Standards of Conduct for Department of the Army · PDF file · 2006-09-29Standards of Conduct for Department of the Army Personnel ... of the US Army Reserve and of the Army ... to

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 negotiating 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, consistent with changes to 10 USC 2397.

o Restructures paragraph 2-2 into three topic areas: gratuities, 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 concerning the receipt of benefits incident to official travel, 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

2

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


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

3

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



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.

3 7

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 compensation, 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 requirements of this regulation. This includes the requirement to avoid actions that reasonably 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 sensitive positions involving classified information 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 civilian-pursuit or business, or a professional activity in civil life, for emolument, hire, or otherwise if the pursuit, business,. or professional 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 preclude 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 personnel 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 conformance with the provisions of this regulation. After a strike begins and while it continues, no military personnel may accept employment with the involved entity at 'the strike location.

d. DA personnel are encouraged to engage in teaching, lecturing, and writing. However, they will not, either with or without compensation, engage in activities that are dependent on information obtained as a result of their Government employment, except 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


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


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


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.-


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


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.


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 inat 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


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.


(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


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


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


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


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


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


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

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ece,

hus

band

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~fe

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ndfa

ther

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andm

othe

r, gr

ands

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rand

daug

hter

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her-

~n

-la

w.M

othe

rin-la

w,s

on-ln

-law

,dau

ghte

r-ln

-law

, br

othe

r-ln

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, 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

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ref

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if they

have

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61 d

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e pm

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dur

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mitt

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ernm

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mpkye

es (see5

.C

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. 57

34.2

02(h

)).

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Whe

n to

File

, a.

With

in 3

0 da

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fter

beco

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andi

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for

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inat

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or e

lect

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to th

e of

fice

of P

resi

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Pre

side

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r by

May

15

of t

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alen

dar

year

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late

r, an

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or

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ay 1

5 of e

ach

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ear

that

suc

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indi

vidu

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cont

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andi

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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

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an

in-

divi

dual

ref

erre

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in

sec

tion

Il(b)

of

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e in

stru

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tha

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t any

tim

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-te

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e P

resi

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Pre

side

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lect

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publ

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noun

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his

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tent

ion

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omin

ate

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indi

vidu

al.

c. W

ithin

30

da

ys

afler

assu

min

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posi

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desc

ribed

inse

ctio

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c)un

less

such

an

ind

iiw

l ha

s le

ft an

othe

r pos

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des

crib

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sect

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Il(c)

w

ithin

30

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prio

r to

ass

umin

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e ne

w p

osi-

tion,

or

has

alre

ady

filed

a re

port

with

res

pect

lo

nom

inat

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for

the

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pos

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Il(b)

) or

as a

can

dida

te fo

r th

e po

sitio

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ectio

n Il(

a)).

d. N

o la

ter

than

May

15

annu

ally

, in

the

case

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thos

e in

a p

ositi

on d

escr

ibed

in s

ectio

n Il(

c). I

n

the

even

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inat

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men

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d do

es

not

acce

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noth

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posi

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ectio

n Il(

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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

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Com

mis

sion

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The

Pre

side

nt a

nd V

ice

Pre

side

nt, w

ith the

Of-

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thic

s.

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f a u

nifo

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vice

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Ser

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con

cern

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d. A

ll ot

hers

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the

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genc

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whi

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e in

divi

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m-

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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

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y th

e P

resi

dent

to p

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requ

ir-in

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onfir

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V.

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ruct

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Thi

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ront

pag

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ur

Sch

edul

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ou m

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ompl

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each

Par

t of

all

Sch

edul

es. I

f you

hav

e no

info

rmat

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epor

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Par

t of

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y P

art o

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edul

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om c

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ith the

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clos

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e as

ass

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page

s.

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form

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disc

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at w

hich

th

e E

thic

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ernm

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ct o

f 19

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m

ay, h

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nclu

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sec

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he fo

rm

such

add

ition

al in

form

atio

n, b

eyo

ndih

e A

ct's

re

qu

irem

ents

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you

may

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clos

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r pu

r-

pose

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cla

rific

atio

n.

c. c

om

bin

e o

n on

e fo

rrn

the

info

rmat

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appl

icab

le

to y

ours

elf,

your

spo

use

and

depe

nden

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ldre

n;

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f mor

e co

nven

ient

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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

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pre

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e en

try w

ith a

n (S

) if

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for

a sp

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f it

pert

ains

to a

dep

ende

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Def

initi

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f the

var

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term

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ed in

thes

e in

- st

ruct

ions

and

det

aile

d in

form

atio

n as

to w

hat

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requ

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sclo

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are

corlt

aine

d in

5 C

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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

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sta

n-

dard

refe

renc

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ater

ials

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h as M

oody

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anu-

al

s)-w

heth

er

such

ent

ities

are

ope

ratin

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des

or b

usin

esse

s. or

priv

ate

inve

strn

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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

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tere

sts

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activ

ities

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t so

lely

inci

dent

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suc

h a

prim

ary

trade

or

busi

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. For

inst

ance

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our

fam

ily s

wim

min

g po

ol s

ervi

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corp

orat

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liab

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ur-

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apa

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r in

vest

men

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d-

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its

pool

serv

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bus

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ou w

ill h

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to re

port

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indi

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lloca

Me

shar

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the

cor-

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bilit

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e a

patim

ent h

ouse

inve

st-

men

t, an

d its

pur

chas

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add

ition

to th

e ite

ms

you?

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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

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usin

ess

nor s

uch

thin

gs as

the

nor-

m

al a

nd c

usto

mar

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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

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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

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urce

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will

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epor

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e va

lue

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d in

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the

type

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ount

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ncom

e ge

nera

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at

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rece

ived

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non-

asse

t sou

rce.

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D

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que

stio

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sign

ed to

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cum

bent

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rmin

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ers

to S

ched

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r ce

rtai

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ite

ms

they

hav

e lis

ted

in B

LOC

K A

.

On

Sch

edul

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are

two

exam

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re r

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he fi

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port

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rived

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e, a

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tiviti

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capi

tal a

ccou

nt i

n the

law

firm

at

the

end

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he

and

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port

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f, in

the

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or m

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ndiv

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mee

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line

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hen

you

have

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um-

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eren

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ds o

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gem

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actio

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a fu

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ntity

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w m

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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

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PUBLIC LAW 91.121

JONES 8 PAUL Q 1 2400 GLEBE ROAD, ARLINCTOM VA 22857 1 35-67-8920

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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

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(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.

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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


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.


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.)


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.


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.


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.


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


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.


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

Documents

Standards of Conduct for Department of the Army · PDF file · 2006-09-29Standards of Conduct for Department of the Army Personnel ... of the US Army Reserve and of the Army ... to