OGE Form 278e Executive Branch Personnel Public Financial Disclosure R

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Ammal Report 2024 for Calendar Year 2023 I U.S. Office of Government Ethics; 5 C.F.R. part 2634 I Form Appro\'ed: 0MB No. (3209-0001) (Updated Nov. 2021)

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Executive Branch Personnel
Public Financial Disclosure Report (OGE Form 278e)

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Electronic Signature - I certify that the statements ! have made In this form are true, complete and correct to the best of my knowledge.
Agency Ethics Offtcfal's Opinion - On the basis of Information contained In this report. I conclude that the filer Is In compliance with applicable laws and regulations (subject to any comments below).
Reponoata(Summary)

Other review conducted by
U.S. Office of Government Ethics Certification

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Warnings

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Knowing and willful falsification of information, or failure to file or report information required to be reported by section 102 of the Ethics in Government Act of 1978. as amended {the Act), may subject you to a civil monetary penalty and to disciplinary action by
your employing agency or other appropriate authority under section 104 of the Act Knowing and willful falsification of Information required to be filed by section 102 of the Act may also subject you to criminal prosecution.
I certify that the statements I have made In this report are true, complete, and correct to the best of my knowledge.

Knowing and willful falsification of information, or failure to file or report information required to be reported by
5 U.S.C. § 13104 of the Ethics in Government Act of 1978, as amended (the Act), may subject you to a civil
monetary penalty and to disciplinary action by your employing agency or other appropriate authority under
5 U.S.C. § 13106 of the Act. Knowing and willful falsification of information required to be filed by 5 U.S.C. § 13104 of
the Act may also subject you to criminal prosecution.

Annual Report 2024 for Calendar Year 2023 | U.S. Office of Government Ethics; 5 C.F.R. part 2634 | Form Approved: OMB No. (3209-0001) (Updated Nov. 2021)

Executive Branch Personnel
Public Financial Disclosure Report (OGE Form 278e)
Filer's Information
Sample Agency, Filer
Test Privacy Act Statement, Sample Agency
Report Year: 2024
Other Federal Government Positions Held During the Preceding 12 Months:
None

Electronic Signature - I certify that the statements I have made in this form are true, complete and correct to the best of my knowledge.

Agency Ethics Official's Opinion - On the basis of information contained in this report, I conclude that the filer is in compliance with applicable laws and regulations (subject to
any comments below).

Other review conducted by

U.S. Office of Government Ethics Certification

Sample Agency, Filer - Page 1

1. Filer's Positions Held Outside United States Government
None

2. Filer's Employment Assets & Income and Retirement Accounts
None

3. Filer's Employment Agreements and Arrangements
None

4. Filer's Sources of Compensation Exceeding $5,000 in a Year
(N/A) - Not required for this type of report

5. Spouse's Employment Assets & Income and Retirement Accounts
None

6. Other Assets and Income
None

Sample Agency, Filer - Page 2

7. Transactions
None

8. Liabilities
None

9. Gifts and Travel Reimbursements
None

Endnotes

Sample Agency, Filer - Page 3

Summary of Contents
1. Filer's Positions Held Outside United States Government
Part 1 discloses positions that the filer held at any time during the reporting period (excluding positions with the United States Government). Positions are reportable even if the
filer did not receive compensation.
This section does not include the following: (1) positions with religious, social, fraternal, or political organizations; (2) positions solely of an honorary nature; (3) positions held as
part of the filer's official duties with the United States Government; (4) mere membership in an organization; and (5) passive investment interests as a limited partner or nonmanaging member of a limited liability company.
2. Filer's Employment Assets & Income and Retirement Accounts
Part 2 discloses the following:
●

●

Sources of earned and other non-investment income of the filer totaling more than $200 during the reporting period (e.g., salary, fees, partnership share, honoraria,
scholarships, and prizes)
Assets related to the filer's business, employment, or other income-generating activities (1) that ended the reporting period with a value greater than $1,000 or (2) from
which more than $200 in income was received during the reporting period (e.g., equity in business or partnership, stock options, retirement plans/accounts and their
underlying holdings as appropriate, deferred compensation, and intellectual property, such as book deals and patents)

This section does not include assets or income from United States Government employment or assets that were acquired separately from the filer's business, employment, or
other income-generating activities (e.g., assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0 - $200 or if the
asset qualifies as an excepted investment fund (EIF).
3. Filer's Employment Agreements and Arrangements
Part 3 discloses agreements or arrangements that the filer had during the reporting period with an employer or former employer (except the United States Government), such as
the following:
●
●
●
●
●

Future employment
Leave of absence
Continuing payments from an employer, including severance and payments not yet received for previous work (excluding ordinary salary from a current employer)
Continuing participation in an employee welfare, retirement, or other benefit plan, such as pensions or a deferred compensation plan
Retention or disposition of employer-awarded equity, sharing in profits or carried interests (e.g., vested and unvested stock options, restricted stock, future share of a
company's profits, etc.)

Sample Agency, Filer - Page 4

4. Filer's Sources of Compensation Exceeding $5,000 in a Year
Part 4 discloses sources (except the United States Government) that paid more than $5,000 in a calendar year for the filer's services during any year of the reporting period.
The filer discloses payments both from employers and from any clients to whom the filer personally provided services. The filer discloses a source even if the source made its
payment to the filer's employer and not to the filer. The filer does not disclose a client's payment to the filer's employer if the filer did not provide the services for which the client
is paying.
5. Spouse's Employment Assets & Income and Retirement Accounts
Part 5 discloses the following:
●

●
●

Sources of earned income (excluding honoraria) for the filer's spouse totaling more than $1,000 during the reporting period (e.g., salary, consulting fees, and partnership
share)
Sources of honoraria for the filer's spouse greater than $200 during the reporting period
Assets related to the filer's spouse's employment, business activities, other income-generating activities (1) that ended the reporting period with a value greater than $1,000
or (2) from which more than $200 in income was received during the reporting period (e.g., equity in business or partnership, stock options, retirement plans/accounts and
their underlying holdings as appropriate, deferred compensation, and intellectual property, such as book deals and patents)

This section does not include assets or income from United States Government employment or assets that were acquired separately from the filer's spouse's business,
employment, or other income-generating activities (e.g., assets purchased through a brokerage account). Note: The type of income is not required if the amount of income is $0
- $200 or if the asset qualifies as an excepted investment fund (EIF). Amounts of income are not required for a spouse's earned income (excluding honoraria).
6. Other Assets and Income
Part 6 discloses each asset, not already reported, (1) that ended the reporting period with a value greater than $1,000 or (2) from which more than $200 in investment income
was received during the reporting period. For purposes of the value and income thresholds, the filer aggregates the filer's interests with those of the filer's spouse and dependent
children.
This section does not include the following types of assets: (1) a personal residence (unless it was rented out during the reporting period); (2) income or retirement benefits
associated with United States Government employment (e.g., Thrift Savings Plan); and (3) cash accounts (e.g., checking, savings, money market accounts) at a single financial
institution with a value of $5,000 or less (unless more than $200 in income was received). Additional exceptions apply. Note: The type of income is not required if the amount of
income is $0 - $200 or if the asset qualifies as an excepted investment fund (EIF).

Sample Agency, Filer - Page 5

7. Transactions
Part 7 discloses purchases, sales, or exchanges of real property or securities in excess of $1,000 made on behalf of the filer, the filer's spouse or dependent child during the
reporting period.
This section does not include transactions that concern the following: (1) a personal residence, unless rented out; (2) cash accounts (e.g., checking, savings, CDs, money
market accounts) and money market mutual funds; (3) Treasury bills, bonds, and notes; and (4) holdings within a federal Thrift Savings Plan account. Additional exceptions
apply.
8. Liabilities
Part 8 discloses liabilities over $10,000 that the filer, the filer's spouse or dependent child owed at any time during the reporting period.
This section does not include the following types of liabilities: (1) mortgages on a personal residence, unless rented out (limitations apply for PAS filers); (2) loans secured by a
personal motor vehicle, household furniture, or appliances, unless the loan exceeds the item's purchase price; and (3) revolving charge accounts, such as credit card balances,
if the outstanding liability did not exceed $10,000 at the end of the reporting period. Additional exceptions apply.
9. Gifts and Travel Reimbursements
This section discloses:
●
●

Gifts totaling more than $480 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.
Travel reimbursements totaling more than $480 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.

For purposes of this section, the filer need not aggregate any gift or travel reimbursement with a value of $192 or less. Regardless of the value, this section does not include the
following items: (1) anything received from relatives; (2) anything received from the United States Government or from the District of Columbia, state, or local governments; (3)
bequests and other forms of inheritance; (4) gifts and travel reimbursements given to the filer's agency in connection with the filer's official travel; (5) gifts of hospitality (food,
lodging, entertainment) at the donor's residence or personal premises; and (6) anything received by the filer's spouse or dependent children totally independent of their
relationship to the filer. Additional exceptions apply.

Sample Agency, Filer - Page 6

Privacy Act Statement
Title I of the Ethics in Government Act of 1978, as amended (the Act), 5 U.S.C. § 13101 et seq., as amended by the Representative Louise McIntosh Slaughter Stop Trading on
Congressional Knowledge Act of 2012 (Pub. L. 112-105) (STOCK Act), and 5 C.F.R. Part 2634 of the U. S. Office of Government Ethics regulations require the reporting of this
information. Failure to provide the requested information may result in separation, disciplinary action, or civil action. The primary use of the information on this report is for review
by Government officials to determine compliance with applicable Federal laws and regulations. This report may also be disclosed upon request to any requesting person in
accordance with sections 105 and 402(b)(1) of the Act 5 U.S.C. §§ 13107 and § 13122(b)(1)or as otherwise authorized by law. You may inspect applications for public access of
your own form upon request. Additional disclosures of the information on this report may be made: (1) to any requesting person, subject to the limitation contained in section
208(d)(1) of title 18, any determination granting an exemption pursuant to sections 208(b)(1) and 208(b)(3) of title 18; (2) to a Federal, State, or local law enforcement agency if
the disclosing agency becomes aware of violations or potential violations of law or regulation; (3) to a source when necessary to obtain information relevant to a conflict of
interest investigation or determination; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5)
to the Office of Management and Budget during legislative coordination on private relief legislation; (6) when the disclosing agency determines 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; (7) to reviewing officials in a new office, department or agency when an employee transfers or is detailed from one
covered position to another, a public financial disclosure report and any accompanying documents, including statements notifying an employee's supervising ethics office of the
commencement of negotiations for future employment or compensation or of an agreement for future employment or compensation; (8) 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; (9) to contractors and other nonGovernment employees working on a contract, service or assignment for the Federal Government when necessary to accomplish a function related to this system of records;
(10) on the OGE Website and to any person, department or agency, any written ethics agreement, including certifications of ethics agreement compliance, filed with OGE by an
individual nominated by the President to a position requiring Senate confirmation; (11) on the OGE Website and to any person, department or agency, any certificate of
divestiture issued by OGE; (12) on the OGE
Website and to any person, department or agency, any waiver of the restrictions contained in Executive Order 13989 or any superseding executive order; (13) to appropriate
agencies, entities and persons when there has been a suspected or confirmed breach of the system of records, the agency maintaining the records has determined that there is
a risk of harm to individuals, the agency, the Federal Government, or national security, and the disclosure 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; and (14) 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 responding to a suspected or
confirmed breach or in preventing, minimizing, or remedying the risk of harm to individuals, the recipient agency or entity, the Federal Government, or national security. See also
the OGE/GOVT-1 executive branch-wide Privacy Act system of records.
Public Burden Information
This collection of information is estimated to take an average of ten hours per response, including time for reviewing the instructions, gathering the data needed, and completing
the form. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Program
Counsel, U.S. Office of Government Ethics (OGE), Suite 500, 1201 New York Avenue, N.W., Washington, DC 20005-3917. 250 E Street S.W., Suite 750, Washington, D.C.
20024-3249.
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 value OMB control number (that number, 3209-0001, is displayed here and at the top of the first page of this OGE Form 278e

FILER NAME - Page 13