Form OGE Form 278e OGE Form 278e Executive Branch Personnel Public Financial Disclosure R

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Overview

Instructions
Cover Page
Part 1
Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Part 8
Part 9
Summary of Contents

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Sheet 1: Instructions

OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
U.S. Office of Government Ethics; 5 C.F.R. part 2634
Executive Branch Personnel Public Financial Disclosure Report (OGE Form 278e)
General Instructions for Completing the OGE Form 278e
For detailed guidance on reporting see: Public Financial Disclosure Guide
Should I Use This Form?		What Parts Must I Complete?
Candidate: Yes, you should file your report using this form.		• All filers must complete Parts 1, 2, 3, 5, 6, and 8.
Other Category of Filer: In most cases, individuals will file their public financial		• Complete Part 4 if you are filing a Nominee or New Entrant report. Otherwise leave blank.
disclosure reports through an electronic financial disclosure system. Do not use		• Complete Part 7 if you are filing an Annual or Termination report. Otherwise leave blank.
this form if you plan to file using an electronic financial disclosure system.
When Must I File?		Warnings
Candidate: Within 30 days of becoming a candidate for nomination or election
to the office of President or Vice President, or by May 15 of that calendar year,		Knowing and willful falsification of information, or failure to file or report
whichever is later, but at least 30 days before the election, and on or before		information required to be reported by 5 U.S.C § 13104 may subject you
May 15 of each succeeding year you continue to be a candidate		to a civil monetary penalty and to disciplinary action by your employing agency
Nominee: No later than 5 days after nomination by the President		or other appropriate authority under 5 U.S.C. § 13106. Knowing and willful
New Entrant: Within 30 days of assuming a covered position		falsification of information required to be filed by 5 U.S.C. § 13104 may also
Annual: No later than May 15 annually		subject you to criminal prosecution
Termination: Within 30 days of leaving a covered position
Are Extensions Available?
Extensions for candidates are granted by the Federal Election Commission. For other filers, the employing agency may grant an extension of up to 45 days for good cause shown with the possibility of one additional extension of up to 45 days.
What Happens if I File Late?
You will be subject to a $200 late filing fee if you filer your report more than 30 days after the due date (including any extensions). A report is considered to be filed when it is received by the agency. Agencies may waive this fee if the delay was caused by extraordinary circumstances. Unless waived, the agency may collect the fee for deposit with the United States Treasury.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 1 of the OGE Form 278e: Filer's Positions Held Outside United States Government
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: Preceding two calendar years and current		Organization Name: Provide the name of the organization.
year to filing date		City/State: Provide the city and state in which the organization is located.
Annual: Preceding calendar year and current year to filing date		Organization Type: Describe the type of organization.
Termination: Current calendar year to termination date (in addition, the preceding		Position Held: Provide the title or a brief functional description of the position
calendar year if an Annual report for that year is required but has not yet been filed)		you hold or held.
		From: Provide the month and year in which you began in the position.
Reporting Requirement:		To: Provide the month and year in which the position ended. If you still hold the
Report any positions that you held at any time during the reporting period		position, write "present."
(excluding positions with the United States Government). Reportable positions
include those of an officer, director, trustee, general partner, proprietor,		Nothing to Report: If you do not have anything to report, write "None."
representative, employee, or consultant of any for-profit or non-profit organization
(whether compensated or uncompensated).
Exceptions:
Do not report the following: (1) positions held as part of your official duties
with the United States Government; (2) positions with religious, social, fraternal,
or political entities; (3) positions solely of an honorary nature; (4) mere membership
in an organization; and (5) passive investment interests as a limited partner or
non-managing member of a limited liability company.
In addition, you do not need to report service as a member of an advisory board or
committee if the following criteria are met: (1) the advisory board or committee is that of
a non-profit or governmental organization; (2) your service is unpaid; (3) you have no
fiduciary duties of the sort exercised by officers, directors, or trustees; and (4) your role
does not involve sufficient supervision by the organization to create a common law
employee-employer relationship.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 2 of the OGE Form 278e: Filer's Employment Assets & Income and Retirement Accounts
Reporting Period:		Value: Report the value of an asset by selecting the appropriate category.
Candidate, Nominee, or New Entrant: Preceding calendar year and current year		Income Type:
to filing date		(1) Income Less than $201: Leave this field blank.
Annual: Preceding calendar year		(2) Asset Qualifies as an EIF: Leave this field blank.
Termination: Current calendar year to termination date (in addition, the preceding calendar year if an Annual Report for that year is required but has not yet been filed)		(3) Dividends, Interest, Capital Gains, or Rent or Royalties: Enter these types of income into the field. (4) Other Income: Provide an appropriate description (e.g., "salary").
Reporting Requirements:		Income Amount:
• Report each source of your earned and other non-investment income over $200		(1) Income Less than $201: Select "None (or less than $201)."
during the reporting period (e.g., salary, fees, partnership share and other business		(2) Asset Qualifies as an EIF: Select the category that corresponds to the total
income, honoraria, scholarships, and prizes).		amount of income received during the reporting period.
• Report each asset related to your business, employment, or other income-		(3) Dividends, Interest, Capital Gains or Rent or Royalties: Select the category that
generating activities if the value of the asset at the end of the reporting period		corresponds to the total amount of income received during the reporting period.
exceeded $1,000 or if more than $200 in income was received during the reporting		(4) Other Cases: Provide the exact amount of income received during the reporting
period (e.g., equity in business or partnership, stock options, retirement plans/		period in the space provided.
accounts and their underlying holdings as appropriate, anticipated payments
such as severance payments, deferred compensation, and intellectual property,		Nothing to Report: If you do not have anything to report, write "None."
such as book deals and patents).
• Report each underlying asset that was worth more than $1,000 at the end of the
reporting period in an individual retirement account (IRA), 401(k), or other defined		Definitions:
contribution plan.		Excepted Investment Fund (EIF): An excepted investment fund is an investment fund that
Exceptions:		is (1) widely held; (2) either publicly traded or widely diversified; and (3) independently
• Do not include assets or income from United States Government employment.		managed, meaning you neither exercise control nor have the ability to exercise control over
• Do not include assets that were acquired separately from your business,		the financial interests held by the fund. A fund is widely diversified if it does not have a
employment, or other income-generating activities (e.g., assets purchased		stated policy of concentrating its investments in an industry, business or single country other
through a brokerage account) because you will report these assets in Part 6.		than the United States or bonds of a single state within the United States.
Do not include account numbers or family members' names.		All mutual funds and exchange-traded funds (ETFs) are excepted investment funds.
Completing the Fields:		Received: You have received income when you have the right to exercise control over the income regardless of whether you have taken actual possession
Description: Provide a description sufficient to identify the asset or source being reported.
EIF: If you are reporting an investment vehicle that invests in assets of its own you
need to report each underlying asset that was individually worth more than $1,000 at
end of the reporting period or from which more than $200 income was received during
the reporting period. As an exception to this requirement, however, you do not need to
report the underlying assets of an investment vehicle that qualifies as an excepted
investment fund (EIF). Indicate whether your entry qualifies as an excepted
investment fund. If your entry is not an investment vehicle at all, select "N/A".
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 3 of the OGE Form 278e: Filer's Employment Agreements and Arrangements
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: As of the date of filing.		Employer or Party: Provide the parties to the agreement or arrangement, other than yourself.
Annual: Preceding calendar year and current year to filing date.		In most cases, the other party will be your employer.
Termination: Current calendar year to termination date (in addition, the preceding		City/State: Provide the city and state of the other parties.
calendar year if an Annual report for that year is required but has not yet been filed).		Status and Terms: Briefly describe the type of agreement or arrangement, its terms
		(in particular, the timing and form of any payments), and its current status.
Reporting Requirement:		Date: Provide the month and year in which the agreement or arrangement began. In many
Report any agreements or arrangements that you had during the reporting period		cases, this will be when you joined the employer or otherwise became eligible for coverage
for the following: (1) continuing participation in an employee welfare		under the agreement or arrangement.
or benefit plan maintained by a former employer; (2) leave of absence;
(3) future employment; or (4) continuation of payments by a former employer		Nothing to Report: If you do not have anything to report, write "None."
(e.g., severance payments).
Exceptions:
Do not report the following: (1) agreements and arrangements with the
United States Government, such as your participation in the Federal Employees
Retirement System or the Civil Service Retirement System; (2) agreements
and arrangements of your spouse or your dependent children; and (3) if you are
filing a Nominee, New Entrant, or Candidate report, any agreement or arrangement
that will end before you file your report.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 4 of the OGE Form 278e: Filer's Sources of Compensation Exceeding $5,000 in a Year
Reporting Period:		Completing the Fields:
Nominee or New Entrant: Preceding two calendar years and current year to filing date		Source Name: Provide the name of the source.
Other Reports: N/A		City/State: Provide the city and state in which this source is located.
		Brief Description of Duties: Provide a brief description of your duties or the
Reporting Requirement:		type of services rendered.
Report any source (except the United States Government) that paid more than
$5,000 for your services during any year of the reporting period. Report		Nothing to Report: If you do not have anything to report and you are filing
employers and any clients to whom you personally provided services. You		a Nominee or New Entrant report, write "None."
must report a source even if the source made its payment to your employer and
not to you. Do not report a client who paid your employer if you did not provide
the services for which the client made the payment.
Exception:
The name of a source of compensation may be excluded only if that information is
specifically determined to be confidential as a result of a privileged relationship
established by law and if the disclosure is specifically prohibited:
• by law or regulation,
• by a rule of a professional licensing organization, or
• by a client agreement that at the time of engagement of the filer's services
expressly provided that the client's name would not be disclosed publicly to any
person.
If you exclude the name of any source, you must indicate in the report that such
information has been excluded, the number of sources excluded, and, if applicable,
a citation to the statute, regulation, rule of professional conduct, or other authority
pursuant to which disclosure of the information is specifically prohibited.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 5 of the OGE Form 278e: Spouse's Employment Assets & Income and Retirement Accounts
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: Preceding calendar year and current year		Complete these fields using the instructions from Part 2 with two exceptions. First,
to filing date		you do not need to provide the exact amount of your spouse's earned income, other
Annual: Preceding calendar year		than honoraria. Instead, simply describe the type of income in the Income Type field
Termination: Current calendar year to termination date (in addition, the preceding		and leave the Income Amount field blank. Second, the value and income amount
calendar year if an Annual report for that year is required but has not yet been filed)		fields include a category labeled "Over $1,000,000." You may use this category
		or you may use the higher value and amount categories.
Reporting Requirement:
• Report each source, but not the amount, of earned income for your spouse over		Nothing to Report: If you do not have anything to report, write "None."
$1,000 during the reporting period.
• Report each source and the exact amount of each honorarium for your spouse over $200
during the reporting period.
• Report each asset related to your 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).
• Report each underlying asset that was worth more than $1,000 at the end of the reporting period in an individual retirement account (IRA), 401(k), or other defined contribution plan.
Exceptions:
• Do not include assets or income from United States Government employment.
• Do not include assets that were acquired separately from your spouse's
business, employment, or other income-generating activities (e.g., assets
purchased through a brokerage account) because you will report these assets
in Part 6.
Do not include account numbers or family member's names.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 6 of the OGE Form 278e: Other Assets and Income
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: Preceding calendar year and current year		Complete these fields using the instructions from Part 2 with one exception.
to filing date		The value and income amount fields include a category labeled "Over $1,000,000."
Annual: Preceding calendar year		You may use this category only for your spouse's or dependent child's assets.
Termination: Current calendar year to termination date (in addition, the preceding		Do not use this category for your assets or assets held jointly with your spouse
calendar year if an Annual report for that year is required but has not yet been filed)		or dependent child.
Reporting Requirement:		Nothing to Report: If you do not have anything to report, write "None."
Report each asset held for investment or the production of income, not already reported
in Part 2 or Part 5, that ended the reporting period with a value greater than $1,000
or from which more than $200 in income was received during the reporting period.
For purposes of the value and income thresholds, aggregate your interests with
those of your spouse and your dependent children. NOTE: Report each underlying
holding of a brokerage account, managed account, or college savings plan that
meets the reporting threshold described above.
Exceptions:
Do not report any of the following: (1) a personal residence that you did not rent
out during the reporting period; (2) retirement benefits from the United States
Government, including the Thrift Savings Plan; (3) income from social security,
veterans' benefits, and other similar United States Government benefits;
(4) deposits in a single financial institution aggregating $5,000 or less in money
market accounts, certificates of deposit, savings accounts, checking accounts or
other cash deposits (unless the income exceeded $200); (5) shares in a single
money market mutual fund aggregating $5,000 or less (unless the income exceeded
$200); (6) loans made by you or your spouse to each other or to a parent,
sibling, child, or grandchild; (7) interests of a spouse living separate and apart with
the intention of terminating the marriage or providing for a permanent separation;
(8) interests of a former spouse or a spouse from whom you are permanently
separated; and (9) payments from a spouse or former spouse associated with a
divorce or permanent separation.
Do not include account numbers or family members' names.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 7 of the OGE Form 278e: Transactions
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: N/A		Description: Provide the name of the asset.
Annual: Preceding calendar year		Type: Specify the type of transaction as a purchase, sale, or exchange.
Termination: Current calendar year to termination date (in addition, the preceding		Date: Provide the month, day, and year of the transaction.
calendar year if an Annual report for that year is required but has not yet been filed)		Amount: Report the amount of the transaction by selecting the appropriate category.
		You may use the "Over $1,000,000" category only for transactions involving
Reporting Requirement:		your spouse's or dependent child's assets. Do not use this category for your assets
		or assets held jointly with your spouse or dependent child.
Report any purchase, sale, or exchange of real property or securities in excess
of $1,000 that was made by you, your spouse, or your dependent child during		Nothing to Report: If you do not have anything to report, write "None."
the reporting period.
Exceptions:
Do not report the following: (1) a personal residence, unless the personal
residence was rented out at any point during the reporting period; (2) cash
accounts (e.g., checking, savings, CDs, money market accounts) and money market
mutual funds; (3) Treasury bills, notes, and bonds; (4) Thrift Saving Plan accounts;
(5) an underlying asset held within an excepted investment fund, an excepted trust,
or a qualified trust; (6) transactions that you already reported in your periodic
transaction report (OGE Form 278-T), unless your agency requires duplicate
reporting; (7) transactions that occurred when you were not a public financial
disclosure filer or an employee of the United States Government; (8) transactions
that occurred solely by and between you, your spouse, and your dependent children;
(9) interests of a spouse living separate and apart with the intention of terminating
the marriage or providing for a permanent separation; and (10) interests of a
former spouse or a spouse from whom you are permanently separated.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 8 of the OGE Form 278e: Liabilities
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: Preceding calendar year and current year		Creditor Name: Provide the name of the creditor/lending institution.
to filing date		Type: Identify the type of liability.
Annual: Preceding calendar year		Amount: Select the appropriate category of amount or value. For revolving charge
Termination: Current calendar year to termination date (in addition, the preceding		accounts, use the value of the liability at the end of the reporting period. For all
calendar year if an Annual report for that year is required but has not yet been filed)		other liabilities, select the category that corresponds to the highest amount owed
		during the reporting period. You may use the "Over $1,000,000" category only for
Reporting Requirement:		your spouse's or dependent child's liabilities. Do not use this category for your
		liabilities or a joint liability for you and your spouse or dependent child.
Report liabilities over $10,000 that you, your spouse, or your dependent child		Year Incurred: Provide the year that the liability was incurred.
owed at any time during the reporting period.		Rate: Provide the interest rate. Describing the rate in reference to a prime rate,
		such as "prime + 1," is also sufficient.
Exceptions:		Term: Specify, in years or months, the time that the loan allows for repayment.
Do not report the following: (1) loans secured by a personal motor vehicle,		If applicable, you may write "on demand" or "revolving."
household furniture, or appliances, provided that the loan does not exceed the
item's purchase price; (2) revolving charge accounts, such as credit card balances,		Nothing to Report: If you do not have anything to report, write "None."
where the outstanding liability did not exceed $10,000 at the end of the reporting
period; (3) personal liabilities owed to a spouse, parent, sibling, or child of yours,
your spouse, or your dependent child; (4) liabilities of a spouse living separate
and apart with the intention of terminating the marriage or providing for a
permanent separation; (5) liabilities of a former spouse or a spouse from whom
you are permanently separated; and (6) obligations arising from divorce or
permanent separation.
Mortgage Reporting
The following officials are required to report mortgage information about an
residence they may own including a personal residence that is not rented out:
• the President
• the Vice-President
• any Presidentially appointed, Senate-confirmed (PAS) appointees and
nominees except for the following:
- Foreign Service Officers below the rank of ambassador,
- uniformed service members 0-6 or below, and
- special Government employees (SGE).
If you are not a nominee or appointee to a PAS position, you are not required to
to report a mortgage or home equity loan secured by your personal residence,
unless you rented out the personal residence during the reporting period.
OGE Form 278e (Updated XXXXXXX) (Expires XXXXX)
Instructions for Completing Part 9 of the OGE Form 278e: Gifts and Travel Reimbursements
Reporting Period:		Completing the Fields:
Candidate, Nominee, or New Entrant: N/A		Source Name: Provide the identity of the source.
Annual: Preceding calendar year.		City/State: Provide the source's city and state of business or residence.
Termination: Current calendar year to termination date (in addition, the preceding		Brief Description: Describe the nature of the item or reimbursement received.
calendar year if an Annual report for that year is required but has not yet been filed).		For travel-related gifts and reimbursements, include a travel itinerary, the dates of
		travel, and the nature of the expenses. Although not required, it is helpful to specify
Reporting Requirement:		your relationship to the source or note the basis on which you accepted the gift or
		reimbursement.
• Report gifts totaling more than $480 that you, your spouse, and your dependent		Value: Provide the fair market value of the gift(s) or travel reimbursement(s).
children received from any one source during the reporting period.
• Report travel reimbursements totaling more than $480 that you, your spouse,		Nothing to Report: If you do not have anything to report, write "None."
and your dependent children received from any one source during the reporting period.
If more than one gift or travel reimbursement was received from a single source:
(1) Determine the value of each item received from that source; (2) exclude each
item valued at $192 or less; and (3) add the value of those items valued at more
than $192. If the total is more than $480, then you must report each item valued
at more than $192.
NOTE: These amounts apply to gifts and travel reimbursements received in
calendar years 2023-2025. The next three-year adjustment of these amounts is scheduled to occur in 2026.
Exceptions:
Do not report the following: (1) anything received from a relative; (2) bequests
and other forms of inheritance; (3) suitable mementos of a function honoring you
(e.g., retirement party); (4) food, lodging, transportation, and entertainment or
reimbursements provided by a foreign government within a foreign country or by
the United States Government, the District of Columbia, or a state or local
government; (5) food and beverages not consumed in connection with a gift of
overnight lodging; (6) anything given to your spouse or dependent child totally
independent of their relationship to you; (7) gifts in the nature of communications
to your office, such as subscriptions to newspapers and periodicals; (8) gifts of
hospitality (food, lodging, entertainment) on the donor's personal or family
premises, as defined in 5 C.F.R. Part 2634; (9) any gifts and travel reimbursements
received when you were not an employee of the United States Government; and
(10) any reimbursements you received for political trips that were required to be
reported under section 304 of the Federal Election Campaign Act of 1971
(2 U.S.C. § 434).

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Sheet 2: Cover Page

OGE Form 278e (Updated XXXXX) (Expires XXXXXX)
U.S. Office of Government Ethics; 5 C.F.R. part 2634 | Form Approved: OMB No. (3209-0001)
Report Type:
Year (Annual Report only):
Date of Appointment:	mm/yyyyy
Date of Termination:	mm/yyyyy
Appointment Type:
Executive Branch Personnel Public Financial Disclosure Report (OGE Form 278e)
Filer's Information
Last Name	First Name	MI	Position	Agency
Other Federal Government Positions Held During the Preceding 12 Months:
Name of Congressional Committee Considering Nomination (Nominees only):
Filer's Certification – I certify that the statements I have made in this report are true, complete, and correct to the best of my knowledge:
Signature:			Date:
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)
Signature:			Date:
Other Review Conducted By:
Signature:			Date:
U.S. Office of Government Ethics Certification (if required):
Signature:			Date:
Comments of Reviewing Officials:

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Sheet 3: Part 1

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 1
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name					Page Number
Part 1: Filer's Positions Held Outside United States Government
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Sheet 4: Part 2

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 2
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name						Page Number
Part 2: Filer's Employment Assets & Income and Retirement Accounts
#	Description	EIF	Value	Income Type	Income Amount
1.		Specify whether the entry qualifies as an Excepted Investment Fund. If the entry is not an investment vehicle at all, select "N/A."			Select a category of income if appropriate. See Part 2 instructions for more information.	Provide the exact amount of income in this field if appropriate. See Part 2 instructions for more information.
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Sheet 5: Part 3

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 3
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name					Page Number
Part 3: Filer's Employment Agreements and Arrangements
#	Employer or Party	City/State	Status and Terms			Date
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Sheet 6: Part 4

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 4
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name					Page Number
Part 4: Filer's Sources of Compensation Exceeding $5,000 in a Year
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Sheet 7: Part 5

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 5
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name						Page Number
Part 5: Spouse's Employment Assets & Income and Retirement Accounts
#	Description	EIF	Value	Income Type	Income Amount
1.		Specify whether the entry qualifies as an Excepted Investment Fund. If the entry is not an investment vehicle at all, select "N/A."			Select a category of income if appropriate. See Part 5 instructions for more information.	Provide the exact amount of income in this field if appropriate. See Part 5 instructions for more information.
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Sheet 8: Part 6

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 6
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name						Page Number
Part 6: Other Assets and Income
#	Description	EIF	Value	Income Type	Income Amount
1.		Specify whether the entry qualifies as an Excepted Investment Fund. If the entry is not an investment vehicle at all, select "N/A."			Select a category of income if appropriate. See Part 6 instructions for more information.	Provide the exact amount of income in this field if appropriate. See Part 6 instructions for more information.
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Sheet 9: Part 7

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 7
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name					Page Number
Part 7: Transactions
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Sheet 10: Part 8

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 8
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name								Page Number
Part 8: Liabilities
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Sheet 11: Part 9

OGE Form 278e (Updated DATE) (Expires XXXXX)
Instructions for Part 9
If you need more pages, follow these instructions. Note: You must add pages before entering information.
Note: This is a public form. Do not include account numbers, street addresses, or family members' names. See instructions for required information.
Filer's Name					Page Number
Part 9: Gifts and Travel Reimbursements
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Sheet 12: Summary of Contents

OGE Form 278e (Updated XXXX) (Expires XXXX)

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 non-managing 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.)

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.

OGE Form 278e (Updated XXXXXX) (Expires XXXXX)

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).

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 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 (note: certain PAS nominees and appointees are required to report all mortgages); (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.

OGE Form 278e (Updated XXXXXX) (Expires XXXXX)

Privacy Act Statement

5 U.S.C. § 13101 et seq., 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 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

non-Government 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), 250 E Street S.W., Suite 750, Washington, DC 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 valid OMB control number (that number, 3209-0001, is displayed here and at the top of the first page of this OGE Form 278e).