& a n true, compble. and car rc l l o l h t ha1 of my knu r l r dp n d br lr f . n d th.1 1 haw ndand urdrnund ch.c o l a of b D brutin5600 1 r ~mpbrmntrdby my mnp(oy~n#b D h p o a r n t ' s ~ l a m m
. ACrOlNTlEMT CCIIOO . F .m TO
HON4TU1f
JOHN K ANDERSON
€STIYATIO MUYmIIQ 01DAV*
OATS
3 OCTOBER 1 9 8 4 I)
mmnvmon%m*LU*nm (.Cr r . w k , r n I ur UuU Ula 5IOO 7 r 1mpblmf l .y nmhlbml
1h.nmlmd lha a h 8Ulemml In lqht of lhr p n r n l and p a p t o v r dutm of tht lndlr~drulLO ewurr that W h actual and appnnt conI lrU of u- am ..dW Y y m l u m l b n u
0 No affUIIIWomtfinmcu) ,n-..(l nporvd
0 Re- rmIinthl f inancul tn-s a n unnlatcd to u l n r d or -brt du-. and no connrts a p p u Lo "mi
k Y @ W d d u l k npuwr m.(#c#p.tlon In malLm ~nvolvnqa rhach may ~n.d.r lht f d l o r ~ n #npor(rd amlu lml f inam~al~ n l e r n uIhr -I lk lo r a-1 con.
nyl will b. -Id by Ckw ~n-nod d u W . Dm*~tund the anler-u and n l r f of tncumbml from all didd u i n p.ndmn# d i m m .
0 D*puml~frat~m. Olhm f*=p*rn) A copy or sry d r w t u a l W Nola* of compbtrd cometan r t m n -111 f d b r
a Tlm fd lonnn nponcd atYilut~onlfinanculan-- .n nhtd to v b # n r d a - m . r dub., but have k n &urmsnd by ih.-male app in l l r l dlWl
LO b. no( w wbunua l u l o d f c l the ~ntw#rlly01 lhr ~ndlv~drul'amm
A copy of that f a n r l drlmnmmuon and rmt~mbt1s aluchrd
0 Th.prapcllu*mployw'. du l ls r t l l r tqu ln pr l tc lpbon In mallen lnrolnnl thr f o l b r u q -d a f f~ ln t~on l f inncu lInl tmU. and th. a-n-1 -.ol
b. co l lvnrmr ld uncll d ~ v u ~ t u nof thn. b rompk(.d C1INT 01 T T U NAY€ AN0 TITLE
GEORGE B SMITH, BG, C h i e f of Staff 01TE
5 OCTOBER 1984 LLOI)I#- COUYILLO(I n#VlRI l r r ,.r&-.-3 .I U I D Dlr (tap 7 .r r u c r m l h u rmhl-1
h duly & m g ~ ( d cov rv l l a lor Deputy Courulkr) . IIun rxamnrd lh* tonpin# M.lemnt and Cva l ru th
Im a r WIU ~ 1 .mupwv*O..a r m ~ u m t m
a Ido a4 corrur d l h l h t upwvuor'a waluaum and nconmnd t k fdlor ln# r U o n
-SlONAtUIIS
B. G. ORTAP COL, JAGC '
OAT* 6 OCTOBER 1 9 8 4
Priv
acy
Act
Sta
tem
ent
The
Eth
ics
in G
over
nmen
tAct
of
1978
,as
amen
d-ed
. 5 U
.S.C
. App
. 52
01 e
t seq,r
equirest
he r
epor
t-in
g of
this
inf
orm
atio
n. T
his
info
rmat
ion
will
be
revi
ewed
by
Gobrn
mento
ffici
als
to d
ete
hin
e cd
m-
plia
nce
wah
app
licaM
e F
eder
alla
ws
and
regu
latio
ns.
and
the
repo
rt m
ay b
e di
sclo
sed
upon
requ
est t
o an
y re
ques
ting
pe
m pu
nuan
t to
sect
ion
205
of th
e A
ct
or a
s ot
herw
ise
auth
oriz
ed b
y la
w. Y
ou m
ay in
spec
t ap
plic
atio
nsfo
r re
view
of
your
ow
n fo
rm u
pon
re-
ques
t. K
now
ing
or w
illfu
l fai
lure
to ti
le o
r re
port
in-
form
atio
nre
quire
dto
be
repo
rted
by s
ectio
n 20
2 of
th
e A
ct (
or f
alsi
ficat
ion)
may
sub
ject
you
to
a c
ivil
pena
lty o
f not
mor
e th
an $
5,00
0 an
d to
dis
cipl
inar
y ac
tion
by y
our e
mpl
oyin
g ag
ency
or
othe
r ap
prop
ri-at
e au
thor
ity. K
now
ing
or w
illfu
l fal
sific
atio
n of
in-
form
atio
n re
quire
dto
be
filed
by
sect
ion
202
of t
he
Act
may
als
o su
bjec
t you
to c
rimin
al p
rose
cutio
nun
-de
r 18
U.S
.C. 5
1001
. lea
ding
to a
fine
of
not m
ore
than
$10
.000
or
impr
ison
men
t for
not
mor
e th
an fi
ve
year
s or
bot
h.
I. In
trod
uctio
n S
cope
of
Di~
loru
ra
. T
he e
dent
of th
e re
port
ing
requ
irem
ent i
s no
ted
inea
ch s
ched
ule.
The
app
licab
le re
port
ing
perio
ds
and
a d
escr
iptio
nof w
ho m
ust c
ompl
ete
each
sch
ed-
ule
and
part
are
desc
ribed
on
page
1 o
f th
e fo
rm.
In a
dditi
on to
yw
r se
para
te fi
nanc
ialin
form
atio
n.
you
are
requ
ired
to r
epor
t in
form
atio
nco
ncer
ning
yo
ur
spou
se a
nd d
epen
dent
chi
ldre
n in
sev
eral
sc
hedu
les
of t
he f
orm
. H
owev
er, n
o re
port
is r
e-qu
ired
with
res
pect
to y
our
spou
se if
he
or s
he is
liv
ing s
epar
ate
and
apar
t fro
m y
ou w
ith t
he in
ten-
tion
of te
rmin
atin
g th
e m
arria
geor
pro
vidi
ngfo
r per
-m
anen
t se
pa
rate
. In
addi
tion.
mre
port
is re
qu
ira
w
ith r
espe
ct to
any
inco
me
or o
blig
atio
nsof
an in
-di
vidu
al a
risin
g fro
m t
he d
isso
lulio
n of
a m
arria
ge
or th
e pe
rman
ents
epar
atio
n fro
m a
spo
use.
The
re
are
othe
r ex
cept
ions
to th
e re
port
ing
of a
sset
san
d in
com
e, tr
ansa
ctio
ns, a
nd li
abili
ties
of a
spo
use
or
depe
nden
t child
whi
ch a
re d
iscu
ssed
inth
e in
stru
c-tio
ns a
pplic
able
to th
ose
subj
ects
.
A b
asic
pre
mis
e of
th
e st
atut
ory
finan
cial
dis
-cl
osur
e re
quire
men
ts is
that
tho
se h
avin
g re
spon
-si
bilit
y fo
r re
view
of r
epor
tsfil
ed p
ursu
ant t
o th
e A
ct
or p
erm
ined
pub
lic a
cces
s to
rep
orts
, mus
t be
giv-
en s
uffic
ient
not
ice
by r
epor
ting
indi
vidu
als
in th
eir
repo
rts c
once
rnin
g th
e na
ture
of
thei
r ou
tsid
e in
-te
rest
s an
d ac
tiviti
esso
that
an
info
rmed
judg
men
t ca
n be
mad
e w
ith r
espe
ct to
the
indi
vidu
als'
com
-pl
ianc
ew
ith a
pplic
able
con
flict
of
inte
rest
law
s an
d st
anda
rds
of c
ondu
ct re
gula
tions
.The
refo
reit
is im
-po
rtant
tha
t yo
u ca
refu
lly c
ompl
ete
the
atta
ched
fo
rm. T
his
repo
rt is
a s
afeg
uard
for
you
as w
ell a
s th
e G
over
nmen
t in
that
it p
rovi
des
a m
echa
nism
for
dete
rmin
ing
actu
al o
r po
tent
ial c
onfli
cts
betw
een
your
pub
lic re
spon
sibi
litie
sand
your
priv
ate
inte
rest
s an
d ac
tiviti
es a
nd a
llow
s yo
u an
d yo
ur a
genc
y to
fa
shio
n ap
prop
riate
pro
tect
ions
aga
inst
suc
h co
n-fli
cts
whe
n th
ey fi
rst
appe
ar.
Def
initi
ons
and
Term
s C
ate
go
y o
f A
mou
nt
Rep
orta
blef
inan
cial
inte
rest
s ar
e di
sclo
sed
eith
er
by e
xact
am
ount
or
by c
ateg
ory
of a
mou
nt, d
e-pe
ndin
gon
the
Inte
rest
as
show
n in
the
form
. You
m
ay, b
ut y
ou a
re n
ot r
equi
red
to,
indi
cate
an e
x-ac
t am
ount
whe
re t
he for
m p
rovi
des
for
a ca
te-
gory
of
amou
nt o
r va
lue.
D
epen
dent
Ch
ild
The
ter
m "
depe
nden
t ch
ild"
mea
ns y
our
son.
da
ught
er, s
teps
on, o
r st
epda
ught
er if
suc
h pe
r-so
n is
eith
er: (
i) un
mar
ried,
unde
r age
21,
and
liv-
ing
in y
our
hous
ehol
d, o
r (ii) a
"de
pend
ent"
of
yo
urs
with
in th
e m
eani
ng o
f sec
tion
152
of t
he In
-te
rnal
Rev
enue
Cod
e of
195
4.
Val
ue
The
term
"va
lue"
gen
eral
ly m
eans
a g
ood
faith
es
timat
e of
the
dol
lar
valu
e if
the
exac
t val
ue i
s ne
ither
kno
wn
nor e
asily
obt
aina
ble
by y
ou. W
hen
valu
ing
asse
ts, y
ou m
ay u
sea
num
ber o
f met
hods
in
add
ition
to a
aoo
d fa
ith e
stim
ate.
The
se a
re
spec
lflca
lly s
et i
ort
h I
n th
e In
stru
ctio
ns
unde
r S
ched
ule
A
Re
latlv
e
The
term
"re
lativ
e"
mea
ns a
n ln
dlvl
dual
who
IS
your
fat
her,
mot
her,
son,
dau
ghte
r, br
othe
r, s
ls-
ter,
uncl
e, a
unt,
grea
t aun
t, gr
eat u
ncle
. firs
t wu
s-In
, ne
phew
, nl
ece,
hus
band
, w
~fe
,gra
ndfa
ther
. gr
andm
othe
r, gr
ands
on,g
rand
daug
hter
,fat
her-
~n
-la
w.M
othe
rin-la
w,s
on-ln
-law
,dau
ghte
r-ln
-law
, br
othe
r-ln
-law
, sl
ster
-ln-la
w,
step
fath
er,
ste
p
mot
her,
step
son,
ste
pdau
ghte
r. st
epbr
othe
r, st
ep
sl
ster
, ha
lf br
othe
r, ha
lf sl
ster
, yo
ur
spou
se's
gr
andf
athe
r or
gr
andm
othe
r or
yo
ur f
lanc
e or
fla
ncee
II. W
ho M
ust
File
a.
Can
dida
tes
for
nom
inat
ion
or e
lecly
to the
office
of P
resi
dent
or
Vce
Pre
side
nt.
b. P
resi
dent
ial n
omin
ees
to p
osm
ons
requ
iring
the
ad-
vice
and
cw
en
t of
the S
ate
, ot
her
than
tho
se
min
ate
d fo
r ju
dici
al o
ffice
or
for a
ppoi
ntm
ent t
o a
rank
in th
e un
ifam
ed services
at a
pay
gra
de o
f 0-6
or
bel
ow.
c. T
he f
ollo
win
g nR
vly
elec
ted
or a
ppoi
nted
offi
cial
s:
The
Pre
side
nt;
The
Vce
Pre
side
nt;
,Om
cers
andenpbye
es(
indudin
gsp
eaalG
cmm
m
en1
empl
oyee
s. a
s de
fined
in 1
8 U
.S.C
. 520
2)
who
se p
os
ilii
are
cla
ss
ii at
GS
16 o
r above
of th
e G
ener
al S
ched
ule,
or
who
se b
asic
rate
of
pay
(exc
ludi
ng"s
tep"
inc
reas
es) u
nder
Om
er p
ay
sch
ed
uk
is e
qual
to
w g
reat
er th
an th
e ra
te fo
r G
S16
(ste
p 1)
(a g
roup
whi
ch in
clud
es a
ll m
em
bers
of
the
Se
ni
Exe
cutiv
e S
ervi
ce);
Mem
bers
of the
unifo
rmed
ser
vice
s w
hose
pay
gr
ade
is 0
7 o
r above;
Offi
cers
or
empl
oyee
s in
any
oth
er p
mnl
on de
tenn
ined
by the
Dire
ctor
of t
heOthce
of G
over
n rn
ent E
rnie
to b
e d
equa
l to
GS
16;
Adm
inis
trativ
e la
w ju
dges
; E
mpk
yees
in the e
xcep
ted
sew
ica
in p
ositi
ons
whi
ch
are
of
a-c
on
fde
nti
i or
po
licy-
mak
ing
cham
cler
, unl
ess
p€6i
lmns
hav
e be
enex
d~
&
ed b
y th
e D
irect
or o
f th
e O
ffice
of
Gov
ernm
ent
Em'i
; The
PlH
mas
ler G
ener
al, the
Dep
uty
Pos
lmaa
er
Gen
eral
, eac
h G
ovem
oc o
f th
e B
aard
of
Gov
er-
norsdtheU.S.PsalServiceanddFmsorem
ploy
eeso
fthe
U.S
.Pos
talS
enri
ceor
Pos
lalR
ate
Com
mis
sion
who
se b
asic
rat
e d
pay
is e
qual
to
or g
reat
er th
an the m
inim
um r
ate
of b
asic
pay
fix
ed f
or G
S16
(ste
p 1)
; an
d The
Dire
ctor
of t
he O
ffioe o
f G
over
nmen
t E
thic
s an
d ea
ch d
esig
nate
d ag
ency
em
its o
fW.
d. I
ncum
bent
officials
hold
ing
posi
tions
ref
erre
dto
in
Sea
ion
lye)
of t
hese
inst
ruct
ions
if they
have
served
61 d
ays
or m
e in M
e pm
ihon
dur
ing the
prec
ed-
ing
cale
ndar
yea
r. e.
%W
in in
diiu
ak
who
per
tam
sgff twrctms
in s
ip
pon
of a
n W
ry
com
mitt
ee c
ompo
sed
in w
hok
or i
n p
an o
f sp
ecia
lGov
ernm
ent e
mpkye
es (see5
.C
.F.R
. 57
34.2
02(h
)).
Ill.
Whe
n to
File
, a.
With
in 3
0 da
ys a
fter
beco
min
g a c
andi
date
for
nom
inat
ion
or e
lect
ion
to th
e of
fice
of P
resi
dent
or V
ice
Pre
side
nt o
r by
May
15
of t
hat c
alen
dar
year
, whi
chev
er is
late
r, an
d on
or
befo
reM
ay 1
5 of e
ach
succ
eedi
ng y
ear
that
suc
h an
indi
vidu
al
cont
inue
s to
be
a c
andi
date
on
such
dat
e.
b. W
ithin
5 d
ays
afte
r th
e tr
ansm
ittal
by
the
Pre
si-
dent
to
the
Sen
ate
of t
he n
omin
atio
n of
an
in-
divi
dual
ref
erre
d to
in
sec
tion
Il(b)
of
thes
e in
stru
ctio
nsor
, prio
r to
tha
t tim
e, a
t any
tim
e af
-te
r th
e P
resi
dent
or
Pre
side
nt-e
lect
has
publ
icly
an
noun
ced
his
or h
er in
tent
ion
to n
omin
ate
the
indi
vidu
al.
c. W
ithin
30
da
ys
afler
assu
min
g a
posi
tion
desc
ribed
inse
ctio
n Il(
c)un
less
such
an
ind
iiw
l ha
s le
ft an
othe
r pos
ition
des
crib
edin
sect
ion
Il(c)
w
ithin
30
days
prio
r to
ass
umin
g th
e ne
w p
osi-
tion,
or
has
alre
ady
filed
a re
port
with
res
pect
lo
nom
inat
ion
for
the
new
pos
ition
(sec
tion
Il(b)
) or
as a
can
dida
te fo
r th
e po
sitio
n (s
ectio
n Il(
a)).
d. N
o la
ter
than
May
15
annu
ally
, in
the
case
of
thos
e in
a p
ositi
on d
escr
ibed
in s
ectio
n Il(
c). I
n
the
even
t suc
h an in
divi
dual
term
inat
es e
mpl
oy-
'
men
t. an
d do
es
not
acce
pt a
noth
er
posi
tion
desc
ribed
in s
ectio
n Il(
c), t
he r
epor
t mus
t be
filed
no
late
r th
an th
e 39
th d
ay a
tter
term
inat
ion,
IV.
Whe
re t
o Fi
le
a. C
andi
date
sfo
r P
resi
dent
and
Vi
P
resi
dent
,with
th
e F
eder
al E
lect
ion
Com
mis
sion
. b.
The
Pre
side
nt a
nd V
ice
Pre
side
nt, w
ith the
Of-
fice
of G
over
nmen
t E
thic
s.
c. M
embe
rs o
f a u
nifo
rmed
ser
vice
, with
the
Ser
v-ic
e S
ecre
taw
con
cern
ed.
d. A
ll ot
hers
, with
the
desi
gnat
edag
ency
ethi
csO
W-
c~
alat t
he a
genc
y in
whi
ch th
e in
divi
dual
is e
m-
ploy
ed o
r in
whi
ch h
e or
she
will
ser
ve.
e. I
n th
e ca
se o
f in
divi
dual
s ap
poin
ted
by o
r to
be
nom
inat
ed b
y th
e P
resi
dent
to p
ositi
ons
requ
ir-in
g c
onfir
mat
ion
of
the
Sen
ate.
se
e 5 C
FR
5734
.604
tc)
lor
expe
dite
d pr
oced
ure.
V.
Gen
eral
Inst
ruct
ions
a.
Thi
s fo
rm c
onsi
sts
of t
he f
ront
pag
e an
d fo
ur
Sch
edul
es. Y
ou m
ust c
ompl
ete
each
Par
t of
all
Sch
edul
es. I
f you
hav
e no
info
rmat
ion
to r
epor
t in
any
Par
t of
a S
ched
ule.
yw
should
indic
ate
"N
one"
. A
repo
rt is
con
side
red
inco
mpl
ete
if an
y P
art o
f an
y S
ched
ule
is le
tt bl
ank.
Sch
edul
e A
co
mbi
nes
a r
epor
t of
inc
ome
item
s (o
ther
than
fr
om c
urr
enl e
mpl
oym
ent
by t
he U
nite
d S
tate
s G
over
nmen
t)w
ith the
dis
clos
ure
of p
rope
rty in
-te
rest
s (g
ener
ally
ref
erre
d to
her
e as
ass
ets)
. S
ched
ule
B d
eals
with
tran
sact
ions
in re
al p
rop
OF
FIC
E O
F P
ER
SO
NN
EL
MA
NA
GE
ME
NT
erty
or
cert
ain
othe
r as
sets
, as
wel
l as
gift
s an
d re
imbu
rsem
ents
. Sch
edul
es C
and
Dre
late
to li
a-
bilit
ies
and
empl
oym
ent r
elat
ions
hips
. Afte
r co
m-
plet
ing
the
first
pa
ge a
nd e
ach
part
of
the
Sch
edul
es (i
nclu
ding
ext
ra s
heet
s of
any
Sch
ed-
ule
whe
re c
ontin
uatio
n pa
ges
are
requ
ired
for
any
part
), c
onse
cutiv
ely
num
ber
all
page
s.
b. T
he in
form
atio
n to
be
disc
lose
d is
onl
y th
at w
hich
th
e E
thic
s in
Gov
ernm
ent A
ct o
f 19
78, a
s am
end-
ed
. and
5 C
FR P
an 7
34 s
peci
fical
ly re
quire
. You
m
ay, h
owev
er, i
nclu
de in
any
sec
tion
of t
he fo
rm
such
add
ition
al in
form
atio
n, b
eyo
ndih
e A
ct's
re
qu
irem
ents
, as
you
may
wis
h to
dis
clos
e fo
r pu
r-
pose
s of
cla
rific
atio
n.
c. c
om
bin
e o
n on
e fo
rrn
the
info
rmat
ion
appl
icab
le
to y
ours
elf,
your
spo
use
and
depe
nden
t chi
ldre
n;
or i
f mor
e co
nven
ient
, use
sep
arat
e sc
hedu
les
to
repo
rt th
e re
quire
d in
form
atio
n ap
plic
able
to fa
- m
ily m
embe
rs. Y
ou m
ay, i
f you
des
ire. d
istin
guis
h an
y en
try fo
r. a
fam
ily m
embe
r by
pre
cedi
ng th
e en
try w
ith a
n (S
) if
it is
for
a sp
ouse
or
a (D
C)'i
f it
pert
ains
to a
dep
ende
nt c
hild
. d.
Def
initi
ons o
f the
var
ious
term
s us
ed in
thes
e in
- st
ruct
ions
and
det
aile
d in
form
atio
n as
to w
hat
is
requ
ired
to b
e di
sclo
sed
are
corlt
aine
d in
5 C
FR
Par
t 73
4.
e. I
n th
e ca
se o
f ref
eren
ces
to e
ntiti
es w
hich
do
not
have
list
ed se
curit
ies o
r are
not
des
crib
ed in
sta
n-
dard
refe
renc
e m
ater
ials
(suc
h as M
oody
's M
anu-
al
s)-w
heth
er
such
ent
ities
are
ope
ratin
g tra
des
or b
usin
esse
s. or
priv
ate
inve
strn
ent p
ools
or o
th-
er p
rivat
e ve
hicl
es (
such
as
IRA
'S) w
hich
are
th
emse
lves
the
med
ia for
ind
irect
fin
anci
al in
- te
rest
s in
trad
es o
r bu
sine
sses
attr
ibut
able
to y
ou
for
purp
oses
of th
e ap
plic
atio
n of
Fed
eral
law
-yo
u m
ust
prov
ide
suffi
cien
t in
form
atio
n ab
out
thes
e pr
ivat
e en
titie
s to
giv
e re
view
ers
of
dis-
cl
osur
e re
ports
an
adeq
uate
bas
is fo
r th
e co
nflic
ts
anal
ysis
requ
ired
by th
e A
ct. T
hus,
exc
ept i
n th
e ca
se o
f priv
ate
inve
strn
ent v
ehic
les
(for w
hich
full
disc
losu
re of
hol
ding
s is
requ
ired)
, you
mus
t dis
- cl
ose
the
prim
ary
trade
or
busi
ness
of p
rivat
e en
- tit
ies,
as
wel
l as
attri
bute
d in
tere
sts
and
activ
ities
no
t so
lely
inci
dent
s! to
suc
h a
prim
ary
trade
or
busi
ness
. For
inst
ance
, if y
our
fam
ily s
wim
min
g po
ol s
ervi
ces
corp
orat
ion
incu
rs a
liab
ility
to p
ur-
chas
e an
apa
rtmen
t hou
se fo
r in
vest
men
t in a
d-
diti
on to
its
pool
serv
ices
bus
ines
s, y
ou w
ill h
ave
to re
port
your
indi
rect
ly a
lloca
Me
shar
e of
the
cor-
para
tion'
s lia
bilit
y, th
e a
patim
ent h
ouse
inve
st-
men
t, an
d its
pur
chas
e, in
add
ition
to th
e ite
ms
you?
.are
requ
ired
to r
epor
t abo
ut y
our
inle
rest
in
the
fam
ily co
rpor
atio
n. Y
ou w
ould
not
, of c
ours
e.
have
to r
epor
t the
da
y-to
da
y tra
nsac
tions
of th
e po
ol s
ewic
es b
usin
ess
nor s
uch
thin
gs as
the
nor-
m
al a
nd c
usto
mar
y te
mpo
rary
liab
ilitie
s it
incu
rs
wlth
its
sup
plie
rs.
1. If
you
need
ass
ista
nce
in c
ompl
etin
g th
ls fo
rm.
cont
act th
e de
sign
ated
age
ncy
ethi
cs o
ffici
al o
f th
e ag
ency
In w
hich
you
ser
ve, w
ill s
erve
or
have
se
rved
.
I. G
ener
al In
stru
ctio
ns
Two
of t
he g
ener
al d
iscl
osur
e re
quire
men
ts of
the
A
ct c
once
rn c
erta
in in
tere
sts
in p
rope
rty (g
ener
ally
re
ferr
ed to
her
e as
ass
ets)
and
ite
ms
of in
com
e.
Sch
eclu
le A
is d
esig
ned
to e
nabl
e yo
u to
mee
t bot
h of
the
se r
epor
ting
requ
irem
ents
. G
ener
ally
a d
e-
scrip
tion
01 yo
ur, y
our
spou
se's
or
depe
nden
t chi
ld's
as
sets
and
sou
rces
of in
com
e is
requ
ired
to b
e lis
t-
ed
in B
LOC
K A
of th
e S
ched
ule.
Rea
ding
from
left
to r
ight
acr
oss
the
page
from
eac
h de
scrip
tion
of th
e as
set o
r in
com
e so
urce
, you
will
be
able
to r
epor
t in
BLO
CK
B th
e va
lue
of e
ach
asse
t, an
d in
BLO
CK
C
the
type
and
am
ount
of i
ncom
e ge
nera
ted
by th
at
asse
t or
rece
ived
from
the
non-
asse
t sou
rce.
BLO
CK
D
is a
que
stio
n de
sign
ed to
lea
d in
cum
bent
s an
d te
rmin
atio
n fil
ers
to S
ched
ule
B fo
r ce
rtai
n of
the
ite
ms
they
hav
e lis
ted
in B
LOC
K A
.
On
Sch
edul
e A
are
two
exam
ples
whi
ch a
re r
ep
re
sent
ativ
e o
f the
rep
ortin
g sc
hem
e o
f thi
s S
ched
- ul
e. T
he fi
rst e
xam
ple
repr
esen
ts th
e P
rope
r met
h-
od o
f re
port
ing
a st
ock
of t
he X
YZ
Com
pany
hel
d by
the
repo
rtin
g in
divi
dual
at th
e en
d o
f the
rep
ort-
in
g pe
riod
whi
ch th
en h
ad a
val
ue o
f W,0
00
. The
in
divi
dual
had
als
o r8
~e
ive
d divi
dend
s of
$1,
500
and
had
purc
hase
d th
e st
ock
durin
g th
e re
port
ing
peri-
od
. Th
e se
cond
exa
mpl
e re
pres
ents
the
pro
per
met
hbd
of r
epor
ting
the
sour
ce o
f $50
,000
of e
arne
d in
com
e fro
m ~
riv
ate
law
ora
ctic
e as
we1
1 as
the
-~
-~
.
.$12
.500
the
repo
rtin
g in
di"id
ual m
aint
aine
d in
the
rived
from
you
r in
com
e, a
sset
s, o
r ac
tiviti
es;
capi
tal a
ccou
nt i
n the
law
firm
at
the
end
of t
he
and
re
port
ing
perio
d. I
f, in
the
first
exa
mpl
e, t
he X
YZ
(iii)
from
whi
ch y
ou n
eith
er d
eriv
e, n
or e
xpec
t to
st
ock
had
been
sol
d ra
ther
than
~u
rch
ase
d, th
ere
deriv
e, a
nv f
inan
cial
or
econ
omic
ben
efit.
-
--
~
. .
beno
entry
in "O
CK
would
'
the
indi
vidu-
al n
o lo
nger
ow
ned
the
stoc
k at
the
end
of t
he re
porb
N
ote:
It i
s ve
ry d
iffic
ult f
or m
ost i
ndiv
idua
ls to
mee
t
line
to th
e rig
ht. H
owev
er, w
hen
you
have
a n
um-
ber o
f diff
eren
t kin
ds o
f fin
anci
al a
rran
gem
ents
and
trans
actio
ns i
nvol
ving
one
ent
ity.
a fu
ll di
sclo
sure
of
all
the
requ
ired
info
rmat
ion
for t
hat e
ntity
may
re-
quire
mor
e th
an o
ne li
ne. Y
w m
ay a
lway
s us
e m
ore
than
one
line
for
cla
rif~
catio
n if yo
u ch
oose
.
Not
e: S
peci
fic re
gula
tions
for t
he re
port
ing
of in
ter-
es
ts i
n p
rope
rty a
nd i
ncom
e ar
e fo
und
in
5 C
FR 7
34.3
01(a
) and
(d)
.
II. P
rope
rty
Inte
rest
san
d A
sset
s (B
LOC
KS
A a
nd
B)
A.
Item
s to
Rep
ort
Rep
ort t
he id
entit
y an
d ca
tego
ry o
f va
luat
ion
of
any
inte
rest
in p
rope
rty (
real
or
pers
onal
) he
ld b
y yo
u, y
our sp
ouse
or a
dep
enda
nt c
hlld
, In
a tr
ade
or b
usin
ess,
or f
or
Inve
stm
ent or
the p
rod
uct
ion
o
f In
com
e w
hich
ha
s a
fair
mar
ket v
alue
whi
ch e
x-
ceed
s $1
.000
as
of t
he c
lose
of
the
repo
rtin
g pe
ri-
od. T
hese
inte
rest
s in
clud
e, b
ut a
re n
ot li
mite
d to
. st
ocks
, bon
ds, p
ensi
on in
tere
sts
and
annu
ities
, fu-
tu
res
cont
ract
s.
mut
ual
fund
s.
IRA
ass
ets,
ta
x sh
elte
rs.
be
ne
ficia
l in
tere
sts
in t
rust
s.
inco
me-
prod
ucin
g ba
nk a
ccou
nts,
rea
l est
ate,
com
mer
cial
an
imal
s, c
rops
and
col
lect
ible
s he
ld fo
r th
e pr
oduc
- tio
n of
inco
me.
Exc
eptio
ns: E
xclu
de y
our pe
rson
al
resi
denc
e an
d an
y pe
rson
al li
abili
ty o
wed
to
you.
yo
ur s
pous
e or
dep
ende
nt c
hild
by
a re
lativ
e. E
x-
clud
e al
so a
ny d
epos
its a
ggre
gatin
g $5
.000
or
less
in
a o
erso
nal s
avin
os a
ccou
nt in
a s
inal
e fin
anci
al
inst
iiutio
n. A
per
so;;a
~sav
ings
a
&d
uZ
inc
~u
de
ia
cert
ifica
te o
f dep
osit
or a
ny o
ther
forr
n of
dep
osit
in
a ba
nk, s
avin
gs a
nd lo
an a
ssoc
iatio
n, c
redi
t uni
on
or s
imila
r in
stitu
tion.
With
res
pect
to
asse
ts o
f a
spou
se o
r a
depe
nden
t ch
ild, do
not
rep
ort ite
ms:
(i)
whi
ch rep
rese
nts y
our
or d
epen
dent
ch
ild's
sol
e fin
anci
al in
tere
st o
r re
spon
sibi
lity
and
of w
hich
you
hav
e no
kno
wle
dge;
(ii) w
hich
are
not
in a
ny w
ay, p
ast o
r pr
esen
t, de
-
ing
per
iod,
but
ther
e w
ould
be
an e
ntry
for
capi
tal
gain
s as
wel
l as
divi
dend
s in
BLO
CK
C if
they
wer
e re
aliz
ed d
urin
g th
e pe
riod.
Nor
mal
ly y
ou w
ill h
ave
to li
st a
n de
m o
nly
once
In
BLO
CK
A w
ith a
ll ot
her
valu
e an
d In
com
e In
for-
m
atio
n as
soci
ated
with
that
item
sho
wn
on th
e sa
me
all
thre
e pa
rts
of t
his
test
, esp
ecia
lly (i
ii). F
or
inst
ance
, if y
ou fi
le a
join
t tax
ret
urn
with
you
r sp
ouse
, yo
u de
rive
a fin
anci
al o
r ec
onom
ic
bene
fit fr
om th
e ite
ms
invo
lved
and
vou a
re.
----,----
char
ged
wth
kno
wle
dge
of
thos
e Ite
ms
The
refo
re, t
hose
ass
et a
nd in
com
e lte
rns
do
not f
it th
e te
st.
A p
erso
nalr
esid
ence
from
which
no
inco
me
isde
rived
sho
uld
not b
e re
port
ed a
s a
prop
erty
inte
rest
be
caus
e it
is n
ot h
eld
for
inve
stm
ent o
r pr
oduc
tion
of in
com
e. H
owev
er, i
f you
hol
d re
side
ntia
l pro
per-
ty
whi
ch is
use
d lo
r inv
eslm
ent o
r in
com
e pu
rpos
es.
such
as
a su
mm
er h
ome
rent
ed d
uring pa
* of
the
year
, yo
u m
ust r
epor
t tha
t in
tere
st.
In th
e ca
se o
f pe
rson
al p
rope
rty s
uch
as a
ntiq
ue
colle
ctio
ns a
nd r
elat
ed h
oldi
ngs,
the
O
tfice
of
Gov
ernm
ent
Eth
ics
deem
s in
term
itten
t sal
es fr
om
such
a c
olle
ctio
n or
hol
ding
s to
dem
onst
rate
that
th
ey a
re h
eld
for
inve
stm
ent o
r th
e pr
oduc
tion
of
inco
me.
Val
uatio
n M
etho
d Th
e st
atut
e pr
ovid
es s
ever
al m
etho
ds yo
u m
ay u
se
for
dete
rm~
nin
g va
luatio
n:
Opt
ion
1-an
y go
od f
aith
est
imat
e of
the
val
ue o
f th
e pr
oper
ty if
the
exac
t val
ue is
un
km
or
not
eas
ily o
btai
nabl
e;
Opt
ion
2-va
lue
base
d up
on a
rec
ent a
ppra
isal
of
the
prop
erty
inte
rest
; O
ptio
n 3-
the
date
of
purc
hase
and
the
purc
hase
pr
ice
of y
our
inte
rest
; O
ptio
n 4-
the
asse
ssed
valu
e of
the
pro
perty
for t
ax
purp
oses
adj
uste
d to
re
flect
cur
rent
m
arke
t va
lue
if th
e ta
x as
sess
men
t is
co
mpu
ted
at le
ss th
an 1
00%
of
curr
ent
valu
e (if
Opt
ion
4 is
use
d, d
escr
ibe
the
man
ner
in w
hich
you
adj
uste
d th
e as
- se
ssed
val
ue);
Opt
ion
5-th
e ye
ar-e
nd b
ook
valu
e of
non
-pub
licly
tra
ded
stoc
k, o
r th
e ye
ar-e
nd e
xcha
nge
valu
e of
co
rpor
ate
stoc
ks,
or t
he-f
ace
va
lue
of c
orpo
rate
bon
ds. or
com
para
ble
secu
ritie
s;
Opt
ion
6-th
e ne
t wor
th o
f you
r int
eres
t (as
in a
bus
i- ne
ss p
artn
ersh
ip o
r ot
her
join
tly h
eld
busi
ness
inte
rest
); O
ptio
n 7-
the
equi
ty v
alue
of
your
inte
rest
(as
in a
so
lely
ow
ned
busi
ness
or
com
mer
cial
en
terp
rise)
; and
O
ptio
n 8-
actu
al
valu
e (e
.g.,
savi
ngs
acco
unts
) or
anv
recw
niz
ed in
dica
tion o
f val
ue fs
uch
assl
ast s
ale
on a
sto
ck e
xcha
ngej
.
You
nee
d no
t dis
ckse
whi
ch m
etho
ds yo
u ch
ose
un-
less
you
wis
h. T
his
is a
cha
nge
from
prio
r fo
rms.
B. W
hat
to S
how
on
the
Form
E
nter
the
iden
tity
of t
he a
sset
in
BLO
CK
A a
nd
then
sho
w th
e ap
plic
able
val
ue in
BLO
CK
B.
Onl
y
the
cate
gory
of v
alue
, rath
ef t
han th
e a
ctual v
aC
w o
t th
e p
ropert
y In
tere
st o
r aa
aet,
mus
t be
sh
own
For a
saet
a su
ch as
stock
s, b
onds
, and
sec
uri-
ties.
rep
ort a
ny h
oldl
ngs
by
you,
your
spouse
or
do
pe
de
nt c
hild
tom
one
sou
rce
tota
llng
mor
e th
an
$1.0
00 In
valu
e ld
cntlt
y th
e h
oldi
ng a
d sh
ow th
e
Cat
egor
y o
f val
ue.
Whe
n ld
entlt
ylng
shar
es o
f pu
b-
llcly
trad
ed s
tock
s, th
e co
mm
on a
bbre
vlat
lon
of t
he
nam
e of t
he c
orpo
ratlo
n m
ay b
e us
ed I
f yo
u ha
ve
Sto
ck I
nter
ests
thro
ugh
an In
vest
men
t trus
t or
mut
ual
fund
, and
the
hold
lngs
of t
he tr
ust o
r fu
nd a
re a
mat
- te
r of
pu
bl~
c reco
rd, y
ou m
ay-ln
stea
d of
~dentlt
y-
Ing
the
fund
's s
hare
hold
ings-
ldentlt
y yo
ur In
tere
st
by s
lmpl
y gl
vlng
the
nam
e of
the
trus
t or
mut
ual fu
nd
If yo
u ho
ld d
iffer
ent t
ypes
of s
ecur
ltles
of th
e sa
me
corp
orat
lon
(e g
. bon
ds a
nd s
tock
s of
"X
" C
orpc
-ra
tlot?
), the
se h
oldl
ngs
shou
ld b
eco
nstd
ered
as
be-
Ing
from
th
e sa
me
sour
ce
for
purp
oses
of
de
term
lnln
g w
heth
er th
e ag
greg
ate
valu
e of
the
In-
tere
st ts
bel
ow o
r ab
ove
the
$1,0
00 v
alue
To
rep
ort
in
tore
nts
in
a b
usi
ness
, a p
rtn
er-
sh
ip,
or J
oln
t ven
ture
, o
r th
e o
wn
en
hlp
01
pro
p-
ert
y h
eld
tor
inve
stm
ent
or
the p
rod
uct
ion
of
in-,
identif
y th
e c
hara
cter
ot y
our o
wnem
hip
in
tere
st,
and,
unle
ss a
publlc
ly t
raded s
ecu
rity
. th
e n
atu
re a
nd lo
mtl
on
ot
the b
us
lne
~
or
in-
tore
at. T
hus.
In th
e ca
se o
f non
-pub
lcly
trade
d se
cu-
rltle
s, s
how
the
natu
re a
nd a
ddre
ss o
f the
bus
ines
s (In
add
ltlon
to 1
1s n
ame)
For
exa
mpl
e, th
e en
try fo
r a
hold
lng
of f
arm
land
mlg
ht s
how
. un
der
BLO
CK
A
"s
ole
ow
nenhlp
of
100
acre
s of
uni
mpr
oved
da
lry f
arm
land
on
Rur
al R
oute
# 1
at
Pln
e B
luff.
M
adls
on C
ount
y. W
lsco
nsln
"
In th
e ca
se o
f hddln
gs
that
are
ess
entia
lly n
on-
pu
bl~
csuc
h as
pnv
ate
trade
s or
bu
sin
ess
es,
Inve
st-
men
t po
ols
or o
ther
prlv
ate
Inve
stm
ent v
ehic
les.
su
ff~
c~e
nl
disc
losu
re m
ust b
e m
ade
to g
lve
revie
w-
ers
an a
dequ
ate
basl
s fo
r th
e co
nfl~
cts a
naly
sls
re
qu
lred
by th
e A
ct T
here
fore
, you
mus
t dis
clos
e th
e pr
lmar
y tra
de o
r bus
lnes
s of
prlv
ate
entitles, a
s w
ell
as I
nter
ests
and
act
lvltl
es n
ot s
olel
y ln
clde
ntal
to
such
a tr
ade
or b
usln
ess
For
exa
mpl
e. 1
1 you
r fa
- m
lly 1s
lnv
olve
d In
a p
rlvat
e re
al e
stat
e In
vest
men
t bu
sine
ss b
ut a
s a
slde
lnte
resl
buy
s st
ock
thro
ugh
the
busm
ess
In a
ban
k, y
ou m
ust d
iscl
ose
In a
ddl-
tlon
to r
eal e
stat
e. (
by ty
pe a
nd g
ener
al lo
catio
n).
that
the
fam
lly b
usm
ess
hold
s an
Inte
rest
in a
ban
k.
In a
ddltl
on. w
hlle
und
er th
e ge
nera
l rul
es o
f Sch
ed-
ule
A a
n ln
dlvl
dual
who
dire
ctly
hol
ds a
n IR
A (
In-
dlvl
dual
Ret
irem
entA
ccou
nt) w
ould
hav
e to
Indl
Cat
e as
val
ue a
nd th
e In
com
e den
vedtrm
It(e
ven
thou
gh
non-
taxa
ble
for
Fed
eral
mix
me
tax
purp
oses
). w
ith-
out f
urth
er d
iscl
osur
e of
wha
t fin
anci
al in
tere
sts
are
attr
ibut
able
to the
indi
vidu
al b
y vi
rtue
of th
e IR
A, i
t is
not
pos
sibl
e to
eva
luat
e th
e in
divi
dual
's c
ompl
i- an
ce w
ith a
pplic
able
law
s an
d re
gula
tions
. If t
he IR
A
wer
e in
vest
ed so
lely
in a
mut
ual fu
nd s
uch
as "
Tem
- pl
eton
Wor
ld F
und.
Inc
." a
nd th
e in
vest
men
t was
di
sclo
sed
in S
ched
ule
A, t
hat
wou
ld b
e s
uffic
ient
. as
that
fun
d's
port
folio
is d
etai
led
in M
oody
's B
ank
and
Fin
ance
Man
ual a
nd c
ould
be
eval
uate
d. I
f.
how
ever
, the
IR
A w
as p
rivat
ely
inve
sted
, det
aile
d di
sclo
sure
of th
e in
vest
men
t wou
ld b
e re
quire
d on
S
ched
ule
A in
the
sam
e am
ount
of
deta
il as
if th
e in
vest
men
t wer
e dl
rect
ly h
eld
b T
rust
s W
~thr
esp
ect
to tr
ust
s in
wh
ich
a k
ne
tic
ial i
n-
tere
st in
prin
cipa
l or
inco
me
is h
eld,
re
po
rt tr
ust
in
tere
sts
an
d tr
ust
ass
ets
wh
ich
ha
d a
va
lue
in
exce
ss o
t 51,000.
You
nee
d no
t rep
ort t
he ld
entlt
y o
f ass
ets
of a
trus
t of w
hlch
you
are
the
bene
flcla
ry
lf th
e In
tere
st 1
s I
a "q
ualll
led
bltn
d tr
ust"
or
"qua
llfle
d dl
vers
l- fle
d tru
st",
whl
ch h
as b
een
cert
lfled
by
the
Of-
ftce
of G
over
nmen
t E
thlc
s, o
r II an
"ex
cept
ed t
rust
", t
hat
IS, o
ne w
hlch
- A
was
not
cre
ated
by
you,
or
your
spo
use
or
depe
nden
t ch
lldre
n, a
nd
B t
he h
oldi
ng o
r so
urce
s o
l lnc
ome
of w
hlch
yo
u, y
our
spou
se a
nd d
epen
dent
chl
ldre
n ha
ve h
ad n
o kn
owle
dge
In s
uch
case
s. I
n lle
u o
f dl
sclo
slng
the
sour
ce a
nd
asse
ts o
f th
e tru
st,
you
shou
ld s
how
In
BLO
CK
A
the
lden
tlty
of t
he tr
ust l
nclu
dlng
the
date
the
trus
t w
as c
reat
ed. a
nd th
e cl
ass
~f~
cat~
on
of t
he t
rust
In-
te
rest
as
a "q
ualtf
md
Mln
d tru
st",
a "qu
allft
ed d
iver
-sl
fled
trust
", o
r an
"ex
cept
ed t
rust
" A
lthou
gh y
ou
n
ee
d n
ot
rep
ort
th
e i
de
ntit
y of
th
e O
SW
LSo
f a
qu
ali
tW or
exc
ep
ted
tru
st,
the
ca
teg
ory
ot
am
ou
nt o
t the
t~
stlnco
me,
it ile
xce
ed
ed5100,
mu
st h
rep
ort
ed
In
BLO
CK
C
Not
e: Y
ou a
re n
ot p
erm
lned
by
the
stat
ute
to
"cre
ate"
an
exc
epte
d tru
st b
y av
oldl
ng p
re
vlou
s so
urce
s of
kno
wle
dge
upon
ent
erln
g G
over
nmen
t ser
vlce
See
subp
art D
of 5
CFR
P
art 7
34
It 1
s no
t ne
cess
ary
to l
dent
lty th
ose
asse
ts o
f a
trust
of w
hlch
a s
pous
e or
dep
ende
nt c
hild
IS a
ben-
ef
lcla
ry 1
1 the
trus
t m
eets
the
sam
e th
ree
part
test
se
t fo
rth
In th
e fir
st p
arag
raph
und
er IIA
. ab
ove
How
ever
,In
app
lyln
g th
e te
st. 1
1 the
trus
t 1s
one
set
up lo
r the
edu
catio
n of
you
r mln
orc
hild
ren
, you
do
re
ceiv
e a
flnan
clal
ben
efit f
rom
such
a tru
st a
nd m
ust
disc
lose
the
asse
ts u
nles
s it
is a
n "e
xcep
ted
trus
t"
disc
usse
d im
med
iate
ly a
bove
. E
xcep
t for
one
of t
he th
ree
trust
s de
scrib
ed a
bove
, yo
u m
ust i
dent
ify e
ach
indi
vidu
al in
vest
men
t hol
d-
ing
of a
trus
t whi
ch h
ad a
val
ue in
exc
ess
of $
1.00
0.
For
exam
ple,
in B
LOC
K A
an
entry
suc
h as
"tru
st
held
by
Firs
t N
atio
nal B
ank
(Bos
ton,
MA
) con
sist
- in
g of
IT
stoc
k. U
.S. T
reas
ury
certi
ficat
es, a
nd D
al-
las
Mun
icip
al B
onds
" m
ight
be
mad
e. In
BLO
CK
B
the
appl
icab
le v
alue
of
each
lrus
t as
set
wou
ld b
e en
tere
d. (A
nd, a
s de
scrib
ed u
nder
IV B
5. T
rust
In-
com
e, b
elow
, the
inco
me
from
eac
h as
set w
ould
be
ente
red
in B
LOC
K C
as
wel
l as
inco
me
from
ass
ets
of t
he t
rust
sol
d du
rlng
the
report
ing p
erlo
d )
Ill. E
arne
d an
d O
ther
N
on-In
vest
men
t lnc
ome
(BLO
CK
S A
an
d C
) A
. Ite
ms
to R
epor
t Fo
r yo
urse
lf. r
epor
t the
lden
ttty
of t
he s
ourc
e In
B
LOC
K
A
and
amou
nt
In B
LOC
K
C
of
non-
lnve
slm
ent l
ncom
e ex
ceed
ing
9100
, fro
m a
ny o
ne
sour
ce, o
ther
tha
n In
com
e fro
m th
e U
nlte
d S
tate
s G
over
nmen
t for
cur
rent
Gov
ernm
ent s
ervl
ces
Suc
h ln
com
e In
clud
es fe
es, s
ala
ries,
cor
nmls
slon
s, co
m-
pens
allo
n fo
r pe
rson
al se
rvic
es.
pe
nsin
pay
men
ts.
hono
raria
. etc
. Rep
ort t
hese
Item
s on th
e sa
me
llne
as a
ny r
elat
ed In
tere
st In
prop
erty
(11
any)
.
For
you
r sp
ouse
, re
port
the
sour
ce, b
ut n
ot t
he
amou
nt,
of y
our
spou
se's
non
-inve
stm
ent i
ncom
e ex
ceed
ing
$1.0
00 fr
om a
ny o
ne s
ourc
e. N
o re
port
of th
e ea
rned
or n
on-in
vest
men
t inco
me
of y
our d
e
pend
ent c
hild
ren
is r
equi
red.
B. W
hat
to S
how
on
th
e Fo
rm
1 H
ON
OR
AR
IA-M
eans
pa
ymen
t of n
umey
or a
ny-
thin
g of
val
ue to
yo
u o
r yo
ur
spou
se, f
or a
n a
p
pear
ance
. spe
ech.
or a
rtde.
(See
2 U
S.C
54
441
for
full
de
l~n
ltmn
) For
ea
ch h
onor
arlu
m y
ou
rece
lved
In e
xces
s of
$10
0 sh
ow th
e Id
entit
y ot
the
so
urc
e I
n B
LOC
K A
, th
e d
ate
and n
et
am
wn
t In
BLO
CK
C F
or y
our
spou
se. y
ou m
ust
show
onl
y th
e so
urce
of
any
hono
rarlu
m o
ver
$1.0
00 a
nd th
e da
te o
f the
eve
nt fo
r whi
ch It
was
re
ceN
ed L
st e
ach
hono
ranu
m se
para
tely
For
ex-
am
ple.
11 y
ou r
ecei
ved
$1.4
00 f
or a
spe
ech
be-
fore
the
Chi
cago
CIV
IC C
lub
on
Mar
ch 1
9, 1
984,
of
wht
ch $
200
was
act
ually
spe
nt fo
r ro
und-
tnp
trave
l, an
d 52
00w
ent t
o th
e ag
ent w
ho m
ade
the
spea
king
arr
ange
men
t, en
ter
In B
LOC
K A
"C
hlca
go C
IVIC
Clu
b, 1
8 La
kesh
ore
Dr.
Chl
ca-
go.
IL",
In B
LOC
K C
und
er O
THE
R s
peci
fy
"Hon
orar
ia";
un
der
AC
TU
AL
AM
OU
NT
. . .
"$1.
000"
. an
d un
der
DA
TE
. . ."
3119
184"
. If
the
sam
e ite
m o
f in
com
e w
as r
ecei
ved
unde
r th
e sa
me
circ
umst
ance
s by
you
r spo
use,
who
is sen-
empl
oyed
as
a m
arke
ting
cons
ulta
nt. y
ou w
ould
en
ter
in
BLO
CK
A.
. . "
S"
. . . "C
hica
go
Civ
ic
Clu
b, 1
8 La
kesh
ore
Dr..
Chi
cago
. IL"
; in
BLO
CK
C
und
er O
THE
R s
peci
fy. .
. "H
onor
aria
";
unde
r A
CTU
AL
AM
OU
NT
leav
e a
blan
k or
fill
in N
IA; a
nd
unde
r dat
e . .
"311
9184
". H
onor
aria
rece
ived
and
dona
ted
to c
harit
y m
ust b
e re
pw
ed
, bu
t a n
ota-
tio
n ex
plai
ning
that
fact
may
be
incl
uded
in re
porl-
in
g s
uch
item
s.
2. O
THE
R I
NC
OM
E-M
eans
all
inco
me,
exc
lusi
ve
of
hono
raria
. ,,r
ecei
ved
from
no
n-in
vest
men
t so
urce
s in
clud
ing
fees
, com
mis
sion
s, s
alar
ies,
in-
com
e fro
m p
erso
nal s
ervi
ces,
pen
sion
s, e
tc. R
e
port
the
identit
y o
t th
e s
ourc
e a
nd g
ive t
he
'act
ual a
mou
nt o
f su
ch in
com
e.
For
exa
mpl
e.
ifyo
u ea
rned
$45
0 te
achi
ng a
t a la
w s
choo
l, en
- te
r in
BLO
CK
A
. . "J
ohn
Jone
s La
w S
choo
l. R
ockv
ille.
M
D";
in
B
LOC
K
C
unde
r O
TH
- E
R. .
."S
alar
y";
and
unde
r A
CTU
AL
AM
OU
NT
. . .
"$45
0". E
xclu
deIm
mto
talin
g h
than
SlW
tro
m a
ny o
ne s
ourc
e. F
or e
xam
ple.
if y
ou
earn
ed $
75 fo
r te
achi
ng in
one
law
sch
od
and
$1
50 fr
om te
achi
ng a
t ano
ther
sch
ool.
repo
rt on
ly
the
$150
am
ount
.
If yo
ur
spouse
has
ear
ned
inco
me
in e
xces
s of
$1
.000
to
m a
ny o
ne s
ourc
e ld
mti
fy t
he
sour
cebut s
how
noth
ing u
&
mo
un
t. n
your
sp
ouse
-is sel
f-em
ploy
ed in
a b
usin
ess
or p
rofe
s-
sion
, for
exa
mpl
e as
a p
ract
icin
g p
sych
okg
iwho
ea
rned
510
,500
dur
ing
the
year
. yo
u ne
ed o
nly
show
und
er B
LOC
K A
. :. "
prac
ticin
g ps
ycho
lo-
gist
".
-
3. U
PD
ATE
-A
Pre
side
ntia
l nom
inee
to a
pos
ition
re
quiri
ng th
e ad
vice
and
-con
sent
of t
he S
enat
e sh
all f
ile w
ith th
e S
enat
e co
mm
ittee
cons
ider
ing
his
or h
er n
omin
atio
n a
repo
rt w
ttiih
sha
ll up
date
all
item
s of
his
or h
er e
arne
d i
man
d ho
nora
r-
ialh
rwg
h th
e pe
riod
endi
ng n
oea
rlier
than
5da
ys
befo
re th
e sc
hedu
led
date
of t
he S
enat
e co
rnm
it-
tee
hear
ing
on th
e n
om
ina
fin. T
his
upda
te sh
all
be p
rovi
ded
in t
he m
anne
r re
ques
ted
by t
he
Sen
ate
com
mitl
ee c
onsi
derin
g th
e no
min
atio
n.
IV.
Inve
stm
ent
lnco
me
(BLO
CK
C)
~e
kr
titem
s of
inve
stm
ent i
ncom
e on th
e sa
me
line o
f S
ched
ule
A a
s th
e re
late
d B
rOm
rtv i
nte
rm
or o
ther
ass
et fr
om w
hich
suc
h in
k&
id
en
ve
d.
Not
e th
at s
ome
prop
erly
inte
resl
s or
oth
er assets
will
not
hav
e a
rela
ted
item
of
real
ized
inco
me.
In
Suc
h a
case
; ch
eck
"Non
e (o
r le
ss th
an $
101)
" in
B
LOC
K C
und
er c
ateg
ory
of a
mou
nt.
A.
ltem
s to
Rep
ort
Rep
ort t
he id
entit
y in
BLO
CK
A a
nd c
ateg
ory
of
valu
e in
BLO
CK
C o
f an
y in
vest
men
t inc
ome
over
$1W f
rom
any
one
sou
rce
rece
ived
by
you,
you
r sp
ouse
or
depe
nden
t chi
ld. o
r whi
ch a
ccru
ed to
the
bene
fit o
f an
y on
e of
you
dur
ing
the
repo
rtin
g peri-
od. F
or p
urpo
ses
of d
eter
min
ing w
heth
er y
ou m
eet
the
over
St W t
hres
hold
from
any
one
sou
rce,
you
m
ust a
ggre
gate
all
type
s of
inve
stm
ent i
ncom
e fro
m
that
sam
e, s
ourc
e.
Inve
stm
ent in
com
e in
clud
es, b
ut is
not
lim
ited
to:
inco
med
eriv
ed fr
om d
ealin
gs in
pro
pert
y, in
tere
st.
rent
s. r
oyal
ties,
div
iden
ds, a
nnui
ties,
inco
me
froi
n en
dow
men
t con
trac
ts, i
ncom
e fr
om d
isch
arge
(for
- gi
vene
ss)
of d
ebts
ow
ed t
o yo
u, y
our
dist
ribut
ive
shar
e of
par
tner
ship
or j
oint
ven
ture
inco
me,
and
in-
com
e fro
m a
n in
tere
st in
an
esta
teor
trus
t. Y
ou n
eed
not s
how
the
exac
t dol
lar a
mou
nt o
f div
iden
ds, r
ents
an
d ro
yalti
es. In
tere
st, c
apita
l gal
ns. a
nd c
erta
in tr
ust
inco
me.
For
thes
e s
xc
ifii
tMes
of in
com
e m
u ne
ed
only
che
ck th
e ca
tego
ry o
f aho
unt o
f the
Item
repo
rt-
ed F
or a
ll "o
ther
inve
stm
ent ln
com
e" a
s de
scrib
ed
In it
em 6
bel
ow.
you
will
hav
e to
rep
ort th
e ex
act
dolla
r am
ount o
f In
com
e fr
om e
ach
sour
ce.
0. W
hat
to S
haw
on
the
Form
1.
DIV
IDE
ND
S--
Sho
w I
n B
LOC
K C
the
cate
gory
of
the
amou
nt y
ou,
your
sp
ou
w o
r dependent
chlld
rec
eive
d as
dlv
ldends
from
inv
estm
ent
sour
ces
lncl
udln
g co
mm
on a
nd p
refe
rred
secu
- nt
les.
end
owm
ent c
ontra
cts,
and
pen
slon
and
an-
nu
tty fu
nds
lde
ntll
y th
e r
ou
rw o
t such
inco
me
and c
heck
the c
ate
gory
ot a
mou
nt. W
hen
Iden
- tlf
ylng th
e so
urce
of
a co
rpor
ate
stoc
k dl
vlde
nd,
you
may
abb
revi
ate
the
corp
orat
e na
me
For
ex-
am
ple,
11 c
ash
dlvl
dend
s of
$95
0 w
ere
rece
lved
fo
r sh
ares
of c
omm
on s
tock
of I
nter
natio
nal B
usl-
ness
Mac
hine
s, e
nter
In B
LOC
K A
"I
BM
com
- m
on",
and
In B
LOC
K C
che
ck th
at d
lv~
dend IP-
com
e w
as r
ecsl
ved
and
chec
k th
e ap
prop
rlate
ca
tego
ry 6
1 am
ount
2
RE
NT
S A
ND
R
OY
ALT
IES
-Sho
w
Inco
me
re-
ce~
vedb
y yo
u, y
our s
pous
e or
dap
ends
nt c
hild
as
ren
tal o
r le
ase
paym
ents
for o
ccup
ancy
or
use
of p
erso
nal o
r re
al p
rope
rty In
whl
ch a
ny o
ne o
f yo
u ha
ve a
n In
tere
st I
n a
ddltl
on, s
how
pay
men
ts
rece
~ve
dfrom
suc
h In
tere
sts a
s co
pyr~
ghts
, roya
l- tie
s, ~
nven
tlons
, pate
nts,
and
mln
eral
leas
es o
r ot
her
Inte
rest
s Id
entlf
y th
e s
ourc
e o
f su
ch in
- co
me a
nd
che
ck t
he c
ate
gory
of
amou
nt.
For
exam
ple,
if y
ou re
ceiv
ed $
2.00
0 as
rent
al in
com
e fro
m a
n ap
artm
ent
build
ing
in M
iam
i. F
lorid
a,
ente
r in
BLO
CK
A.
. ."a
part
men
t bu
ildin
g, a
t 58
02 B
isca
yne
Blv
d., M
iam
i. FL
". a
nd in
BLO
CK
C
che
ck t
hat
rent
al in
com
e w
as r
ecei
ved
and
chec
k th
e ap
ciro
pria
te c
ateg
ory
of a
mou
nt.
3. I
NT
ER
ES
T-ld
en
tlty
the
so
urc
e
an
d
the
ca
teg
ory
of
amou
nt o
f an
y in
tere
st e
arne
d or
re
ceiv
ed b
y yo
u, y
ou
r sp
ou
se o
r d
ep
en
de
nt
child
as
inco
me
from
inve
stm
ent h
oldi
ngs
incl
ud-
ing:
bill
s an
d no
tes,
loan
s, p
rom
isso
ry n
otes
, an-
nu
ity f
unds
, bo
nds,
and
oth
er
secu
ritie
s. F
or
exam
ple,
if y
ou e
arne
d (b
300
in in
tere
st d
urin
g th
e ca
lend
ar y
ear
on a
Sav
ings
Cer
tific
ate
with
Fed
- er
al-S
avin
gs an
d Lo
an, e
nter
in'B
LOC
K'A
"Fed
- er
al S
avin
gs a
nd L
oan
(Bal
timor
e. M
D)-
Sav
ings
C
ert
ifica
te",
and
in B
LOC
K C
che
ck th
at in
tere
st
inco
me
was
rec
eive
d an
d ch
eck
the
appr
opria
te
cate
go
ryb
f am
ount
. .
4. C
AP
ITA
L G
AIN
S-R
epor
t in
com
e fro
m' c
apita
l ga
ins
rece
ived
or r
ealiz
ed b
y yo
u, y
ou
r sp
ouse
o
r d
ep
en
de
nt c
hild
from
sal
es o
r ex
chan
ges
ol
prop
erty
, bus
ines
s in
tere
sts,
par
tner
ship
inte
rest
s or
sha
red
owne
rshi
p in
vest
men
t int
eres
ts. I
de
n-
tlfy
th
e s
ou
rce
an
d c
he
ck t
he c
ate
go
v.o
f am
ount
of
the
gain
. An
exam
ple
of a
n en
try i
n
BL0
CK
.A m
ight
be
';sal
e of
on
eth
ird
inte
rest
in
100-
acre
farm
in H
amilt
on C
ount
y, Io
wa"
and
in
BLO
CK
C c
heck
!hat
cap
ital g
ains
wer
e re
ceiv
ed
and
chec
k th
e ap
prop
riate
cat
egor
y of
am
ount
. 5. T
RU
ST
INC
OM
E-R
epor
t th
e ca
teg
ory
o
t a
mo
un
t an
d th
a ty
pe
of
any
inco
me
of $
1 00
or
mor
e re
ceiv
ed from
any
trus
t. Y
ou n
ssd
no
t ide
n-
tify
the
sour
ce fr
om w
hich
the
trus
t rec
eive
d th
e in
com
e w
hen
the
trus
t is
: (i)
a "
qual
ified
blin
d
trus
t" o
r "q
ualif
ied
dive
rsifi
ed tr
ust"
, w
hich
has
be
en c
ertif
ied
by th
e O
ffice
of G
over
nmen
t Eth
ics;
or
(ii)
an
"exc
epte
d tr
ust"
, on
e w
hich
was
not
cr
eate
d di
rect
ly b
y, a
nd a
bout
whi
ch n
o k
now
l- ed
ge o
f hol
ding
s or
sour
ce o
f inc
ome
of th
e tru
st
is p
osse
ssed
by
you,
you
r sp
ouse
or
depe
nden
t ch
ild. N
ote,
you
are
not
per
mitt
ed b
y th
e st
atut
e to
"cr
eate
" an
exc
epte
d tru
st b
y av
oidi
ng p
revi
- ou
s so
urce
s of
kno
wle
dge
upon
ent
erin
g G
over
n-
men
t ser
vice
. See s
ubpa
rt D
of 5
CFR
Par
t 734
. W
hene
ver
you
are
requ
ired
to i
dent
ify t
he
sour
ce o
f tru
st in
com
e, e
ither
for
you
rsel
f or
for
a sp
ouse
or.
child
, it
is n
ot e
noug
h si
mpl
y to
say
"J
ohn
Jone
s T
rust
". G
ener
ally
, the
inve
stm
ent
hold
ings
of
the
trus
t, di
scus
sed
abov
e un
der
"Pro
perty
Inte
rest
s and
Ass
ets"
, an
d th
e in
com
e de
rived
from
eac
h ho
ldin
g m
ust b
e id
entif
ied
to
the
sam
e ex
tent
as
if he
ld d
irect
ly. H
owev
er,
if
the
trust
is,
a q
ualif
ied
trust
or
an e
xcep
ted
trus
t, in
BLO
CK
'sho
w
only
the
iden
tity
of th
etr
ust
in-
clud
ing
the
date
the
tru
st w
as c
reat
ed,
and
in
BLO
CK
C c
heck
the
clas
sific
atio
n of
the
trus
t in-
tere
st a
s a
"qu
alie
d b
tind
trus
t", "q
ualif
ted
dive
r-
sifie
d tr
ust"
, or
"e
xcep
ted
trus
t",
and
chec
k ca
tego
ry o
f am
ount
of
the
inco
me
real
ized
. 6.
OTH
ER
IN
VE
ST
ME
NT
INC
OM
E-R
epor
t m
y
item
s o
f in
veu
mo
nt
Inco
me e
xc
nd
lng
St W
w
hk
h a
re n
6t d
a8
crlb
ed
abov
e, s
uch
as in
com
e fro
m b
usin
ess
inte
rest
s, p
rope
rty d
ealin
gs, a
nnui
- tie
s, a
n es
tate
, or
a di
strib
utiv
e sh
are
of a
pan-
ners
hip
or j
oint
bus
ines
s ve
ntur
e's
inco
me.
To
iden
tify
the
sour
ces
of o
ther
inve
stm
ent i
ncom
e.
eith
er fo
r yo
urse
lf;yo
ur
spou
se; o
r a
depe
nden
t ch
ild,
brie
flych
arac
teriz
e. in
BLO
CK
'A, t
he n
a-
ture
of t
he b
usin
ess
or inv
estm
ent i
nter
est,
and
whe
n a
pp
lica
ble
, th
e lo
catio
n:
for
exam
-p
le. .
"o
ne-t
hird
ow
ners
hip
in a
ret
ail f
urni
ture
st
ore
at 1
010
Gra
ndA
ve..
Chi
cago
. IC
':. In
BLO
CK
C
, un
der
OTH
ER
spe
cify
the
appl
icab
le ty
pe o
f in
com
e. fo
r exa
mpl
e. .
."di
strib
utiv
e sh
are"
fro
m
a pa
rtne
rshi
p or
"g
ross
in
coin
e"
from
a
prop
rieto
rshi
p, a
nd u
nder
AC
TUA
L A
MO
UN
T th
e ac
tual
am
ount
of s
uch
incd
me
whi
Ch
was
rea
lized
du
ring
the
repo
rtin
g pe
riod.
V. T
rans
actio
ns T
est
(BLO
CK
D)
BLO
CK
D IS
to
be
com
plet
ed b
y in
cum
bent
and
te
rmln
atlo
n fll
ers
only
It
IS d
eslg
ned
to a
ssls
t you
In
det
erm
lnln
g w
hlch
ass
ets
In B
LOC
K A
will
als
o ha
ve to
be
repo
rted
In P
art I
of S
ched
ule
B a
s be
-In
g pu
rcha
sed,
soi
d or
exc
hang
ed d
urln
g th
e re
port-
In
g pe
rlod
You
will
nee
d to
che
ck "
YE
S'o
r "N
O"
In B
LOC
K D
for
any
real
pro
pert
y or
stoc
ks, b
onds
, co
mm
od
~t~
esfutu
res,
and
oth
er fo
rms
of s
ecur
tties
lls
ted
In B
LOC
K A
You
nee
d no
t ans
wer
the
ques
- tlo
ns fo
r an
y ot
her
k~n
ds o
f Ite
ms
liste
d In
BLO
CK
A
If y
ou a
nsw
er "
Yes
" fo
r any
suc
h Ite
m, y
ou m
ust
also
rep
ort t
he d
etal
ls o
f th
e pu
rcha
se,
sale
or
ex-
chan
ge In
Par
t Iof
Sch
edul
e B
I. P
art
I-Tra
nsac
tions
A
. G
ener
al In
stru
ctio
ns a
nd
ltem
s to
Rep
ort
Thi
s pa
rt is
td b
e c
ompl
eted
by
incu
mbe
nts
and
term
inat
ion
filer
s on
ly. G
ive
a de
scrip
tion,
the
date
. an
d th
e ca
tego
ry o
f am
ount
of a
ny p
urch
ase,
sal
e.
or e
xcha
nge
of a
ny r
eal p
rope
rty, st
ocks
, bon
ds,
com
mod
ities
futu
res
and
othe
r se
curit
ies
by y
ou,
your
spo
use
or d
epen
dent
chi
ld w
hen
the
amou
nt
invo
lved
in th
e tra
nsac
tion
exc
ed
ed
$1.
000.
Thi
s w
ilt in
clud
e th
e tra
nsac
tion
for
any
asse
t for
whi
ch
you
answ
ered
"Yes
" in
BLO
CK
D o
f S
ched
ule
A.
It a
lso
incl
udes
repo
rtin
g an
y sa
le o
r ex
chan
ge of
an a
sset
inv
olvi
ng a
n am
ount
exc
eedi
ng $
1.00
0 w
hen
the
sold
or
exch
ange
d as
set d
id n
ot y
ield
irr
com
e of
mor
e th
an $
100
(and
the
refo
re w
as n
ot
repo
rted
on S
ched
ule
A),
or r
epor
ting th
e pu
rcha
se
of a
n as
set i
nvol
ving
an
amou
nt e
xcee
ding
$1.
000'
bu
t at t
he e
nd o
f the
repo
rtin
g per
iod
havi
ng a
val
ue
less
than
$1.
000
and
earn
ing i
mof
$1 00or
less
du
ring
the
repo
rtin
g pe
riod
(and
ther
efor
e no
t. a
p
pear
ing
on S
ched
ule
A).
The
exa
mpl
e on
the
form
sh
ows
the
prop
er w
ay to
dis
clos
e th
e X
YZ
com
mon
st
ock
the
repo
rting
indi
vidu
al.p
urch
ased
for $
35.0
00
on 2
/1/8
3. N
ote
on S
ched
ule
A. th
at th
ere
is a
n en
- tr
y fo
r the
sto
ck a
s w
ell s
ince
it w
as s
till h
etd
at t
he
end
of t
he r
epor
ting
perio
d an
d th
at th
e r
epor
ting
indi
vidu
al p
rope
rly n
oted
"Y
es"
in B
LOC
K D
.
You
nee
d no
t re
port
a tra
nsac
tion
invo
lvin
g (1
) yo
ur p
erso
nal
resi
denc
e(s)
; (2)
a m
oney
mar
ket
mut
ual fu
nd o
r pe
rson
al b
ank
acco
untF
(3) a
n as
set
of y
our s
pous
e or
depe
nden
t chi
ld if
the
asse
t mee
ts
the
thre
e-pa
rt te
st s
et f
orth
und
er th
e in
stru
ctio
ns
for
Sch
edul
e A
, at 1
I.A.;
and
(4) a
hol
ding
ofa
"qua
lib
fied
blin
d tr
ust"
, a
"qua
lifie
d di
vers
ified
trus
t".o
r an
"e
xcep
ted
trus
t".
You
will
nee
d to
repo
rt an
y tra
ns-
actio
ns o
f a
busi
ness
or
com
mer
cial
ent
erpr
ise
in
whi
ch y
ou,
your
spo
use
or d
epen
dent
child
hav
e a
dire
ct p
ropr
ieta
ry o
r ge
nera
l par
tner
ship
inte
rest
.
You
are
req
uire
d to
rep
ort a
ny c
over
ed tr
ansa
c-
tion
of a
ny c
ompa
ny. i
nves
tmen
t poo
l, or
oth
er e
n-
tity,
in w
hich
you
, you
r sp
ouse
or
depe
nden
t child
ha
ve a
n in
tere
st if
(i)
the
entit
y is
'not d
escr
ibed
in
stan
dard
refe
renc
e m
ater
ials
, or (
ii) th
e tra
nsac
tion
is n
ot in
cide
ntal
to th
e pr
imar
y tra
de o
r bu
sine
ss o
f th
e en
tity
as in
dica
ted
by y
ou o
n S
ched
ule
A. (
See
al
so s
ectio
n V
(e) o
f the
Gen
eral
Inst
ruct
ions
pre
ded-
in
g th
ose
for
Sch
edul
e A
,)
0:
Wha
t to
Sho
w o
h th
e Fo
rm
Und
er id
entif
icat
ion of
ass
ets,
iden
tify t
he p
rope
rty
or s
ecur
ities
invo
lved
in th
e pu
rcha
se, s
ale
or e
x-
chan
ge, a
nd g
ive
the
date
of
the
trans
actio
n. F
or
exam
ple,
und
er ID
EN
TIF
ICA
TIO
N O
F A
SS
ET
S.
. . "G
MC
com
mon
sto
ck";
un
der T
YP
E O
F TR
AN
S-
AC
TIO
N. .
. che
ck ty
pe; un
der
DA
TE
. . . e
nter
dat
e tra
nsac
tion
occu
rred
; und
er A
MO
UN
T O
F TR
AN
S-
AC
TIO
N. .
. che
ck th
e c
ateg
ory
of v
alue
of t
he s
ale
pric
e, p
urch
ase
pric
e, o
r ex
chan
ge v
alue
of
the
prop
erty
invo
lved
in th
e tra
nsac
tion.
II.P
art
II-G
ifts
and
R
eim
burs
emen
ts
A.
Gen
eral
In
st~
cti
on
s
Thi
s P
an
is to
be
com
plet
ed b
y in
cum
bent
s an
d te
rmin
atio
n fil
ers
only
. The
Act
req
uire
s yo
u to
dis
- cl
ose
the
rece
ipt o
f gi
fts,
in-k
ind
trav
el e
xpen
ses.
an
d ca
sh r
eim
burs
emen
ts b
y yo
u or
you
r sp
ouse
fr
om a
ny o
ne s
ourc
e ot
her
than
the
U.S
. G
over
n-
men
t. G
ener
ally
, the
se a
re (1
) gift
s of
in
kln
d s
erv-
ic
es o
f tra
nspo
rtatlo
n. lo
dgin
g, fo
od o
r ent
erta
inm
ent
aggr
egat
ing
$250
or
mor
e fr
om a
ny o
ne s
ourc
e. (2
) ca
sh r
eim
burs
emen
ts a
ggre
gatin
g $2
50 o
r m
ore
from
any
one
sou
rce
for
any
kind
of
expe
nse,
and
(3
) ot
her
gifts
, w
heth
er t
angi
ble
or i
ntan
gibl
e, a
g-
greg
atin
g $1
00 o
r m
ore
from
any
one
sou
rce.
Thi
s re
port
ing
requ
irem
ent a
pplie
s to
gift
s an
d re
imbu
rse
men
ts re
ceiv
ed b
y yo
ur s
pous
e to
the
exte
nt th
e gi
ft w
as n
ot g
iven
to h
im o
r he
r to
tally
inde
pend
ent
of
his
or
her
rela
tions
h~p to
you
.
B.
ltem
s to
Rep
ort
Rep
ort g
ifts
rece
ived
by
you,
you
r sp
ouse
or d
e-p
en
de
nt c
hild
dur
ing
the
repo
rtin
g pe
riod.
A "
gift"
m
eans
any
pay
men
t. fo
rbea
ranc
e, a
dvan
ce, r
ende
r-
ing
or d
epos
it of
mon
ey, o
r an
ythi
ng o
f va
lue,
un-
le
ss c
onsi
dera
tion
of
equa
l or
gr
eate
r va
lue
is
rece
ived
by
the
dono
r. I
n de
term
inin
g w
hich
gift
s an
d re
imbu
rsem
ents
mus
t be
repo
rted
or a
ggre
gat-
ed
for
purp
oses
of m
eetin
g th
e th
resh
old
disc
losu
re
amou
nts,
exc
lud
e th
ese
item
s'
i.G
ifts
havi
ng a
val
ue le
ss th
an $
35;
ii. G
ifts
rece
ived
from
"re
lativ
es"
(see
def
initi
on
' in
Intr
oduc
tion)
; iii
. Beq
uest
s an
d oi
her
form
s of
inh
erita
nce;
iv
. Sui
labl
e m
emen
tos d
a fu
nctio
n ho
norin
g the
re
port
ing
indi
vadu
al;
v. F
ood,
lodg
ing.
tran
spor
tatio
n, a
nd e
nter
tain
- .
men
t pro
vide
d by
a fo
nig
n g
over
nmen
t with
-in
a fo
reig
n c
ou
ntr
y or
by
the
Uni
ted
Sta
tes
Gov
ernm
ent;
vi.
Foo
d an
d be
vera
ges c
onsu
med
at b
anqu
ets.
re
cept
ions
or
sim
ilar
even
ts;
vii.
Gift
s in
-kin
d of
foo
d. Ic
dgin
g, tr
ansp
orta
tion
and
ente
rtai
nmen
t ag
greg
atin
g le
ss t
han
$250
in
val
ue r
ecei
ved
from
any
one
sou
rce
durin
g th
e pr
eced
ing
cale
ndar
yea
r (f
or p
ur-
pose
s of
the
$25
0 ag
greg
atio
n in
.thi
s ex
clu-
si
on, i
tem
s w
ith a
fair
mar
ket v
alue
of.$
35 o
r le
ss n
eed
not
be c
ount
ed);
vi
ii. G
ifts
(oth
er th
an.tr
ansp
orta
tion.
lodg
ing,
food
or
ent
erta
inm
ent)
aggr
egat
ing
less
than
$10
0
in v
alue
rec
eive
d fr
om a
ny o
ne s
ourc
e (f
or
purp
oses
of t
he $
100
aggr
egat
ion
in th
is e
x-
clus
ion,
you
nee
d no
t cou
nt a
ny it
ems
with
a
fair
mar
ket v
alue
of $
35 o
r W,n
oc a
ny it
em
for w
hich
, in
an u
nusu
al b
se
, a p
ublic
ly a
vail-
ab
le r
eque
st fo
r w
aive
r w
as g
rant
ed):
ix
. Gift
s gi
ven
to a
spo
use
tota
lly in
depe
nden
t of
his
or
her
rela
tions
hip
to y
ou;
x. G
ift it
ems
in th
e na
ture
of c
omm
unic
atio
ns to
yo
ur o
ffice
, su
ch a
s su
bscr
iptio
ns to
new
s-
pape
rs a
nd p
erio
dica
ls;
xi. G
lfts
of h
ospi
talit
y on
the
dono
r's p
erso
nal o
r fa
mily
pr
emis
es,
as
defin
ed
in
5 C
FR
5734
.105
(i);
xi^. G
ifts
and
re~m
burs
emen
ts re
ceiv
ed d
urin
g no
n-F
eder
al e
mpl
oym
ent p
er~
ods;
and
xiii.
Re~
mbu
rsem
ents
you
rece
ived
for
pol
itica
l tr
ips
whi
ch w
ere
requ
ired
to b
e re
port
ed u
n-
der s
ectlo
n 30
4 of
the
Fed
eral
Ele
ctio
n C
am-
paig
n A
ct o
f 19
71 (
2 U
S.C
. 434
).
C
Wha
t to
Sho
w o
n t
he
Form
1
TR
AN
SP
OR
TATI
ON
. LO
DG
ING
. FW
D. E
NT
ER
- T
AIN
ME
NT
-Rep
ort
the
~d
en
t~ty
of
th
e s
ourc
e.
a b
ne
l des
crip
tion,
an
d th
e a
pp
rox
tmle
val
- u
e of
~n
-ktn
dg~
ftsof
tran
spor
tatlo
n, lo
dg
~n
g, fw
d
or e
nter
taln
men
t agg
rega
tlng
$250
or
mor
e fr
om
any
one
sour
ce w
h~
chw
ere
rece
~ve
d by
you
or
you
r sp
ouse
and
wh
~ch
do n
ot fa
ll w
~th
~n
an
y of
th
e ca
tegories
of e
xclu
s~on
s enu
mer
ated
abo
ve
To
reac
h a
$250
aggre
gatio
n,
you
dete
rm~
ne
whe
ther
any
one
or
com
b~na
tton
of t
he c
ompo
- ne
nts
w~
th~
n g
~ft
cate
gory
rece
~ve
d from
one
th
~s
so
urce
(tr
ansp
orta
t~on
, lod
g~
ng
, food
and
ent
er-
ta~
nmen
t)am
ount
s to
$25
0 or
mor
e In
val
ue F
or
exam
ple,
~f y
ou s
pent
a w
eeke
nd a
t a
hunt
tng
lodg
e ow
ned
by A
mC
oal
Cor
pora
tion,
and
you
re
ce~
ved lo
dg
~n
g fa~
rly v
alue
d at
$15
0, f
ood
val-
ued
at $
100.
and
ent
erta
lnm
ent v
alue
d at
$12
5.
the
aggr
egat
e va
lue
of th
e g
~ft
~s
$3
75
A g
~ft
of
th~
snat
ure-
-hos
p~ta
l~tya
t a lo
dge
owne
d by
a c
or-
pora
tlon
rath
er t
han
an ~
nd
~v~
du
al-
wo
uld
not
qu
al~
fyas
a "p
erso
nal h
osp
~ta
l~ty
" excl
us~
on To
repo
rt t
h~
s g~
ftyou
wou
ld s
how
, un
der S
OU
RC
E
"Am
Coa
l Co
p ,1
210
Nor
th S
t. C
hcag
o. IL
".
unde
r B
RIE
F D
ES
CR
IPT
ION
"l
odg~
ng, fo
od.
and
ente
rtat
nmen
t as
a gu
est
at h
unttn
g lo
dge
owne
d by
A
mC
oal",
an
d un
der
VA
LUE
"$
375"
2
OT
HE
R
GIF
TS
-Rep
ort
the
~d
en
tlty
of
the
sour
ce.
a br
lhl
deac
ripl
lon,
an
d th
e v
alu
e o
f g
~ft
s oth
er t
han
tran
spor
tatlo
n, lo
dg
~n
g, fo
od o
r en
tert
alnm
ent a
ggre
gatln
g $1
00 o
r m
ore
In v
al-
ue fr
om a
ny o
ne s
ourc
e, o
ther
than
exc
lude
d gi
fts
whi
ch y
ou
or
you
r s
po
un
rece
ived
dur
ing
the
cale
ndar
yea
r. T
hus,
if y
ou a
nd y
our s
pous
e ea
ch
rece
ive
a $6
0 fig
urin
e fr
om th
e sa
me
dono
r, th
e gi
ft ha
s a
valu
e of
mor
e th
an $
100,
and
it m
ust
be re
port
ed. T
o re
port
theg
ift,
iden
tify t
he s
ourc
e.
brie
fly d
escr
ibe
the
item
s, a
nd s
how
the
val
ue.
In th
e ca
se o
f the
figu
rines
, rep
ort o
n th
e fo
rm u
n-
der
SO
UR
CE
.
"Art
ifact
C
o..
153
Uta
h S
t..
Om
aha.
NE
". a
nd u
nder
BR
IEF
DE
SC
RIP
TIO
N
"tw
o po
rcel
ain
figur
ines
". U
nder
VA
LUE
"$
120"
wou
ld
be s
how
n.
3. R
EIM
BU
RS
EM
EN
TS
-Rep
ort
the
so
urc
e a
nd
th
e a
ppro
xim
ate
valu
e of
any
cas
h re
imbu
rse-
m
ents
(ex
cept
tho
se f
rom
the
Un
~te
d S
tate
s G
over
nmen
t) a
ggre
gatin
g $2
50 o
r m
ore
whi
ch
you
or
your
spo
use
rece
ived
fro
m a
ny o
ne
sour
ce. F
or e
xam
ple.
it y
ou w
ere
re~m
burs
ed$4
00
for t
rave
l and
lodg
ing
expe
nses
in c
onne
ctio
n w
ith
a sp
eech
you
mad
e lo
r the
Sta
te R
ealto
rs A
ssoc
l- at
ion,
you
wou
ld r
epor
t thi
s ite
m o
n th
e fo
rm b
y sh
owin
g un
der S
OU
RC
E. .
."S
tate
Rea
ltors
As-
so
c..
45 B
ridge
St..
Den
ver.
CO
"; u
nder
BR
IEF
D
ES
CR
IPT
ION
. .
"tra
vel
expe
nses
for
spee
ch
mad
e in
Den
ver"
; an
d un
der V
ALU
E.
."$
400"
w
ould
be
show
n. If
you
r spo
use
mad
e th
is s
peec
h an
d re
ceiv
ed th
e re
imbu
rsem
ent t
otal
ly in
depe
n-
dent
of h
is o
r he
r rel
atio
nshi
p to
you
, no
info
rma-
tio
n fo
r th
is it
em n
eed
be r
epor
ted.
N
ote:
It y
ou r
ecei
ve in
-kin
d se
rvic
es o
f tr
ansp
orta
- tio
n, l
odgi
ng,
food
and
ent
erta
inm
ent
or a
re
imbu
rsem
ent o
f offi
cial
trav
el e
xpen
ses
from
a
non-
prof
it ta
x-ex
empt
inst
itutio
n cat
egor
ized
by
the
IRS
as
one
falli
ng w
ithin
the
term
s of
26
U.S
.C. 5
01(c
)(3),
you
mus
t rep
ort t
he n
ame
of th
e or
gani
zatio
n, a
brie
f des
crip
tion
of t
he
in-k
ind
serv
ices
or t
he re
imbu
rsem
ent a
nd th
e va
lue.
If k
now
n, y
ou m
ay a
lso
wis
h to
not
e th
e da
te y
ou r
ecei
ved
the
requ
ired
writ
ten
ap
pr
oval
from
you
r age
ncy
to a
ccep
t suc
h.ite
ms.
I. P
art
I-Lia
bilit
ies
A.
Gen
eral
Inst
ruct
ion
s T
he A
ct r
equi
res
you
to d
iscl
ose
cert
ain
of y
our
finan
cial
liab
ilitie
s. T
he e
xam
ples
on
the
form
sho
w
how
to r
epor
t a m
ortg
age
on
real
esl
ate
the
repo
rt-
ing
indi
vidu
al h
eld
for t
he p
rodu
ctio
n of
inco
me
and
a pr
omis
sory
not
e m
ade
to a
n in
divi
dual
. Not
e th
at
you
will
nee
d to
dis
clos
e th
e,da
te, i
nter
est r
ate
and
term
(if
appl
icab
le) o
f ea
ch li
abili
ty.
Als
o n
oti
you
mus
t d~
sclo
se the
high
est a
mou
nt o
wed
on
any
lia-
bilit
y he
ld d
uri
ng
the
re
po
rtin
g p
arlo
d, n
ot ju
st a
t th
e en
d of
the
perio
d. If
the
liabi
lity
was
com
plet
ely
paid
dur
ing
the
perio
d, y
ou m
ay a
lso
note
that
on
th
e fo
rm if
you
wis
h.
B.lte
ms
to R
epo
rt
Ide
ntit
y a
nd
glv
e th
e c
ateg
ory ol
amou
ntof
the
liabi
litie
s w
hich
you
, yo
ur sp
ew
or
dq!e
nden
t ch
lld o
wed
to a
ny c
redi
tor,
oth
er t
han
a re
lativ
e.
whi
ch e
xcee
ded
$10.
000
at a
ny t
ime
durin
g th
e re
port
able
per
iod,
exc
ept:
i, a
mor
tgag
e se
cure
d by
real
pro
pert
y w
hich
is
the
pers
onal
resi
denc
e (or
a s
econ
d re
side
nce
not u
sed
for
prod
ucin
g in
com
e) o
f you
or y
our
spou
se;
ii,a
loan
sec
ured
by
a pe
rson
al m
otor
veh
icle
. ho
useh
old
furn
~tu
re,or
app
lianc
es, w
here
the
lpan
doe
s no
t exc
eed
the
purc
hase
pric
e of
the
ite
m:
iii, a
rev
olvi
ng c
harg
e ac
coun
t w
here
the
out
- st
andi
ng li
abili
ty d
id n
ot e
xcee
d $1
0.00
0 as
of
the
clos
e of
the
prec
edin
g ca
lend
ar y
ear;
and
iv. a
ny li
abili
ty o
f you
r spo
use
or d
epen
dent
chi
ld
whi
ch re
pres
ents
the
sole
fina
ncia
l int
eres
t or
resp
onsi
bilit
yof t
he s
pous
e or
chi
ld, a
nd a
bout
w
hich
you
hav
e no
kno
wle
dge,
and
whi
ch is
no
t re
late
d to
you
r in
com
e, a
sset
s, o
r ac
tivi-
ties,
and
con
cern
ing
whi
ch y
ou n
eith
er d
eriv
e no
r exp
ect t
o de
rive
any
finan
cial
or
econ
om-
ic b
enef
it.
You
are
requ
ired
to re
port
any
liabi
lity o
f any
com
- pa
ny, i
nves
tmen
t poo
l, or
oth
er e
ntity
, in
whi
ch y
ou,
your
spo
use
or d
epen
dent
chi
ld h
ave
an in
tere
st.
if (i)
the
entit
y is
not
des
crib
ed in
sta
ndar
d re
fere
nce
mat
eria
ls, o
r (ii
) the
liab
ility
is n
ot in
cide
ntal
to th
e pr
imar
y tr
ade
or b
usin
ess
of th
e en
tity
as in
dica
ted
by y
ou o
n S
ched
ule
A. (
See
als
o se
ctio
n V
(e) o
f the
G
ener
al In
stru
ctio
ns p
rece
ding
thos
e fo
r S
ched
ule
A). C. W
hat
to S
how
on
th
e Fo
rm
Und
er N
AM
E A
ND
AD
DR
ES
S O
F C
RE
DIT
OR
. . .
the
nam
e an
d ad
dres
s of
the
act
ual c
redi
tor
mus
t be
sho
wn
unle
ssth
e re
potti
ng in
divi
dual
is o
nly
able
to
iden
tify
a fid
ucia
ry a
nd c
ertif
ies
in th
e re
port
that
he
has
mad
e a
good
faith
effo
rt to
det
erm
ine
who
th
e ac
tual
cre
dito
r is
and
was
una
ble
to d
o so
, or
up
on h
is c
ertif
icat
ion
that
suc
h de
term
inat
ion
is
othe
rwis
e im
prac
ticab
le. U
nder
TY
PE
OF
LIA
BIL
I-
TY
. . .
brie
fly in
dica
te th
e na
ture
of t
he li
abili
ty. U
n-
der
DA
TE
. . .
ente
r da
te l
oan
incu
rred
; un
der
IN-
TE
RE
ST
RA
TE
. ..
no
te th
e se
t rat
e or
. if a
var
iabl
e on
e. .t
he fo
rmul
a us
ed to
var
y th
e ra
te,
i.e.
prim
e
+2
%; a
nd u
nder
TE
RM
. . .t
he d
urat
ion
of th
e lo
an.
pect
s to
rec
eive
a lu
mp
sum
pay
men
t fro
m th
e la
w
natu
re. N
o re
po
rl is
mq
uim
d ra
gmrd
ing a
ny p
oaC
br
ief d
escr
iptio
n of
the
serv
ices
you
prov
ided
. Whe
n C
heck
the
cat
egor
y of
val
ue.
firm
he
has
W in
ord
er to
ent
er t
he G
over
nmen
t. tl
on
s h
eld
by
you
r spo
use
or a
hp
en
do
nt c
Mld
. a
sour
ce h
as p
aid
you
dire
ctly
, you
sho
uld
have
a
B. W
hat
to S
how
on
the
Form
II.
Par
t Il-
Agr
eem
ents
or
U
nder
DE
SC
RiP
TlO
N O
F T
ER
MS
. . .d
escr
ibe
the
agre
emen
t or
arr
ange
men
t w
ith a
ppro
pria
te
Arr
ange
men
ts '
spe
cilii
ity. U
nder
PA
RT
IES
. . .s
how
the
nam
e o
l the
A
. G
ener
al ln
stru
ctio
k an
d or
gani
zatio
n, o
r en
tity.
and
(if a
pplic
able
) the
nam
e lte
ms
to R
epor
t an
d lil
le o
f the
offi
cial
, cor
pora
te o
ffiie
r. o
r pr
inci
pal
-P
rovi
de in
form
atio
n reg
ardi
ng a
ny a
gree
men
ts o
r pe
rson
resp
onsi
ble
for
carr
ying
out
the
term
s of
the
arra
naem
ents
vou
hav
e co
ncer
nino
iil
futu
re e
m-
agre
emen
t or
arra
ngem
ent.
Und
er D
AT
E. .
. sh
ow
ploy
men
t; (ii
) a ie
ave
01 a
bsen
ce d
ui$
yo
ur p
erio
d th
e da
te o
f any
suc
h ar
rang
emen
t. N
o re
po
rt is
re
of
Gov
ernm
ent s
ervi
ce; (
iii) c
ontin
uatio
n of p
aym
ents
q
ulre
d re
ga
rdin
g a
ny a
gree
men
t or a
rran
gem
ent
by a
form
er e
mpl
oyer
oth
er tha
n th
e unite
d-s
tate
s e
nte
red
into
by
a sp
ouae
or
de
pe
nd
en
t ch
ild.
Gov
ernm
ent;
and
(iv) c
ontin
uing
par
ticip
atio
n in
an
empl
oyee
wel
fare
or
bene
fit p
lan
mai
ntai
ned
by a
fo
rmer
em
ploy
er. T
his
incl
udes
any
arr
ange
men
ts
or n
egot
iatio
ns w
ith-a
fut
ure
empl
oyer
ent
ered
into
by
a t
erm
inat
ion
filer
. Fo
r pu
rpos
es o
f pu
blic
dis
- cl
osur
e on
ly, y
ou m
ust d
iscl
ose
any
nego
tiatio
ns fo
r fu
ture
em
ploy
men
t fro
m th
e po
int y
ou a
nd a
pot
en-
I..P
art
I-Pos
ition
s H
eld
t~ 3
tial p
rivat
e se
ctor
em
ploy
er h
ave
agre
ed to
.you
r fu
- A
. lte
ms
to R
epor
tN
U1
5
lure
em
ploy
men
t by
that
em
ploy
er w
heth
er o
r no
t R
epor
t al
l pos
ition
s he
ld a
t an
y tim
e du
ring
the
YO
U h
ave
settl
ed a
ll of
the
term
s, s
uch
as s
alar
y, ti
- re
porti
ng p
erio
d, a
s w
ell a
s th
ose
posi
tions
you
cur-
%
tle
, ben
efits
, and
dat
e em
ploy
men
t is
to b
egin
. You
r re
ntly
hol
d as
an
offic
er, d
irect
or, t
rust
ee, p
artn
er.
agen
cy m
ay r
equi
re in
tern
al d
iscl
osur
e of
neg
otia
- pr
oprie
tor,
repr
esen
tativ
e, e
mpl
oyee
or
cons
ulta
nt
1: Ip
tio
ns m
uch
earli
er a
nd y
ou s
houl
d se
ek g
uida
nce
rn
of (
i) an
y co
rpor
atio
n, c
ompa
ny, f
irm,
part
ners
hip,
be
fore
con
duct
ing
any
nego
tiatio
ns w
ith p
erso
ns
trust
. or
othe
r bu
sine
ss e
nter
pris
e; (i
i) an
y no
n-pr
ofit
3
with
who
m y
ou d
o bu
sine
ss. A
crim
inal
sta
tute
, 18
or
gani
zatio
n; (
iii)
any
labo
r or
gani
zatio
n; (
iv)
any
rn
U.S
.C.
5208
, app
lies
to a
ctio
ns y
ou m
ay ta
ke w
hile
ed
udat
iona
l ins
titut
ion;
or
(v) o
ther
inst
itutio
n ot
her
3
@
nego
tiatin
g fu
ture
priv
ate
sect
or e
mpl
oym
ent.
than
the
Uni
ted
Sta
tes
Gov
ernm
ent.
Exc
lude
pos
i- A
(D
2
The
exa
mpl
e on
the
for
m s
how
s th
e se
vera
nce
tions
hel
d in
any
rel
igio
us, s
ocia
l, fr
ater
nal,
or p
olit
- O
D 0
agre
emen
t und
er w
hich
the
repo
rtin
g in
divi
dual
ex-
ic
al e
ntity
, and
any
pos
ition
s so
lely
of an
hon
orar
y Q
, -:
Be
sure
lo re
port
on S
ched
ule
A a
ny in
com
e yo
u re
ceiv
ed fr
om a
ctin
g in
any
of
thes
e po
sitio
ns.
B. W
hat
to S
how
on
the
Fonn
G
ive
the
nam
e, a
ddre
ss a
nd b
rief d
escr
iptio
n of
th
e or
gani
zatio
n, th
e tit
le o
r ot
her
brie
f fu
nctio
nal
desc
riptio
n of
the
pos
ition
, and
the
date
s yo
u he
ld
the
posi
tion.
If y
ou c
urre
ntly
hol
d th
e po
sitio
n, in
the
entry
blo
ck u
nder
TO
not
e "P
rese
nt".
II. P
art
Il-C
ompe
nsat
ion
in
Exc
ess
of
$5,0
00
Pai
d b
y O
ne S
ourc
e A
. G
ener
al ln
stm
ctio
ns
Thi
s P
art i
s to
be
com
plet
ed b
y no
min
eesan
d ne
w
entra
nts
only
. T
his
Act
req
uire
s th
at y
ou d
iscl
ose
your
sou
rces
of c
ompe
nsat
ion
in e
xces
s of
$5,
000
and
the
na
ture
of t
he d
utie
s yo
u pr
ovid
ed. T
his
in-
clud
es n
ot o
nly
the
sour
ce o
f yo
ur s
alar
y or
oth
er
fees
, but
the
disc
losu
re o
f clie
nts
for w
hom
you
per
- so
nally
pro
vide
d $5
.000
in s
ervi
ces
even
thou
gh th
e cl
ient
s' p
aym
ent w
as m
ade
to y
our
empl
oyer
, firm
or
oth
er b
usin
ess
affil
iatio
n. T
he e
xam
ple
on t
he
foim
sho
ws
the
prop
er w
ay to
dis
clos
e th
e busi
neC
af
filia
tion
whi
ch p
aid
the
repo
rting
indi
vidu
al's
com
- pe
nsat
ion,
in th
is c
ase
a la
w fi
rm, a
nd a
clie
nt o
f the
fir
m fo
r w
hom
the
rep
ortin
g in
divi
dual
per
sona
lly
prov
ided
ove
r $5
.000
wor
th o
f se
rvic
es. T
his
Par
t do
es n
ot r
equi
re y
ou t
o di
sclo
se t
he v
alue
of
the
com
pens
atio
n fo
r th
ese
serv
ices
; it d
oes
requ
ire a
corr
espo
ndin
g en
try o
n S
ched
ule
A. A
clie
nt w
ho
paid
you
r bu
si~
tssaf
filia
tion
$5,0
00 or
mor
e fo
r you
r se
rvic
es w
ill a
ppea
r on
ly i
n th
is P
art.
B.
ltem
s to
Rep
ort
Rep
ort t
he n
atur
e of
the
dut
ies
perfo
rmed
or s
ew-
ices
rend
ered
for a
ny p
erso
n (o
ther
than
the
Uni
ted
Sta
tes
Gov
ernm
ent) f
rom
whi
ch co
mpe
nsat
ion
in e
x-
cess
of
$5.0
00 in
any
of
the two
prec
edin
g C
alm
- da
r yea
rs, o
r the
pre
sent
cal
enda
r yea
r was
rec
eive
d by
you
'or
an e
ntity
whi
ch b
illed fo
r yo
ur s
ervi
ces
(bus
ines
s af
filia
tion)
. Exc
lude
: (i)
info
rmat
ion t
o th
e ex
tent
that
11I
S co
ns~
dere
dconf~
dentia
las a
res
ult
of a
prlv
llege
d re
lalio
nsh~
p est
ablis
hed
by la
w, o
r (ii)
ln
form
at~
onabo
ut p
erso
ns fo
r w
hom
ser
vlce
s w
ere
prov
lded
by
a bu
sine
ss a
ff~
hat~
on
yw
wer
e of
wh
~ch
a
mem
ber,
partn
er o
r em
ploy
ee u
nles
s yo
u w
ere
dire
ctly
~nv
olve
dIn th
e pr
ovls
lon
of the
se
rvic
es T
he
nam
e of
a c
llent
of
a la
w l
~rm
1s no
t gen
eral
ly c
on-
s~dere
dconf~
dent~
alNB
report
la r
qu
ire
d re
gard
- in
g c
om
pensa
tion p
aid
to
your
spousc
or
a de
pend
ent
child
.
C W
hat
to S
how
on
the
Form
U
nder
SO
UR
CE
gl
ve t
he n
ame
and
addr
ess
of the
per
son
to w
hom
ser
vlce
s w
ere
pro
v~ded, fo
r ex
ampl
e. "
New
ark
Rea
l Est
ate
Co
(New
ark.
NJ)
";
and
unde
r BR
IEF
DE
SC
RIP
TIO
N
the
tltle
or o
ther
b
r~e
flunct
~onal
of th
e se
wlc
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nder
ed.
desc
r~pt~
on
lor e
xam
ple
"tax
man
ers
rese
arch
ed fo
r abo
ve f
~rm
w
hile
an
ass
oci
ate
w~
th Qul
nn a
nd O
uspe
nsky
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po
rt~
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NS
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23 1986
Sgn
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)O
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Use
Onl
vI
Rep
ortin
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erio
ds
hrc
urn
knt.
: C
ompl
ete
Sch
edul
esA.
8,C
, andPanIo
f D.T
he
repo
rting
per
iod
isth
e pr
eced
ing
cale
ndar
yee
r ex
cept
for
Par
t II
of S
ched
ule
C a
nd P
art I
dS
ched
ule
Dw
hem
you
mus
t als
o in
clud
ean
y p
os
itih
elda
agre
emen
tsor
arm
gem
ents
mad
e from
the
begi
nnin
g of
the
tili
ng y
ear
until
the
date
you
file
.
Tw
min
dam
FW
M: C
ompl
ete
Sch
edul
es A
, B. C
, an
d P
art I
of D
. The
rep
ortin
g pe
riod
begi
ns a
t the
end
of t
he p
erio
d co
v-er
ed b
y yo
ur p
revi
ous
tilin
gan
d en
dsat
the
date
of t
erm
ina
fi.
No
mlm
r, N
aw E
ntre
ntm
and
Cm
dld
.te
s fo
r P
rnld
on
tand
Vk
. P
msl
d.n
t:C
ompl
ete
Sch
edul
esA
. C, a
nd D
. (C
an
diit
es
do n
ot f
ile P
art IIo
f S
ched
ule
D.)
Sc
Mk
A-Th
e re
porti
ngpe
riod
for In
com
e(B
L0C
KC
) and
Tra
nsac
tions
Tes
t (BLO
CK D
) is
the
prec
edin
gca
lend
arye
ar
and
the
curr
ent c
alen
dar y
ear up
to th
e da
te o
f fil
ing.
Val
ue
asse
ts in
BLO
CK
B a
s of
any
dat
e yo
u ch
oose
that
is
with
in
31 d
ays
of t
he d
ate
of filing
.
Sch
edul
eC
, P
art I
(Lia
biliti
es)-T
he
repo
rtin
gpe
riod
is th
e pr
eced
ing
cale
ndar
year
and
the
curren
t cal
enda
r yea
r up
to
any
date
you
chm
mth
at is
with
im 3
1da
ys o
f the
date
of M
ing.
kh.d
uh
C, P
wlII(
Agr
eem
ents
and
Ar
v*
any
agre
emen
ts o
r ar
rang
emen
ts a
s of
the
date
dfil
ing.
Sch
edul
e %
The
repo
rting
per
iod
is th
e pr
eced
ing
hm
, ca
lend
ar y
ears
and
the
curren
t cal
enda
r ye
ar u
pto
the
dY
e
of f
iling.
I l
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bo
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pY
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Sch
edul
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Rep
ortin
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divi
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ame
Ass
ets
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Inco
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SM
ITH
. JO
HN
A
. -
Pa*
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umbe
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k?,"::: I
~n
dg
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y re
al p
ropert
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tock
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mm
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futu
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and
oth
er
s,urltles
liste
d In
B
LOC
K
A,
d~
dyou
purc
hase
, se
ll, or
ex
chan
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he
Item
dur
lng
the
report
ing p
erlo
d fo
r a
valu
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at e
xcee
ds $
1000
'
All
File
rs:
In B
LOC
K C
rep
ort t
he ty
pe
an
d a
mou
nt o
f ln
com
e e
xcee
ding
$10
0 or
mor
e re
ceiv
ed fr
om
the
ass
ets
an
d o
ther
sou
rces
of
lnco
me
llst
ed In
BLO
CK
A.
You
must
re
p
ort
the
act
ual a
mou
nt o
f an
y ln
com
e n
d of
a ty
pe
sp
ec~
fically
note
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elow
. You
need
not r
ep
ort
the
act
ua
l am
ount
of y
our
spou
se's
ear
ned
Inco
me,
only
the s
ourc
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BLO
CK
A
. Y
OU
may
not
che
ck "
qu
allf
led
tru
st"
un
less
you
hav
e a b
llnd t
rust
wht
ch h
as
been
spe
c~f~
callya
ppro
ved
by th
e O
ffice
of G
over
nmen
t Eth
lcs
If yo
u, y
our
spou
se o
r depen-
dent
ch
lld a
re th
e be
nefic
iary
-of a
tru
st w
hlc
h n
o o
ne
of y
ou c
reate
d a
nd h
as
no
know
l-ed
ge o
f th
e a
sset
s. r
efer
to t
he
lnst
ruct
lon
s to
se
e 1
111q
uallf
les
as a
n "
exc
epte
d tr
ust
."
If "n
one"
(o
r le
ss th
an $
101)
IS c
he
cke
d u
nder
Cat
egor
y o
f Am
ount
of
Inco
me.
no o
ther
e
ntr
les
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be
mad
e In
BLO
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C fo
r th
at
Item
r~
llFile
n:
In B
LOC
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A
repo
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) th
e id
enti
of e
ach
asse
t he
ld f
or
the
prod
uc-
tlon o
~ln
co
mea
t th
e cl
ose
of
the
re o
fling
perio
d w
hich
had
a f
air
mar
ket
varu
e ex
. d
in
g
and
(b)
any
othe
r as
set
Or
'Our
ce
of
inco
me
whi
ch g
ener
ated
Ove
r $1
00 I
n in
com
e du
rlng
the
repo
rtin
g pe
rlod.
T
his
Incl
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b
ut
1s
not
llmlte
d t
o e
m
ploy
ers,
st
ocks
bo
nds
tax
shel
ters
ba
nk
acco
unts
, re
al'
pro
pe
b,
mut
ual
'fund
s.
peru
lons
IR
A.
puet
s,
asse
ts of
cert
aln
trus
ts
cbm
mod~
t~esfu
ture
s pe
rson
al b
usl-
m'
and
partn
ersh
ip
~ni
eres
ts.E
xdud
e yo
ur
pers
onal
res
~den
ceun
less
you
ren
t ~
t out
See
inst
ruct
ions
fo
r ru
les
on
bank
ac
coun
ts a
nd c
ompl
ex h
oldi
ngs.
All
Flle
n:
In B
LOC
K B
rep
ort
the
Valu
e o
f ea
ch a
sset
lis
ted
In
BLO
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A w
hic
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ad a
fair
mar
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ceed
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$lW
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t th
e th
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BLO
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A
Ass
ets
& In
com
e So
urce
s
ldentlf
y ea
ch a
sset
and
lnco
me
sour
ce
of y
ours
, you
r sp
ouse
(S) a
nd y
our
depe
nden
t ch
~ld(
DC
).
NO
NE
BLO
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CIn
com
e B
LOC
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V
alua
tion
of
Ass
ets
:, DC
7 a S 3 DC 4 5 6 ' . 8 9 10
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BLO
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ansa
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st
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IBM
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IBM
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imp
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He
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nta
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N
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on
31
2 Hil
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t.
Reno.
NV
Sp
ee
ch
to
Mooee
Lo
dg
e,
Mu
sco
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OK
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RCPORTOF#)DMDDEfLNSERtLATtDEMTLOY~MtAS REQUIREDBY
PUBLIC LAW 91.121
JONES 8 PAUL Q 1 2400 GLEBE ROAD, ARLINCTOM VA 22857 1 35-67-8920
Ow@ApprrvwlNe. 22-RON8
* I.XJRETlRC0 YILITARV Of ClCCl l . MAJILT. CWOR OR ADOVC -@- 13CORYCR YILITARV OCCICEI) UAJ/LT. CUOn 011 A IOVC
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TLOYIWATIOM OC SERVICE WITH 000.
D . c1CORMEII LWPLOVCC OF. OR COMSULTAMT TO. OCCCMSE COWTIIACTOn WWO DURlMG LAST CISCAL YEAR .AS ~ Y ~ L O V L O
mV 000 AT SALARV EQUAL TO 01ADOVC.YIWIUUW O t O SALARV
llcor 5 l h ~10 apply lo r e p o r l i n l ~.alrloricsA. 9 and C ONLY WAUL AND AOOIICSI OC OCCCNSL COW TnACTOR CMCLOVCI~SI
MlRD AEROSPACE, 2700 S l g r l i i e B lvd , Palo A l t o , CA 80010
OATCIS1 OC ACCEPTANCE O? LWPLOVUCNT WITH OCCCMSC C W T n A C T O I E M ~ L O v E I l s lrlt nu lwv?rr rmpluvcd bv J c h n ~ c c w k u t r 0.CI.l.r $1- h c k r l v o d o h el 011 awh ..yloymrntJ 3 ERY '984 OATC O t SEPAnATlOW C ~ O YACTIVE DUTV O n TE~WIWATIOM OC 000 LwCCovuLnT
ASST TO THE DEPUTY CHIEF OF STAFF FOR RESEARCH, DEVELOPMENT, AND ACQUISITION
B POSITION ~ITLCIS) &NO m n ~ c ?OCSC~IPTIOWISI oc won% C E ~ C O ~ W C Oron DECLMSC c o m T r * c T o n CWCCOVCRISI.
CONSULTANT ON DEFENSE CONTRACTS
(Ic.u11 ( h ~I 6 Wply lo uporlin4 cr l r f iu ry D ONLY
s COYT(O* TITLEIS) AWO ~RIEC O~SC~IPTIO*IS~ or OUTICS w l t n o c r A n t u c w t or o r r r w s c c u r L o v c n o u n ~ w cL A S T C I K A L VEAR.
4. WAUEIS) OF OLCEWSECO)(T~ACTORIS~DV WMOY vou w e r e e w r L o v c o on w n o u IOU SLIVCO AS A COWSULTANT on o v n c n w t s c .
8. INCLUSIVE OATES OF EUPLOVYCWT I V . OR SEnVICC WITH. OECCWSC C O W T ~ A C T O ~ E Y P L O V E I I I S I ~
I POSlTlOW TlTLClSl AWO D I l C C O C S C ~ I P T I O ~ I S ~OC WOnK PLllFORWCD FOR OCCCMSC COHTIACTORISI.
Figure 145. Sample of a completed DD Form 1787
25 SEPTEMBER 1986 UPDATE lAR 600-50
Appendix A AR 600-15 Related publications Indebtedness of Military Personnel
\
A related publication is merely a source of add~t~onal ~nformation.The.user does not have to read ~t to un-' derstand th~sregulation.
AR 1-210 Participation in Activities of Private Associations
AR 1-211 ,
Attendance of Military Personnel at Private Organizations Meetings
AR 10-5 Department of the Army
AR 20-1 Inspector General Activities and Procedures
AR 3747 Contingency Funds of the Secretary of the Army
AR 145-1 Senior ROTC Program: Organization, Ad-ministration, and Training
AR 145-2 Junior Program and National Defense Ca-det Corps: Organization, Administration, Operation, and Support
(9AR 210-1 Private Organization Department of the Army ~nstailations
AR 210-7 Commercial Sol ic i ta t ion on Army Installations
AR 600-21 Equal Opportunity Program in the Army
AR 600-29 Fund-Raising Within the Department of the Army
AR 600-47 Reporting Procedures on Defense Related Employment
AR 600-291 Foreign Government Employment
AR 621-7 ,
Acceptance of Fellowship, Scholarships, or Grants
AR 624-100 Promotion of Officers on Active Duty
AR 672-5-1 Military Awards
AR 690-700 Personnel Relations and Services (General)
AR 690-700.771 Civilian Personnel
DODI 5410.20 Public Affairs Relations with Business and Nongovernmental Organizations Represent-ing Business
DODD 5500.2
AR 210-10 Administration
DODD 5500.7 Standards of Conduct ,
AR 215-1 5 CFR 734 Executive Personnel Financial Disclosure
The Administration of Army Morale, Wel- R, uirementsfare, and Recreation Activities and Nonap-propriated Fund Instrumentalities
AR 215-2
5 CFR 735 Employee Responsibilities and Conduct
The Management and Operation of Army CPR 713 Morale, Welfare, and Recreation Programs Civilian Personnel Regulation, Equal Em-and Nonappropr ia ted F u n d I n s t r - ployment ~~~~~~~i~~ umentalities
CPR 771
Nonappropriated Funds and Related Activ- F ~ M734 ities Personnel Policies and Procedures Financial Disclosure Requirements
AR 340-18 FPM 771 The Army Functional Files System Agency Administrative Grievance System
Public InformationAR360-5
Chapter 304, FPM
JTR AR 360-61 Joint Travel Regulation Volume 2, chapter Community Relations 6
25 SEPTEMBER 1986 UPDATE AR 600-50
Appendix B Digest of Conflict of Interest.Laws
5 1 . Conflict of Interest Laws The statutes digested in this appendix are subject to changing administrative and judi-cial interpretation. Before. acting or failing to act because of these statutes, D A person-nel are encouraged to consult legal counsel.
B-2. 18 USC 203 a. Subsection (a) prohibits officers o r
Government employees from directly or in-directly receiving, agreeing to receive, or seeking any compensation for services ren-dered or to be rendered before any depart-ment o r agency in connection with any contract, claim, controversy or particular matter in which the United States is a party or has a direct and substantial interest. The purpose of this section is to reach any situa-tion, including those where there is no in-ten t t o be c o r r u p t e d o r t o p rov ide preferential treatment, in which the judg-ment o r efficiency of a Government agent might be influenced because of payments or gifts made by reason of the position occu-pied to that official ,in a manner otherwise than provided by law.
b. Subsection (b) makes it unlawful to of-fer or pay compensation, the solicitation or receipt of which is barred by subsection (a).
53. 18 USC 205 a. This Section prohibits Government
personnel from acting as agent or attorney for anyone else before a department, agency, or court in connection with any particular matter in which the United States is a party or has a direct and substantial interest.
b. The following exemptions are allowed: (1) Section 205 does not prevent Govern-
ment personnel from giving testimony under oath or making statements required to be made under penalty of perjury or con-tempt or from representing another person, without compensation, in a disciplinary, loyalty, or other personnel administration proceeding.
(2) Section 205 also authorizes a limited waiver of its restrictions and those of sec-tion 203 for the benefit of an officer or em-ployee, including a special Government employee, who represents his own parents, spouse, or child, or a person or estate he serves as a fiduciary. The waiver is available only if approved by the official making ap-pointments to the position. In no event does the waiver extend to his representation of any such person in matters in which he has participated personally and substantially or which, even in the absence of such partici-pation, a re t h e subject of his official responsibility.
(3) Finally, section 205 gives the head of a department or agency the authority to al-low a special Government employee to rep-resent his or her regular employer or other outside organization in the performance of
work under a Government grant or contract if the department or agency head certifies and publishes in the Federal Register that t h e n a t i o n a l i n t e r e s t r e q u i r e s s u c h representation.
8-4. 18 USC 208 a. Subsection (a) requires executive
branch personnel to refrain from personal and substantial participation as Govern-ment personnel through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or otherwise in any particular matter in which, to their knowl-edge, they, their spouses, minor children, or partners have financial interest or in which business or nonprofit organizations with which such personnel are ammekdaffiliat-ed or are seeking employment have financial-interests. The test of what constitutes a par-ticular matter is whether the individual might reasonably anticipate that his or her Government action, o r the decision in which he or she participates or with respect to which he or she advises. will have a di-rect and predictable effect upon such finan-cial interests.
b. Subsection (b) vermits agencies to. , - -grant an ad hoc exemption in writing from subsection (a) if the outside financial inter-est is deemed in advance not substantial enough to affect the integrity of Govern-ment services. Categories of financial inter-ests may also be made nondisqualifying by a general regulation published in the Federal Register. Shares of a widely held, diversified mutual fund or regulated investment com-pany have been exempted as being too re-mote o r inconsequential t o affect the integrity of the services of Government personnel.
8-5. 18 USC 209 Subsection (a) prevents executive branch personnel from receiving, and anyone from paying them, any salary or supplementation of salary from a private source as compen-sation for their Government service. Subsec-tion (b) permits participation in a bona fide pension plan or other employee, welfare or benefit plan maintained by a former employ-er. Subsection (c) exempts special Govern-ment employees and anyone serving the Government without compensation. Subsec-tion (d) exempts contributions, awards, or other expenses under the Government Em-ployees Training Act (5 USC 2301-2319).
B-6. 18 USC 207 Section 207 applies to former DOD person-nel. The prohibitions contained in 18 USC 207 are set forth in chapter 5.
8-7. Summary of laws particularly applicable to retired Regular officers Prohibited activities are shown below.
a. Claims. A retired Regular officer of the Armed Forces may not, within 2 years of retirement, act as agent or attorney for prosecuting any claim against the Govern-ment, or assist in the prosecution of such a
claim, or receive any gratuity or any share of or interest in such a claim in considera-tion for having assisted in the prosecution of such a claim, if such claim involves the Mil-itary Department in whose service he holds a retired status or if such claim involves any subject matter with which he or she was di-
Q rectly connected while on active duty (see 18 USC 283).
b. Selling. (1) A retired Regular officer is prohibit-
ed, a t all times from representing any per-s o n i n t h e sa le of a n y t h i n g t o t h e Government through the Military Depart-ment in whose service he holds a retired sta-tus (see 18 USC 281).
(2) Payment may not be made from any appropriation, for a period of 3 years after his name is placed on that list, to an officer on a retired list of the Regular Army, the Regular Navy, the Regular Air Force, the Regular Marine Corps, the Regular Coast Guard, the National Oceanic and Atmos-pheric Administration, or the Public Health Service, who is engaged for himself or others in selling, or contracting or negotiat-ing to sell, supplies or war materials to an agency of the Department of Defense, the Coast Guard, the National Oceanic and At-mospheric Administration, o r the Public Health Service. (See 37 USC 801(b) as amended, October 9, 1962, *Pub.L.No. 87-777, formerly 5 USC 59(c).)
(3) For the purpose of this statute, "sell-ing" means-
(a) Signing a bid, proposal, or contract; (b) Negotiating a contract; (c) Contacting an officer or employee of
any of the foregoing departments or agen-cies to obtain or negotiate contracts; negoti-ate o r discuss changes in specifications, price, cost allowances, or other terms of contract; or settle disputes concerning per-formance of a contract; or
(d) Any other liaison activity with a view toward the ultimate consummation of a sale although the actual contract therefor is sub-sequently negotiated by another person.
5 8 . Employment Neither these statutes nor this regulation preclude a retired Regular officer from ac-cepting employment with a domestic private industry solely because his employer is a contractor with the Government.
Presidential appointees a. For the period defined in (b) below, no
Presidential appointee employed by or serv-ing in any component of the Department of Defense may accept post-Government emolovment-
(1) With any defense contractor he or she has dealt with.
( 2 ) A s a p r i m a r y G o v e r n m e n t representative.
(3) In the negotiation or settlement of a Government contract.
25 SEPTEMBER 1986 UPDATE AR 600-50
contractor. c. The knowing violation of these provi-
sions may result in the following penalties: (1) Upon conviction, the appointee may
be fined UD to $5.000 or imbrisoned for a period up to 1 year;
(2) The employing contractor shall for-feit up to $50,000 in liquidated damages pursuant to contractual requirements.
6-9. Laws.applicableto DOD personnel There are legal prohibitions concerning the following activities that may subject present and former DOD personnel to criminal or other penalties:
a. Aiding, abetting, counseling, com-manding, inducing, or procuring another to commit a crime under any criminal statute (see 18 USC 201).
b. Concealing or failing to report to proper authorities the commission of a felo-ny under any criminal statute if such per-sonnel know of the actual commission of the crime (see 18 USC 4).
c. Conspiring with one or more persons to commit a .crime under any criminal stat-ute or to defraud the United States, if any party to the conspiracy does any act to ef-fect the object of the conspiracy (see 18 USC 371).
d. Lobbying with appropriated funds (see 18 USC 1913).@ e. Disloyalty and striking (see 5 USC 7311, 18 USC 1918). f. Disclosure of classified information
(see 18 USC 798, 50 USC 783); and disclo-sure of confidentialinformation (see 18 USC 1905).
g. Habitual use of intoxicants to excess (see 5 USC 7352).
h. Misuse of a Government vehicle (see 31 USC 638a(c)(2)).
i. Misuse of mailing privilege (see 18 USC 1719).
j. Deceit in an examination or personnel action in connection with Government em-ployment (see 18 USC 1917).
k. Committing fraud or making false statements in a Government matter (see 18 USC 1001).
I. Mutilating or destroying a public record (see 18 USC 2071). .
m. Counterfeiting and forging transpor-tation requests (see 18 USC 508).
n. Embezzlement of Government money or property (see 18 USC 641); failing to ac-count for public money (see 18 USC 643); and embezzlement of the money or property of another person in the possession of an employee by reason of his Government em-ployment (see 18 USC 654).
( o. Unauthorized-use of documents relat-ing to claims from or by the Government (see 18 USC 285).
p. Certain political activities (see 5 USC 7321-7327 and 18 USC 602, 603, 607, and
21
608). These statutes apply to civilian em-ployees; regulations govern military personnel.
q. Any person who is required to register under the Foreign Agents Registration Act of 1938 (see 18 USC 219) may not serve the Government as an officer or employee. The section does not apply to-
(1) Reserves who are not on active duty or<whoare on active duty for training or
(2) A special Government employee in any case in which the department head cer-tifies to the Attorney General that his or her employment by the United States Govern-ment is in the national interest.
r. Soliciting contributions for gifts or giv-ing gifts to superiors, or accepting gifts from subordinates (see 5 USC 7351). (This prohi-bition applies to civilian employees.)
s. Acceptance of excessive honoraria (see 2 USC 441 (i)).
t. Acceptance, without Congressional au-thority, of any present, emolument, office or title, or employment of any kind whatever, from any king, prince, or foreign state by any person holding any office of profit in or trust of the Federal Government, including all retired military officers and Regular en-listed personnel. (US Constitution, Art. I, Sec.9., C1 8.)
5 SEPTEMBER 1986 UPDATE AR 600-50
Appendix C where an employee may properly be in those-such as Federal, State, or local tax-attendance; or (3) permitting acceptance of es-which are imposed by law. loans from banks or other financial institu-
FOR RELEASE TO MONDAY A.M. tions on customary terms to finance proper Part IIIStandards of Ethical Conduct for PAPERS, MAY 10, 1965 and usual activities of employees, such as Special Government Employees
home mortgage loans. This section shall be
Officeof the White House Press Secretary effectiveup0n issuance of such regu1ations. Sec. 301. This part applies to all "special(c) It is the intent of this section that em- G~~~~~~~~employees~as define, in set-
THE WHITE HOUSE ployees avoid any action, whether or tion 202 of Title 18 of the United Statesspecifically prohibited by subsection Code, who are employed in the Executive
EXECUTIVE ORDER 11222 which might result in, or create the appear- Branch. ance of-
PRESCRIBING STANDARDS OF ETHICAL CONDUCT FOR
GOVERNMENT OFFICERS AND EMPLOYEES
By virtue of the authority vested in me by Section 301 of Title 3 of the United States Code, and as President of the United States, it is hereby ordered as follows:
Part I-Policy
Sec. 101. Where government is based on the consent of the governed, every citizen is entitled to have complete confidence in the integrity of his government. Each individual officer, employee, or advisor of government must help to earn and must honor that trust by his own integrity and conduct in all offi-cial actions.
Part 11-Standards of Conduct
Sec. 201. (a) Except in accordance with regulations issued pursuant to subsection (b) of this section, no employee shall solicit or accept, directly or indirectly, any gift, gratu-ity, favor, entertainment, loan, or any other thing of monetary value, from any person, corporation, or group which-
(1) Has, or is seeking to obtain, contrac-tual or other business or financial relation-ships with his agency;
(2) Conducts operations or activities which are regulated by his agency; or
(3) Has interests which may be substan-tially affected by the performance or non-performance of his official duty.
(b) Agency heads are authorized to issue regulations, coordinated and approved by the Civil Service Commission, implementing the provisions of subsection (a) bf this se; tion and to provide for such exceptions therein as may be necessary and appropriate in view of the nature of their agency's work and the duties and responsibilities of their employees. For example, it may be appro-priate to provide exceptions (1) governing obvious family or personal relationships 'where the circumstances make it clear that it is those relationships rather than the busi-ness of the persons concerned which are the motivating factors-the clearest illustration being the parents, children or spouses of federal employees; (2) permitting accept-ance of food and refreshments available in the ordinary course of a luncheon or dinner or other meeting or on inspection tours
(1) Using public office for private gain; (2) Giving preferential treatment to any
organization or person; (3) Impeding government efficiency or
economy; (4) Losing complete independence or im-
partiality of action; (5) Making a government decision
outside official channels; or (6) Affecting adversely the confidence of
t h e public in the in tegr i ty of the Government.
Sec. 202. An employee shall not engage in any outside employment, including teach-ing, lecturing, or writing, which might re-sult in a conflict, or an apparent conflict, between the private interests of the employ-ee and his official government duties and re-sponsibilities, although such teaching, lecturing, and writing by employees are gen-erally to be encouraged so long as the laws, the provisions of this order, and Civil Ser-vice Commission and agency regulations covering conflict of interest and outside em-ployment are observed.
Sec. 203. Employees may not-(a) have direct or indirect financial inter-
ests that conflict substantially, or appear to conflict substantially, with their responsibil-ities and duties as Federal employees, or
(b) engage in, directly or indirectly, fi-nancial transactions as a result of, or pri-marily relying upon, information obtained through their employment. Aside from these restrictions, employees are free to en-gage in lawful financial transactions to the same extent as private citizens. Agencies may, however, further restrict such transac-tions in the light of the special circum-stances of their individual missions.
Sec. 204. An employee shall not use Fed-eral property of any kind for other than offi-cially approved activities. He must protect and conserve all Federal property, including equipment and supplies, entrusted or issued to him.
Sec. 205. An employee shall not directly or indirectly make use of, or permit others to make use of, for the purpose of furthering a private interest, official information not made available to the general public.
Sec. 206. An employee is expected to meet all just financial obligations, especially
Sec. 302. A consultant, adviser or other special Government employee must refrain from any use of his public office which is motivated by, or gives the appearance of be-ing motivated by, the desire for private gain for himself or other persons including par-ticularly those with whom he has family, business, or financial ties.
Sec. 303. A consultant, adviser, or other special Government employee sha?l not use any inside information obtained as a result of his government service for private per-sonal gain, either by direct action on his part or by counsel, recommendations or suggestions to others, including particularly those with whom he has family, business, or financial ties.
Sec. 304. An adviser, consultant, or other special Government employee shall not use his position in any way to coerce, or give the appearance of coercing, another person to provide any financial benefit to him or persons with whom he has family, business, or financial ties.
Sec. 305. An adviser, consultant, or other special Government employee shall not re-ceive or solicit from persons having business with his agency anything of value as a gift, gratuity, loan or favor for himself or per-sons with whom he has family, business, or financial ties while employed by the govern-ment or in connection with his work with the government.
Sec. 306. Each agency shall, at the time of employment of a consultant, adviser, or other special Government employee require him to supply it with a statement of all oth-er employment. The statement shall list the name; o i all the corporations, companies, firms, State or local government organiza-tions, research organizations and education-al or other institutions in which he is serving as employee, officer, member, own-er, director, trustee, adviser, or consultant. In addition, it shall list such other financial information as the appdinting department or agency shall decide is relevant in the light of the duties the appointee is ta per-form. The appointee may, but need not, be required to reveal precise amounts of invest-ments. The statement shall be kept current throughout the period during which the em-ployee is on the Government rolls.
25 SEPTEMBER 1986 UPDATE AR 600-50
Part IV-Reporting of Financial Interests
Sec. 401. (a) Not later than ninety days after the date of this order, the head of each agency, each Presidential appointee in the Executive Office of the President who is not subordinate to the head of an agency in that Office, and each full time member of a com-mittee, board, or commission appointed by the President, shall submit to the Chairman of the Civil Service Commission a statement containing the following:
(1) A list of the names of all corpora-tions, companies, firms, or other business enteiprises, partnerships, nonprofit organi-za t ions , and educat ional % o ro the r institutions-
(A) with which he is connected as an em-ployee, officer, owner, director, trustee, partner, adviser, or consultant; or
(B) in which he has any continuing finan-cial interests, through a pension or retire-ment plan, shared income, or otherwise, as a result of any current or prior employment or business or professional association; or
(C) in which he has any financial interest through the bwnership of stocks, bonds, or other securities.
(2) A list of the names of his creditors, other than those to whom he may be indebt-ed by reason of a mortgage on property which he occupies as a personal residence or to whom he may be indebted for current and ordinary household and living expenses.
(3) A list of his interests in real property or rights in lands, other than property which he occupies as a personal residence.@ (b) Each person who enters upon duty after the date of this order in an office or position as to which a statement is required by this section shall submit such statement not later than thirty days after the date of his entrance on duty.
(c) Each statement required by this sec-tion shall be kept up to date by submission of amended statements of any changes in, or additions to, the information required to be included in the original statement, on a quarterly basis.
Sec. 402. The Civil Service Commission shall prescribe regulations, not inconsistent with this part, to require the submission of statements of financial interests by such em-ployees, subordinate to the heads of agen-cies, as the Commission may designate. The Commission shall prescribe the form and content of such statements and the time or times and places for such submission.
Sec. 403. (a) The interest of a spouse, mi-nor child, or other member of his immediate household shall be considered to be an in-terest of a person required to submit a state-ment by or pursuant to this part.
(b) In the event any information required to be included in a statement required by or pursuant to this part is not known to the person required to submit such statement but is known to other persons, the person concerned shall request such other persons
to submit the required information on his behalf.
(c) This part shall not be construed to re-quire the submission of any information re-lating to any person's connection with, or interest in, any professional society or any charitable, religious, social, fraternal, educa-tional, recreational, public service, civic, or political organization or any similar organi-zation nat conducted as a business enter-prise and which is not engaged in the ownership or conduct of a business enterpise.
Sec. 404. The Chairman of the Civil Ser-vice Commission shall report to the Presi-dent information contained in statements required by Section 401 of this part which may indicate a conflict between the financial interests of the official concerned and the performance of his services for the Govern-ment. The Commission shall report, or by regulation require reporting, to the head of the agency concerned any information con-tained in statements submitted pursuant to regulations issued under Section 402 of this part which may indicate a conflict between the financial interests of the officer or em-ployee concerned and the performance of his services for the Government.
Sec. 405. The statements and amended statements required by or pursuant to this part shall be held in confidence, and no in-formation as to the contents thereof shall be disclosed except as the Chairman of the Civil Service Commission or the head of the agency concerned may determine for good cause shown.
Sec. 406. The statements and amended statements required by or pursuant to this part shall be in addition to, and not in sub-stitution for, or in derogation of, any similar requirement imposed by law, regulation, or order. The submission of a statement or amended statements required by or pursu-ant to this part shall not be deemed to per-mit any person to participate in any matter in which the participation is prohibited by law, regulation, or order.
Part V-Delegating Authority of the President Under Sections 205 and 208 of Title 18 of the United States Code
Relating to Conflicts of Interest
Sec. 501. As used in this part, "depart-ment" means an executive department, "agency" means an independent agency or establishment or a Government corporation, and "head of an agency" means, in the case of an agency headed by more than one per-son, the chairman or comparable member of such agency.
Sec. 502. There is delegated, in accord-ance with and to the extent prescribed in Sections 503 and 504 of this part, the au-thority of the President under Sections 205 and 208(b) of Title 18, United States Code, to permit certain actions by an officer or
employee of the Government, including a special Government employee, for appoint-ment to whose position the President is responsible.
Sec. 503. Insofar as the authority of the President referred to in Section 502 extends to an appointee of the President subordinate to or subject to the Chairmanship of the head of a department or agency, it is dele-gated to such department or agency head.
Sec. 504. Insofar as the authority of the President referred to in Section 502 extends to an appointee of the President who is within or attached to a department or agen-cy for purposes of administration, it is dele-gated to the head of such department or agency.
Sec. 505. Notwithstanding any provision of the preceding sections of this part, this part does not include a delegation of the au-thority of the President referred to in Sec-tion 502 insofar as it extends to:
(a) The head of any department or agen-cy in the Executive Branch;
(b) Presidential appointees in the Execu-tive Office of the President who are not sub-ordinate to the head of an agency in that Office; and
(c) Presidential appointees to commit-tees, boards, commissions, or similar groups established by the President.
Part VI-Providing for the Performance by the Civil Service Commission of Certain
Authority Vested in the President by Section 1753 of the Revised Statutes
Sec. 601. The Civil Service Commission is designated and empowered to perform, without the approval, ratification, or other action of the President, so much of the au-thority vested in the President by Section 1753 of the Revised Statutes of the United States (5 USC 631) as relates to establishing regulations for the conduct of persons in the civil service.
Sec. 602. Regulations issued under the authority of Section 601 shall be consistent with the standards of ethical conduct pro-vided elsewhere in this order.
Part VII-General Provisions
Sec. 701. The Civil Service Commission is authorized and directed, in addition to re-sponsibilities assigned elsewhere in this order:
(a) To issue appropriate regulations and instructions implementing Parts 11, 111, and IV of this order;
(b) To review agency regulations from time to time for conformance with this or-der; and
(c) To recommend to the President from time to time such revisions in this order as may appear necessary to ensure the mainte-nance of high ethical standards within the Executive Branch.
25 SEPTEMBER 1986 UPDATE AR 600-50
Sec. 702. Each agency head is hereby di-rected to supplement the standards provid-ed by law, by this order, and by regulations of the Civil Service Commission with regu-lations of special applicability to the partic-ular functions and activities of his agency. Each agency head is also directed to assure
(1) The widest possible distribution of regulations issued pursuant to this section, and
(2) The availability of counseling for those employees who request advice or interpretation.
Sec. 703. The following are hereby revoked:
(a) Executive Order No. 10930 of May 5, 1961.
(b) Executive Order No. 11125 of Octo-ber 29, 1963.
(c) Section 2(a) of Executive Order No. 10530 of May 10, 1954.
(d) White House memorandum of July 20, 1961, on "Standards of Conduct for Ci-vilian Employees."
(e) The President's Memorandum of May 2, 1963, "Preventing Conflicts of Inter-est on the Part of Special Government Em-ployees." T h e effective da te of this revocation shall be the date of issuance by the Civil Service Commission of regulations under Section 701(a) of this order.
Sec. 704. All actions heretofore taken by the President or by his delegates in respect to the matters affected by this order and in force at the time of the issuance of this or-der, including any regulations prescribed or approved by the President or by his dele-gates in respect to such matters, shall, ex-cept as they may be inconsistent with the provisions of this order or terminate by op-eration of law, remain in effect until amended, modified, or revoked pursuant to the authority conferred by this order.
Sec. 705. As issued in this order, and ex-cept as otherwise specifically provided here-in, the term "agency" means any executive department, or any independent agency or any Government corporation; and the term "employee" means any officer or employee of an agency.
LYNDON B. JOHNSON
THE WHITE HOUSE,
May 8, 1965
25 SEPTEMBER 1986 UPDATE AR 600-50'
Appendix D Code of Ethics for Government Service
A n y person in G o v e r n m e n t se rv ice should-
a. Put loyalty to the highest moral prin-ciples and to country above loyalty to per-sons, party, or Government department.
b. Uphold the Constitution, laws, and * regulations of the United States and of all
governments therein and never be a party to their evasion.
c. Give a full day's labor for a full day's pay; giving earnest effort and best thought to the performance of duties.
d. Seek to find and employ more efficient and economical ways of getting tasks accomplished.
e. Never discriminate unfairly by the dis-pensing of special favors or privileges to anyone, whether for remuneration or not; and never accept, for himself or herself or for family members, favors or benefits under circumstances which might be construed by reasonable persons as influencing the perfor-mance of governmental duties.
f: Make no private promises of any kind binding upon the duties of office, since a Government employee has no private word which can be binding on public duty.
g. Engage in no business with the Gov-ernment, either directly or indirectly, which is inconsistent with the conscientious per-formance of Government duties.
h. Never use any information gained con-fidentially in the performance of govern-mental duties as a means of making private profit.
i. E x p o s e c o r r u p t i o n w h e r e v e r discovered.
j. Uphold these principles, ever conscious that public office is a public trust.
25 SEPTEMBER 1986'UPDATE AR 600-50
Appendix E Examples of Conflicts of Interest Situations
The situations discussed below are merely examples of the types of activities or rela-tionships which may result in conflicts or the appearance of conflicts of interest. They are by no means the only ways that conflicts arise.
a. A person is responsible for major poli-cy issues that significantly affect the opera-tions of the Army, DOD, or the executive branch and has a financial interest in a de-fense contractor who may be affected by such operations. (Example: An officer is a member of the Selec t Commi t t ee (SELCOM), Program Guidance and Re-view Committee, General Staff Council, or Army Staff Council, and owns stock in cor-poration X, a possible subcontractor for a new weapon system.)
b. A person occupies a key sensitive posi-tion in the Army, is involved routinely and extensively with official decisions involving or affecting Army contractors, and has a fi-nancial interest in a contractor who-may be a f f e c t e d b y s u c h d e c i s i o n s . (Example: An officer is a member of ,the Budget Review Committee, in-process re-view groups, preliminary review groups, Army System Acquisition Review Council, or other council that exerts substantial in-fluence on the Army materiel acquisition process and owns corporate bonds in corpo-ration Y, a DOD contractor specializing in target acquisition systems.)
c. A person commands an organization and has a direct or indirect financial interest in an entity doing business with the organi-zation; or a person is a staff officer who is required to deal with or make recommenda-tions that may affect entities in which he or she has a direct or indirect financial interest. (Example 1: An installation or unit com-mander owns stock in corporation Y whose subsidiary, corporation Z, provides spare parts to the installation or unit through a local dealer under a basic ordering agree-ment. Even though the commander does not participate in the ordering of spare parts, subordinates acting under his or her authority are taking actions that appear to benefit his or her financial interests. Example 2: An officer with primary staff re-sponsibility for a subject area other than procurement (e.g., Director of Readiness) who owns stock in DOD contractors is required by job description to maintain liai-son with defense-related contractors who may be affected by decisions reached within the command. Fxample 3: An individual occupies a positlon as Head of Contracting Activity or functions as a principal staff as-sistant for procurement activities and owns stock in corporation X or its subsidiary that does or attempts to do business with that o r g a n i z a t i o n o r i t s s u b o r d i n a t e organizations.)
d. A person is involved through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or other-wise in official matters in which the person, a spouse, a dependent child, or member of the household has a direct or indirect finan-cial interest. (Example: An officer recom-mends level of supply for item X. His or her spouse owns stock in a subcontractor known to be involved in manufacture of item X.)
e. A person occupies a senior position having substantial responsibility and influ-
,ence and has financial interests in entities involved in his or her area of expertise. (Example: An officer who functions as the Army expert and point of contact for mat-ters in a particular subject area (e.g., CG, US Army Information Systems Command (USAISC), has holdings in a DOD contrac-tor that specializes in contracts on that par-ticular subject (e.g., communications and electronics material). Although the contrac-tor may not be doing business with the Army, an appearance of conflicting interests exists by virtue of the potential for personal and substantial participation by recommen-dation, advice, investigation, or otherwise in matters that may affect the contractor and benefit the financial holdings of the person.)
J: A person appears to have divided loy-alties between the duties of an official posi-tion and outside activities on behalf of a corporation (Example: An officer who ap-proves or is otherwise involved in DA rec-ommendations concerning Servicemen's Group Life Insurance (SGLI) serves on the board of directors for a tax exempt associa-tion that provides life insurance for its members.)
g. A person working in the research and development area has frequent contacts with either current or potential defense con-tractors. He or she decides that he or she should leave Government service (by either retirement or resignation). The individual contacts the representatives of the compa-nies with which he or she has officially dealt to explore the possibility of future employ-ment. If the employee then participates in an official matter that affects the company with which he or she is discussing future employment, he or she has a conflict of in-terest under 18 USC 208. Any contact relat-ing to future employment in which an individual voluntarily participates is consid-ered negotiating for employment. This is the case even when the contact is initiated by the prospective employer.
25 SEPTEMBER 1986 UPDATE AR 600-50
Glossary
Sectlon I
Army National Guard
JTR Joint Travel Regulation
MACOM
a person on leave from or having any under-standing, plans, or pending contacts regard-ing such a relationship in the future.
Major Army Command DA personnel All civilian officials and employees of DA,
NAFI including special Government employees nonappropriated fund instrumentality and employees of NAFIs; all active duty of-
ficers (commissioned and warrant); ~rofes-
ARNGUS OGE
Army National Guard of the United States Office of Government Ethics sors and cadets a t the US Mfiitary Academy; and enlisted members of the Army. In chapters 1 and 2, the term also in-
OJCS cludes all officers and enlisted personnel of ARSTAF Army Staff
Organization of The Joint Chiefs of Staff the Army Reserve and Army National Guard of the United States when they are
OPM performing Federal duties or engaging in CFR Office of Personnel Management any activity directly related to the perfor-Code of Federal Regulations mance of a Federal duty or function.
CPO civilian personnel office
CPR civilian personnel regulation
DA Department of the Army
DAEO designated agency ethics official
DCA Defense Communications Agency
DIA Defense Intelligence Agency
dir directive
DNA Defense Nuclear Agency
DOD Department of Defense
DOJ Department of Justice
DSCC Deputy Standards of Conduct Cou
FAR Federal Acquisition Regulations
FOIA Freedom of Information Act
FPM Federal Personnel Manual
GS general schedule
HHS Health and Human Services
IG inspector general
OSD Office of the Secretary of Defense
PL public law
RA Regular Army
SA Secretary of the Army
SES Senior Executive Service
SGLI Servicemen's Group Life Insurance
SJA staff judge advocate
TIG The Inspector General
TJAG The Judge Advocate General
TRADOC Training and Doctrine Command
UCMJ 'Uniform Code of Military Justice
nselor USAFAC US Army Finance and Accounting Center
USAISC US Army Information Systems Command
USAR United States Army Reserve
USC United States Code
Section II Terms
Affiliation A relationship as an employee, officer, own-er, director, member, trustee, partner, advis-er, agent, representative, or consultant, or as
Designated agency ethics official The official (i.e., Army General Counsel) designated by the Secretary of the Army to administer the Standards of Conduct or the delegate (i.e., The Judge Advocate General) of s ch an official.P DOD contractor A person, corporation or other entity that provides services or supplies, or both, to DOD under a contract directly with DOD (e.g., NAFI contractors).
DOD personnel All civilian officials and employees, includ-ing special Government employees, of all the offices, agencies, and departments in DOD (including NAFIs), all active duty of-ficers (commissioned and warrant), and en-listed members of the Army, Navy, Air Force, and Marine Corps.
Employment A relationship under which an individual
Former officers or employees This term includes full-time civilian officers or employees who have left Government service, special Government employees who have left Government service, retired of-ficers released from active duty, and Re-serve officers released from active duty. The term does not include enlisted personnel.
Frocked This term is generally limited to officers in the grades of 0-6 and higher and refers to the act of officially wearing the rank insignia of a higher grade for prestige or other neces-sary purposes but without receiving the pay and allowances of the higher grade nor pos-sessing the authority to perform functions of the higher grade that are required by law or regulation. (See AR 624-100, para 2-12.)
Gratuity Any gift, favor, entertainment, hospitality, meal, transportation, loan, or other tangible
25 SEPTEMBER 1986 UPDATE AR 600-50 43
item, and any intangible benefits (for exam-ple discounts, passes, and promotional ven-dor training), given or extended to or on behalf of DOD personnel, their immediate families, or households for which fair mar-ket value is not paid by the recipient or the US Government.
~ono;arium A payment of money or anything of value to DA personnel as consideration for an ap-pearance, speech, or article.
Inside information Information-
a. That is gained by DA personnel and former officers and employees while they are or were employed by their agency;
b. That is of a privileged nature
. . . .-i.e, any information that is received by the individual which they know or reasonably should know is not in-tended for public dissemination); and
c. The use of which would give the indi-vidual or third party an unfair advantage in a commercial or some other activity.
MACOM commanders and major commanders Those commanders listed in AR 10-5; the Superintendent, US Military Academy; and the Commanding General, US Army Recruiting Command.
Military personnel All officers (commissioned and warrant), professors, and cadets at the US Military Academy, and enlisted personnel of the Army on active duty.
Nominal value An item that is of a sentimental nature and that has little or no intrinsic value to one other than the recipient.
Procurement function Any function relating to--
a. The negotiation, award, administra-tion, or approval of a contract;
b. The selection of a contractor: c. The negotiation or approval of changes
in a contract; d. Quality assurance, operation and devel-
opmental testing, the approval of payment or auditine of a orocurement Droeram.
Procurement official DA personnel who have participated in the performance of any procurement function-% connection with a contract for $25.000 or more awarded by DOD.
Reserve officer Includes both officers of the ARNGUS and the USAR:
Senior employees and designated positions A civilian employee at the executive level, or a three- or four-star general. I t also means other persons holding positions that
have been designated as senior employee po-sitions by the Director, Office of Govern-ment Ethics.
_L-__l_--l-senior Ethics Counselor or Ethics Counselor Those personnel designated to serve in the , capacities described in paragraph 2-9. This term includes those persons performing sim-ilar duties in agencies outside DOD.
Special Government employee A person who is retained, designated, ap-pointed, or employed to perform, with or without compensation, not to exceed 130 days during any period of 365 consecutive days, temporary duties either on a full-time or intermittent basis. The term also includes a Reserve officer while on active duty solely for training for any length of time, or who is serving voluntarily on extended active duty for 130 days or less. It does not include en-listed personnel.
25 SEPTEMBER 1986 UPDATE AR 600-50
M TAB TAB TAB TAB TAB i I I I I I I
CERTIFICATE OF PRELIMINARY REVIEW OF SF 278 For use of this form, see AR 600-50; the proponent agency is TJAG
I I I REPORTING REPORTING SUPERVISOR'S
EACH REVIEWER CHECK APPROPRIATE BLOCKS I INDIVIDUAL'S INDIVIDUAL'S I DSCC DSCC SUPERVISOR,
1. I have thoroughly reviewed the attached Financial Disclosure Report 1)
(SF 278), dated
with any attachments, submitted by: ~
the reporting individual. My review considered the reported financial interests/affiliations in light of the reporting individual's duties (past, present, or prospective, as applicable) to determine the presence of both actual and apparent conflicts of interests.
2. On the basis of my review, I have determined that:
a. The form is administratively correct.
(1) All information related to official matters (e.g., title of position, dale of appointment or termination, etc.) is correct;
(2)All items appear complete (i.e., there is an entry or the word "None" in every section);
(3)All required schedules are completed (i.e., schedules A, B, C,and D are completed for annual and termination Reports, schedules A and D are completed for nomination and assumption Reports); and
(4) The reported information is consistent (e.g., an investment asset reported in (4)schedule B as having been purchased or sold during the reporting period normally should be listed in schedule A as well).
b. A position description, in sufficient detail to accomplish a meaningful review, and other pertinent documents are attached to the Financial Disclosure Report.
c. No conflict or appearance of confllct exists. This determination is based on the fact that: (NOTE: Items (I), (2) and (3) are mutually exclusive, therefore check only one.)
(1) No financial interests/affiliations have been reported;
(2) No entities in which a financial interest/affiliation has been reported do or attempt to do business, in their own name or through wholly owned or controlled subsidiaries, with any organization/activity within which the reporting individual performs duties or exercises official influence; or
(3)Although the following entities in which a financial interest/affiliation has been ( 3 )reported do or attempt to do business with an organization/activity within which the reporting individual performs duties or exercises official influence, the duties of the reporting individual are completely unrelated to matters involving these entities (list these entities here *):
'The reporting individual's DSCC will determine which, if any, of the entities are do~ng business with the reporting ~ndividual'sorganization/activity and list those entities here and/or in para 2d in the space provided. If the reportin individual's supervisor or the supervisor's DSCC is aware of the additional entities, he or she sfould also list them.
I
DA FORM 4971-R, OCT 84 EDITION OF JUL 82 IS OBSOLETE
, M TAB TAB TAB TAB
1 REPORTING (EACH REVIEWER CHECK APPROPRIATE BLOCKS) INDIVIDUAL'S
DSCC
d A conflict or appearance of conflict exists because duties require the 24@ reporting individual's participation in matters involving, or which reasonably appear to involve, the following reported financial interestslaffiliations (list these entities hem):
This conflict or appearance of conflict (has been) (will be) resolved by: I I ( 1 ) Formal disqualification (copy attached). I I I
I I
(2) Change or limitation of duties without reassignment.
(3) Divestiture of the interest (or termination of the aniliation) and disqualification, if necessary, pending such divestiture (or termination of the affiliation).
(4) Transfer, reassignment, or resignation.
(5) Exemption under 18 U.S.C. 208(b). Reported interests have properly been determined by the reporting individual's immediate supervisor (paragraph 2-1 lg, AR 600-50) not to be so substantial as to affect the integrity of the Individual's service. A comprehensive determination and finding is attached.
(6) Establishment of a qualified blind trust IAW the Ethics in Government (6) Act. (Because this does not resolve the conflict or appearance of conflict for some time. One or more of the alternatives above must be used in the interim.)
3. Additional comments to expedite final review at Headquarters. Department of 3) the Army, are attached. (If none, do not check this block.)
4. Based on the results of my review (and corrective action taken, if necessaIy), Ihave determined that: except as noted above, the information contained in this Financial Disclosure Report discloses no conflict of interest under applicable laws and regulations.
a. NAME RANK TELEPHONE NUMBER
I TITLE ORGANIZATION
Deputy Standards of Conduct Counselor of Reporting Individual SIGNATURE DATE
1 b. NAME RANK TELEPHONE NUMBER
I TITLE ORGANIZATION Supervisot of Reporting Individual
SIGNATURE DATE
c. NAME RANK TELEPHONE NUMBER I
Deputy Standards of Conduct I 'TITLE ORGANIZATION
Counselor of Immediate Supervisor SIGNATURE DATE
PAGE 4 01FORM 4971-R, OCT 84
a U . S . GOVERNMENT PRINTING OFFICE: 1986-490-999~40372
25 SEPTEMBER 1986 UPDATE R-FORMS
Forward to unit publlcatlons officer for consolidation on DA Form 12-QU-R
Fill out ... Deta&..
This page Is for internal use within your 2. The unit publications offlcer should unit. consolidate the entire unit's requirements, 1. To change their initial distribution enter those requirements on DA Form requirements, individual users or sections 12-QU-R, and submit the DA 12-QU-R to of a unit should complete this DA Form the address preprlnted on the form. Only 12-13 (UPDATE Subscription Page) and unit publications officers may submit DA submit it to their unit publications officer. Form 12-QU-R. (DA 12-Series Circular).
(Publication No.) AR 600 -50
To: Publications Officer
FOR COMPLETION BY USER OF PUBLICATION
From: (Organ~zatlon, Name, and Telephone Number)
Number of copies desired Current number of copies received. for section use
DA FORM 12 - 13, Previous editions of DA Form 12 - 1 3 are obsolete and may 110t be used. I