Fill and Sign the Schwab 2011 Supplementary Tax Information

CFC Event Review – USDA Office of Ethics In order to assure that official fundraising events held on behalf of the U. S. Department of Agriculture’s Combined Federal Campaign (CFC) program comply with CFC, General Services Administration, and ethics program regulations, each event must be reviewed by the USDA Office of Ethics no later than 15 workdays prior to the date of the event. Within 3 workdays of receiving such notice, the Office of Ethics will either determine compliance with regulation, or contact the sponsoring organization to resolve those elements prohibited by regulation. Failure to obtain review from the Office of Ethics may result in cancellation of the event. In order to obtain review, the requesting organization must provide the following information: 1. Name of agency, person, or organization planning to hold the event along with their e-mail and phone number; 2. Event date and time; 3. Brief description of the event to be held; 4. Copies of all event advertisements including posters and fliers; 5. Location of the event; 6. Date building manager approved use of official space; and 7. Building manager’s name and telephone number: Complete the checklist below. Provide an explanation for unchecked items. ____ All cash proceeds from sales of items or services will go to the CFC General Fund. [If participants are to be provided the opportunity to designate specific charities, such designations shall only be accomplished through pledge cards.] ____ No for-profit organizations (i.e., Tupperware, Avon, Mary Kay, etc.) will be involved in the event. Items will either be donated by USDA employees or purchased for sale. ____ No employee or other individual will sell items with a percentage of the sale donated to CFC. For example, no employee will sell crafts, and in turn, donate a percentage of the sale to CFC. ____ No fees will be charged to enter events. ____ If the event is to include raffle prizes, they are modest in value and nature, and no prize exceeds $100. ____ No portion of this event is to be conducted off government-owned or -leased property. Title and Description of Event: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ The above responses are correct and complete to the best of my knowledge. _______________________________________________ Event Coordinator’s Signature: Date: Print Event Coordinator’s Name: Office Telephone Number: _________________________________________________ Deliver this form to the Office of Ethics Branch serving your Agency. Departmental Administration, FAS, RMA, and Staff Offices should deliver the form to the OE Headquarters Room 347-W Whitten Building. For a complete list of ethics advisors, visit http://www.usdaethics.net/cgi/ead_gen.pl?all 2 Office of Ethics Branch: ________________ Title of Event: ________________ CFC Event Approval The Office of Ethics finds that the above proposed event complies with ethics rules and CFC regulations and is consistent with Agency practice. Date: ___________________ _______________________________ Ethics Specialist CFC Event Disapproval The Office of Ethics has found issues precluding the running of this event. Please call us immediately at ________________________ so that we may discuss solutions to the problems noted. Date: ___________________ _______________________________ Ethics Specialist . 3