OGE Form 601 Executive Branch Legal Expense Fund Quarterly Report

OGE Form 601 (Expires DATE)
U.S. Office of Government Ethics; 5 C.F.R. part 2635

Executive Branch Legal Expense Fund Quarterly Report (OGE Form 601)
General Instructions for Completing the OGE Form 601
Should I use this Form?

Terminating Executive Branch Employment

If you are an executive branch employee with a Legal Expense Fund approved

If you are terminating your executive branch employment, please check

under Subpart J of 5 C.F.R. part 2635, use this form to complete the required

the box indicating it is an employment termination report. If the trust will

quarterly report.

continue to exist after you leave executive branch employment, check
the box indicating that the trust will continue. The report should include

Quarterly Report Due Date and Reporting Period

information from the beginning of the quarter through your last day of
employment. Note: The employment termination report is due on

April 30 for the period of January 1 to March 31.

your last day of employment.

July 30 for the period of April 1 to June 30.
October 30 for the period of July 1 to September 30.

Extensions

January 30 of the following year for the period of October 1 to December 31.
You may seek up to a 30-day extension for filing your report. You must
If the due date falls on a weekend or Federal Holiday, the report will be due

file a written request that includes the reason for the extension with your

the next business day.

employing agency. If you are a Designated Agency Ethics Official or

Trust Termination Reports

OGE. Extensions may be granted for good cause shown.

Please check the box indicating it is a trust termination report. The report should

Late Filing

include inforrmation from the beginning of the quarter through the trust
termination date. Note: The trust termination report is due 30 days after the

If a report is not filed by the due date (including any revised due date

trust terminates.

set by an approved extension), the employee forfeits the ability to accept

anonymous whistleblower, you must file your extension request with

contributions or make distributions until the report is filed.
Warnings
Knowing and willful falsification of information required to be filed by
Subpart J of 5 C.F.R. part 2635 may subject you to criminal prosecution.

Instructions for Completing Part 1 of the OGE Form 601: Contributions
Donation Reporting Requirement:

Completing the Fields:

Report any contribution of $250 or more made during the reporting period. You also
must report contributions from a single donor of $250 or more given in a single

Donor Name: Provide the name of the individual or entity that donated.

calendar year on the report filed on January 30 of the following year, unless they
have been disclosed on a prior quarterly report.
Example: If Donor A gives you $125 in the first quarter, and $150 in the
second quarter, you are not required to disclose the contribution on reports due on
either on April 30 or July 30, but you must disclose Donor A's $275 in contributions
on your report due on January 30.
Nothing to Report: If you do not have anything to report, write "None."

City/State: Provide the city and state of the primary address of the
donor.
Employer: If the donor is an individual, provide the name of the donor's
employer.
Date: Provide the date or dates of the contribution(s).
Amount: Provide the total amount of the contributions from the donor
that have not previously been reported.

Instructions for Completing Part 2 of the OGE Form 601: Distributions
Distribution Reporting Requirement:

Completing the Fields:

Report any distribution of $250 or more made during the reporting period. You also
must report distributions made to a single source of $250 or more in a single

Payee Name: Provide the name of the individual or entity paid.

calendar year on the report filed on January 30 of the following year, unless they
have been disclosed on a prior quarterly report.

Date: Provide the date or dates of the distribution(s).

Example: If you pay ABC Law Firm $200 in the third quarter, and $5000 in the

Amount: Provide the total amount of the distributions to the payee that

fourth quarter, you must disclose the $5200 distribution to ABC Law Firm on

have not previously been reported.

your report due on January 30.
Brief Description of the Purpose: Provide a brief description of the
Nothing to Report: If you do not have anything to report, write "None."

OGE Form 601 (expires DATE)

reason for the payment (e.g. "Legal Services" or "Trustee Fees").

PRIVACY ACT STATEMENT FOR LEF TRUSTS AND REPORTING INFORMATION
OGE’s Legal Expense Fund Regulation at 5 CFR part 2635 subpart J (“LEF Regulation”) requires the reporting of this information.
The information will be reviewed by Government officials to determine compliance with the LEF Regulation and other applicable
ethics laws and regulations and provide advice regarding the trust beneficiaries recusal requirements. The information will also be
used to permit transparency into the finances of legal expense funds. Failure to provide the requested information may result in the
legal expense fund not being approved, prior approval for the legal expense fund being withdrawn, or suspension of the ability to raise
or spend funds. Contributions received by executive branch employees for legal expenses that are not in compliance with the LEF
Regulation may violate the Standards of Conduct for Employees of the Executive Branch and result in disciplinary action.
This information will be publically posted to the OGE website at www.oge.gov (subject to certain exceptions set forth in the LEF
Regulation) in accordance with OGE/GOVT-3, Legal Expense Fund Trust Documents, Reports, and Other Name-Retrieved Records,
routine use “c.” Please see OGE/GOVT-3 for more information about the maintenance and disclosure of this information.

PUBLIC BURDEN INFORMATION - QUARTERLY AND TERMINATION REPORTS
This collection of information is estimated to take an average of 2 hours per report. 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, 3209-000X, is displayed here and in the upper left-hand corner of the
first page of this form.

OGE Form 601 (expires DATE)

OGE Form 601 (Expires DATE)
U.S. Office of Government Ethics; 5 C.F.R. part 2635 Form Approved: OMB No. 3209-XXXX

Quarter:
Year:
Trust Termination
Report:

Employment Termination
Report:

Trust will continue after
Employment Termination

Executive Branch Legal Expense Fund Quarterly Report (OGE Form 601)
Beneficiary Information
Last Name

First Name

MI

Position

Agency

Beneficiary Certification: I certify that the statements I have made in this report are true, complete, and correct to the best of my knowledge:
Signature and Date:

Agency Ethics Official's Opinion: On the basis of the information contained in this report, I conclude the beneficiary is in compliance with applicable regulations.
Signature and Date:

Other Review Conducted By:
Signature and Date:

U.S. Office of Government Ethics Certification (if required):
Signature and Date:

Comments of Reviewing Officials:

OGE Form 601 (Expires DATE)

Instructions for Part 1
Note: This is a public form. Do not include street addresses or account numbers. See instructions for required information.

Beneficiary Name

Page Number

Part 1: Contributions
Donor Name

#

1
2

3
4
5
6
7
8
9
10
11
12
13
14
15
16

City/State

Employer of Donor

Date

Amount

OGE Form 601 (Expires DATE)

Instructions for Part 1
Note: This is a public form. Do not include street addresses or account numbers. See instructions for required information.

Beneficiary Name

Page Number

Part 1: Contributions
Donor Name

#

1
2

3
4
5
6
7
8
9
10
11
12
13
14
15
16

City/State

Employer of Donor

Date

Amount

OGE Form 601 (Expires DATE)

Instructions for Part 1
Note: This is a public form. Do not include street addresses or account numbers. See instructions for required information.

Beneficiary Name

Page Number

Part 1: Contributions
Donor Name

#

1
2

3
4
5
6
7
8
9
10
11
12
13
14
15
16

City/State

Employer of Donor

Date

Amount

OGE Form 601 (Expires DATE)

Instructions for Part 2
Note: This is a public form. Do not include street addresses, account numbers, or information protected by attorny client privlege. See instructions for required information.

Beneficiary Name

Page Number

Part 2: Distributions
Payee Name

#

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Date

Amount

Purpose

OGE Form 601 (Expires DATE)

Instructions for Part 2
Note: This is a public form. Do not include street addresses, account numbers, or information protected by attorney client privilege. See instructions for required information.

Beneficiary Name

Page Number

Part 2: Distributions
Payee Name

#

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Date

Amount

Purpose