OGE Form 450

• Date: 30 November 2021
• Section: Office of Government Ethics (OGE)

OGE Form 450, 5 CFR Part 2634, Subpart I

U.S. Office of Government Ethics (Nov. 2021)

Expires 11/30/24

Form Approved

OMB No. 3209-0006

What is the

Reporting Period?

New Entrants:

Part I – Report assets as of the date of filing but report sources of earned income,

honoraria, and other non-investment income for the preceding 12 months.

Part II – Report liabilities as of the date of filing.

Part III – Report positions for the preceding 12 months.

Part IV – Report agreements and arrangements as of the date of filing.

Annual Filers: Report the required information for the preceding calendar year

(January 1 – December 31).

If you have any questions about how to complete this form, please contact your ethics

What if I Have

Questions?

official or go to the Office of Government Ethics web site at www.oge.gov and select

2*( Form 450&RQILGHQWLDO)LQDQFLDO'LVFORVXUH5HSRUW under Forms Library.

PENALTIES

Falsification of information or failure to file or report information required to be reported may subject you to

disciplinary action by your employing agency or other authority. Knowing and willful falsification of information

required to be reported may also subject you to criminal prosecution.

Privacy Act Statement

Title I of the Ethics in Government Act of 1978 (5 U.S.C. app. 101), Executive Order 12674 (as modified by Executive Order 12731), and 5

CFR Part 2634, Subpart I, of the Office of Government Ethics (OGE) regulations require the reporting of this information. Failure to

provide the requested information may result in separation or disciplinary action. The primary use of the information on this form is for

review by Government officials of your agency, to determine compliance with applicable Federal conflict of interest laws and regulations.

Additional disclosures may be made pursuant to the routine uses set forth in OGE/GOVT-2: (1) to a Federal, State, or local law

enforcement agency if the disclosing agency becomes aware of a violation or potential violation of law or regulation; (2) to a source when

necessary to obtain information relevant to a conflict of interest investigation or decision; (3) to the National Archives and Records

Administration in records management inspections; (4) to the Office of Management and Budget during legislative coordination on private

relief legislation; (5) 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 when the adjudicator determines the records to be relevant to the proceeding; (6) to

reviewing officials in a new office, department or agency when an employee transfers or is detailed from one covered position to another;

(7) 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; (8) to contractors and other non-Government employees working for the Federal Government to accomplish a

function related to this OGE Government-wide system of records; (9) 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 (10) 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.

Note: When an agency is requested to furnish such records to OGE, such a disclosure is to be considered as made to those officers and

employees of the agency which co-maintains the records who have a need for the records in the performance of their official duties in

accordance with the Ethics in Government Act and other pertinent authority conferred on OGE, pursuant to the provisions of the Privacy

Act at 5 U.S.C. 552a(b)(1). This confidential report will not be disclosed to any requesting person unless authorized by law. See also the

OGE/GOVT-2 Executive Branch Confidential Financial Disclosure Reports Privacy Act system of records.

Public Burden Information

It is estimated that completing this form, including reviewing the instructions and gathering the data needed, takes an average of three

hours. No private citizen is required to respond to a collection of information unless it displays a currently valid OMB control number as

printed in the top right-hand corner of the first page of this form. Send comments regarding the burden estimate or any other aspect of this

collection of information, including suggestions for reducing this burden, to: Program Counsel, U.S. Office of Government Ethics, Suite

500, 1201 New York Avenue, NW, Washington, DC 20005-3917. Do not send your completed OGE Form 450 to this address.

CONFIDENTIAL FINANCIAL DISCLOSURE REPORT

Executive Branch

Why Must I File?

The duties and responsibilities of your position require you to file the Confidential

Financial Disclosure Report to avoid involvement in a real or apparent conflict of

interest. The purpose of this report is to assist employees and their agencies in

avoiding conflicts between official duties and private financial interests or affiliations.

The information you provide will only be used for legitimate purposes, and will not be

disclosed to any requesting person unless authorized by law. (See the Privacy Act

Statement at the bottom of this page.) Please ensure that the information you provide

is complete and accurate.

When Must I File?

New Entrants: The report is due within 30 days of your assuming a position

designated for filing, unless your agency requests the report earlier or your agency

grants you a filing extension.

Annual Filers: The report is due no later than February 15, unless your agency

grants you a filing extension.