Form FR 28c FR 28c Pre-Hire Conflict of Interest Screening

Pre-hire Conflict of Interest Screening
Board of Governors
of the Federal Reserve System
Washington, DC 20551

Name:

An equal opportunity employer

OMB Control No. 7100-0379
Approval expires October 31, 2023
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Division:

Title of job for which you are applying:
Working for the central bank of the United States carries with it responsibility for maintaining public trust in the Federal
Reserve System. In order to determine whether your financial interests or outside relationships pose any potential
conflicts of interest, we require you to provide the information requested below to the extent not previously described on
your employment application (FR 28), which is hereby incorporated by reference.
Financial Interests
To the best of your knowledge, list any debt or equity interests, such as stocks or bonds, owned directly or indirectly (such
as through a trust) by you, your spouse, or minor child(ren) in any: bank or bank holding company; savings & loan holding
company; thrifts; consulting firm or law firm advising financial institutions; economic forecasting firm or other economic
consulting firm; or a vendor or contractor that you know works with the Federal Reserve. In addition, list any interests in a
mutual fund or exchange traded fund with a policy of concentrating in the financial sector.1
1. Financial sector funds typically have terms like “Banking” or “Financial” in their names. Diversified funds (e.g., large cap funds, S&P 500 funds,
targeted retirement date funds) do not need to be reported. If you are unsure about whether an asset falls into any of these categories, please notify
your Board Human Resources representative.

Check here if you have nothing to report for this section.
Financial Interest

Owner

Relatives in Related Businesses
To the best of your knowledge, disclose any position held by your spouse, child, parent, or sibling as an employee, officer,
director, or trustee of: any bank, bank holding company, savings & loan holding company, or affiliate of any such entity;
consulting firm or law firm advising financial institutions; economic forecasting or other economic consulting firm; or a
vendor/contractor that you know works with the Federal Reserve.
Check here if you have nothing to report for this section.
Company or Entity

Position

Relationship

Outside Positions and Activities
A Board employee's compensated outside employment must be reviewed and approved by the employee's division and
the Board's Ethics Office, and some unpaid positions can raise conflicts of interest concerns. Please disclose below any
outside employment, paid work, or business you plan to engage in if you become a Board employee. Please also disclose
any outside position2. (including an uncompensated position) you plan to hold while employed by the Board. Do not
disclose positions with religious, social, fraternal, or political entities.
2. Reportable positions include officer, director, trustee, general partner, proprietor, representative, employee, or consultant of any corporation, firm,
partnership, or other business enterprise, or any non-profit organization or educational institution.

Public reporting burden for this collection of information is estimated to average 0.5 hours per response, including the time to gather and maintain data in
the required form and to review instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to Secretary, Board of Governors of the Federal Reserve System,
Washington, DC 20551; and to the Office of Management and Budget, Paperwork Reduction Project (7100 -0379), Washington, DC 20503. The Federal
Reserve may not conduct or sponsor, and an organization (or a person) is not required to respond to a collection of information unless it displays a
currently valid OMB control number.
FR 28c

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Pre-hire Conflict of Interest Screening—(continued)
Check here if you have nothing to report for this section.
Name of Organization, Employer, or Business

Position

Other Potential Conflicts
In the space below, please disclose any other situations, arrangements, or investments that you believe could pose a
conflict of interest based on the duties of the position for which you are applying.
Check here if you have nothing to report for this section.

I certify that my statements on this form, and any attachments to it, are true, complete, and correct to the best of my
knowledge and belief and are made in good faith.
By typing my name, I am signing this document electronically and intend that my electronic signature be treated as
the legal equivalent of having placed my handwritten signature on this document. I affirm that the information I have
submitted is complete and true to the best of my knowledge.

Date (MM/DD/YYYY)

Name:

Privacy Act Statement
AUTHORITY
The collection of this information is authorized by Section 10 of the Federal Reserve Act (12 U.S.C. § 244), the Ethics in Government
Act of 1978, 5 U.S.C. app; the Ethics Reform Act of 1989, Pub. L. 101-194; and 5 C.F.R. 2638.104(c)(2) and (4).
PURPOSE
The Board collects the information you provide on this form in order to manage and document compliance with the Board's and
the Federal Government's ethics program requirements.
DISCLOSURE
Furnishing this information is voluntary; however, failure to furnish the requested information may delay or prevent employment
by the Board.
ROUTINE USES
The information you provide will be stored in the system of records entitled BGFRS-1 “FRB—Recruiting, Onboarding, and Placement
Records” and BGFRS-41 “FRB—Ethics Program Records.” All or part of the information may be disclosed outside the Board in
accordance with routine uses, A, B, C, D, E, F, G, H, I, and J (see “General Routine Uses of Board Systems of Records available at
https://www.federalreserve.gov/files/SORN-page-general-routine-uses-of-board-systems-of-records.pdf).
Furthermore, all or part of the information may be disclosed outside of the Board in order: to disclose information to any source from
which additional information is requested (to the extent necessary to identify the individual, inform the source of the purpose(s) of the
request, and identify the type of information requested), when necessary to obtain information relevant to a Board decision to hire or
retain an employee, issue a security clearance, conduct a security or suitability investigation of an individual, classify jobs, let a
contract, or issue a license, grant or other benefit.
FR 28c

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