Form Approved: OMB No. 3209-0007
(Revised 2/2023, Expires 2/28/2026)
U.S. OFFICE OF GOVERNMENT ETHICS
Blind Trust Communications
Expedited procedure for securing approval of proposed communications.
Under the requirements of the Ethics in Government Act, the regulations of the U.S. Office of Government Ethics, and the provisions of trust instruments that have been approved by this Office, all communications between the trustee of a qualified trust and the interested parties or their representatives must be in writing and specifically approved by the Director of the U.S. Office of Government Ethics prior to being transmitted. No oral communications are permitted. The only exceptions to the prior approval requirement for written communications relate to quarterly and annual reports conforming to standard formats, which are distributed by the trustee.
The most expedient manner of securing prior approval is to email a copy of the proposed communication to the U.S. Office of Government Ethics attorney assigned to your trust.
Our staff is always available to discuss a proposed communication or any other concerns which may arise by telephone: 202-482-9300. Please direct your telephone calls to the attorney assigned to your trust.
January 15, 2022
MODEL QUARTERLY REPORT TO SETTLOR
Honorable Marcus M. Mandarin
Chairman, Regulatory Commission
Washington, DC 20415
Re: Qualified Blind Trust
of March 20, 2020
Dear Mr. Mandarin:
Pursuant to Paragraph (A) of Article SIXTH of your Qualified Blind Trust, this is to inform you that as of December 31, 2021, the aggregate market value of the assets representing your interest in the Trust was $1,894,532.00.
Sincerely,
Metropolis Trust Company
by:
__________________________
Trust Officer
cc: Director, U.S. Office of Government Ethics
Suite 500
1201 New York Avenue, NW.
Washington, DC 20005-3917
January 15, 2022
MODEL REPORT OF ASSET SOLD OR VALUE LESS THAN $1,000
Honorable Marcus M. Mandarin
Chairman, Regulatory Commission
Washington, DC 20415
Re: Qualified Blind Trust
of March 20, 2020
Dear Mr. Mandarin:
Pursuant to Article Fourth of your Qualified Blind Trust, this is to inform you that as of December 31, 2021, ____________ has been completely disposed of or has a value of less than $1,000.
Sincerely,
Metropolis Trust Company
by:
__________________________
Trust Officer
cc: Director, U.S. Office of Government Ethics
Suite 500
1201 New York Avenue, NW.
Washington, DC 20005-3917
January 15, 2022
MODEL QUARTERLY REPORT TO SETTLOR
Honorable Marcus M. Mandarin
Chairman, Regulatory Commission
Washington, DC 20415
Re: Qualified Diversified
Trust of March 20, 2020
Dear Mr. Mandarin:
Pursuant to Paragraph (A) of Article SEVENTH of your Qualified Diversified Trust, this is to inform you that as of December 31, 2021, the aggregate market value of the assets representing your interest in the Trust was $1,894,532.00.
Sincerely,
Metropolis Trust Company
by:
__________________________
Trust Officer
cc: Director, U.S. Office of Government Ethics
Suite 500
1201 New York Avenue, NW.
Washington, DC 20005-3917
January 15, 2022
MODEL ANNUAL REPORT TO SETTLOR
Honorable Marcus M. Mandarin
Chairman, Regulatory Commission
Washington, DC 20415
Re: Qualified Blind Trust
of March 20, 2020
Dear Mr. Mandarin:
Pursuant to Paragraph (B) of Article SIXTH of your Qualified Blind Trust, your K-1 for the Trust with respect to the calendar year 2021 is hereby transmitted to you.
Sincerely,
Metropolis Trust Company
by:
__________________________
Trust Officer
Enclosure
cc (with enclosure):
Director, U.S. Office of Government Ethics
Suite 500
1201 New York Avenue, NW.
Washington, DC 20005-3917
January 15, 2022
MODEL ANNUAL REPORT TO SETTLOR
Honorable Marcus M. Mandarin
Chairman, Regulatory Commission
Washington, DC 20415
Re: Qualified Diversified
Trust of March 20, 2020
Dear Mr. Mandarin:
Pursuant to Paragraph (B) of Article SEVENTH of your Qualified Diversified Trust, this is to inform you that for the calendar year 2021, $46,589.54 was paid to you in respect of such Trust (or applied for your benefit therefrom).
Sincerely,
Metropolis Trust Company
by:
__________________________
Trust Officer
cc: Director, U.S. Office of Government Ethics
Suite 500
1201 New York Avenue, NW.
Washington, DC 20005-3917
Privacy Act Statement
Section 102(f) of the Ethics in Government Act of 1978 as amended (the “Act”), 5 U.S.C. Appendix, § 102(f), and subpart D of 5 C.F.R. part 2634 of the regulations of the U.S. Office of Government Ethics (OGE) require the reporting of this information for the administration of qualified trusts under the Act. The consequences of failing to provide the requested information are as follows: for proposed qualified trusts, OGE may be unable to review or approve the trust under the Act; for existing qualified trusts, OGE may revoke the trust certification or trustee approval previously granted. The primary use of the information on the trust instrument prepared based in part upon this model draft document is for review by Government officials of OGE and the agency of the Government employee for whom the trust is being established to determine compliance with applicable Federal laws and regulations as regards qualified trusts. Additional disclosures of the information may be made:
To disclose pertinent information to the appropriate Federal, State, or local agency responsible for investigating, prosecuting, enforcing, or implementing a statute, rule, regulation, or order where the disclosing agency becomes aware of an indication of a violation or potential violation of civil or criminal law or regulation.
To disclose information to any source when necessary to obtain information relevant to a conflict-of-interest investigation or determination.
To disclose information to the National Archives and Records Administration or the General Services Administration in records management inspections conducted under authority of 44 U.S.C. 2904 and 2906.
To disclose information to the Office of Management and Budget at any stage in the legislative coordination and clearance process in connection with private relief legislation as set forth in OMB Circular No. A-19.
To disclose information when the disclosing agency determines that that the records are arguably relevant to a proceeding before a court, grand jury, or administrative or adjudicative body; or in a proceeding before an administrative or adjudicative body when the adjudicator determines the records to be relevant to the proceeding.
To disclose the public financial disclosure report and any accompanying documents to reviewing officials in a new office, department or agency when an employee transfers or is detailed from a covered position in one office, department or agency to a covered position in another office, department or agency.
To disclose information to a Member of Congress or a congressional office in response to an inquiry made on behalf of, and at the request of, an individual who is the subject of the record.
To disclose the information to contractors, grantees, experts, consultants, detailees, and other non-Government employees performing or working on a contract, service, or other assignment for the Federal Government, when necessary to accomplish an agency function related to this system of records.
To disclose information to appropriate agencies, entities, and persons when: (1) the agency maintaining the records suspects or has confirmed that there has been a breach of the system of records; (2) the agency maintaining the records has determined that as a result of the suspected or confirmed breach there is a risk of harm to individuals, the agency (including its information systems, programs, and operations), the Federal Government, or national security; and (3) the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with the agency's efforts to respond to the suspected or confirmed breach or to prevent, minimize, or remedy such harm.
To disclose information to another Federal agency or Federal entity, when the agency maintaining the record determines that information from this system of records is reasonably necessary to assist the recipient agency or entity in (1) responding to a suspected or confirmed breach or (2) preventing, minimizing, or remedying the risk of harm to individuals, the recipient agency or entity (including its information systems, programs, and operations), the Federal Government, or national security, resulting from a suspected or confirmed breach.
For additional information please see the OGE/GOVT-1 Governmentwide Privacy Act System of Records.
Penalties
Knowing or willful falsification of information on the trust document prepared from this model draft or failure to file or report information required to be reported under Title I of the Act and 5 C.F.R. part 2634 of the OGE regulations may lead to disqualification as a trustee or other fiduciary as well as possible disqualification of the underlying trust itself. Knowing and willful falsification of information required under the Act and the regulations may also subject you to criminal prosecution.
Public Burden Information and Paperwork Reduction Statement
This collection of information is estimated to take an average of 20 minutes per communication letter, given the estimated amount of time deemed necessary to prepare a communication. You can send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Program Counsel, U.S. Office of Government Ethics, Suite 500, 1201 New York Avenue, NW., Washington, DC 20005-3917. Do not send your completed communication letter to this address; rather, see the remainder of the instructions to this model set of drafts.
Pursuant to the Paperwork Reduction Act, as amended, an agency may not conduct or sponsor, and no person is required to respond to, a collection of information unless it displays a currently valid OMB control number (that number, 3209-0007, is displayed here and in the upper right-hand corner of the first page of this OGE model qualified trust draft document).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | aebraud |
| File Modified | 0000-00-00 |
| File Created | 2022-10-19 |