Nominee Report   U.S. Office of Government Ethics; 5 C.F.R. part 2634   Form Approved: OMB No. (3209-0001) (March 2014)

Executive Branch Personnel
Public Financial Disclosure Report (OGE Form 278e)
Filer's Information
Combs, Susan
Assistant Secretary (Policy, Management, and Budget), Department of the Interior
Other Federal Government Positions Held During the Preceding 12 Months:
None
Names of Congressional Committees Considering Nomination:
●
Committee on Energy and Natural Resources

Electronic Signature - I certify that the statements I have made in this form are true, complete and correct to the best of my knowledge.
/s/ Combs, Susan [electronically signed on 04/06/2017 by Combs, Susan in Integrity.gov]

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).
/s/ Loftin, Melinda, Certifying Official [electronically signed on 07/12/2017 by Loftin, Melinda in Integrity.gov]

Other review conducted by

U.S. Office of Government Ethics Certification
/s/ Apol, David, Certifying Official [electronically signed on 07/13/2017 by Apol, David in Integrity.gov]

 1. Filer's Positions Held Outside United States Government
#

ORGANIZATION NAME

CITY, STATE

ORGANIZATION
TYPE

POSITION HELD

FROM

TO

1

Texas Wildlife Association

San Antonio,
Texas

Non-Profit

Director

1/1989

Present

2

Texas Aspires (formerly Texas Institute for
Education Reform)

Austin, Texas

Non-Profit

Vice Chair and
Director

5/2015

3/2017

3

It's Time Texas

Austin, Texas

Non-Profit

Director

5/2016

3/2017

4

The Anywhere Woman Project

Austin, Texas

Non-Profit

President and
Director

5/2016

Present

5

Combs Cattle Company

Austin, Texas

Corporation

President

9/1995

Present

6

Texas Public Policy Foundation

Austin, Texas

Non-Profit

Visiting Senior
Fellow

3/2015

Present

7

University of Texas Center for Identity

Austin, Texas

Non-Profit

Fellow

2/2015

Present

8

Texas State History Museum Foundation

Austin, Texas

Non-Profit

Board Member

1/2011

8/2016

9

Family Trust 2

Austin, Texas

Trust

Trustee

1/1984

Present

2. Filer's Employment Assets & Income and Retirement Accounts
#

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1

Texas Employee Retirement System
Defined Benefit Plan (value not readily
ascertainable)

N/A

None (or less
than $1,001)

Retirement
Payments
(Income
Amount Per
Month)

$5,143

2

Texas Employee Retirement System 457
Plan - Cash Payments

No

2.1

BlackRock US Total Bond Index Fund
(WFBIX)

Yes

$1,001 - $15,000

$201 - $1,000

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

2.2

BlackRock Short Term Investment W

Yes

$1,001 - $15,000

None (or less
than $201)

2.3

Fidelity Diversified International Fund
(FDIVX)

Yes

$1,001 - $15,000

None (or less
than $201)

2.4

Vanguard Institutional Index Institutional
Plus Fund (VIIIX)

Yes

$1,001 - $15,000

None (or less
than $201)

2.5

Vanguard Wellington Fund Admiral (VWENX)

Yes

$1,001 - $15,000

None (or less
than $201)

2.6

Victory Munder Mid Cap Core Growth Y
Fund (MGOYX)

Yes

$1,001 - $15,000

None (or less
than $201)

3

Roth IRA

No

3.1

Cash Account - US Bank

N/A

$1,001 - $15,000

None (or less
than $201)

4

IRA SEP

No

4.1

Schwab Government Money Fund (SWGXX)

Yes

$15,001 $50,000

None (or less
than $201)

4.2

Motorola Solutions Inc (MSI)

N/A

$1,001 - $15,000

None (or less
than $201)

5

Combs Cattle Company

N/A

$1,001 - $15,000

None (or less
than $201)

6

"Texas Tenacity: A Call for Women to Direct
Their Destiny," Greenleaf Book Group, LLC.
(value not readily ascertainable)

N/A

Rent or
Royalties

INCOME
AMOUNT

$1,001 - $2,500

3. Filer's Employment Agreements and Arrangements
#

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

1

State of Texas - Employee Retirement
System Defined Benefit Plan

Austin, Texas

I will continue to participate in this defined benefit
plan.

1/1993

 #

EMPLOYER OR PARTY

CITY, STATE

STATUS AND TERMS

DATE

2

State of Texas - Employee Retirement
System 457 Plan

Austin, Texas

I will continue to participate in this defined
contribution plan. The plan sponsor has not made
and will not make any contributions.

1/2012

4. Filer's Sources of Compensation Exceeding $5,000 in a Year
None

5. Spouse's Employment Assets & Income and Retirement Accounts
#

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1

Motorola Solutions 401K Plan

No

1.1

MSI Target Date Retirement Income Fund

Yes

2

Goldman Sachs IRA

No

2.1

Goldman Sachs US Equity Insights Fund
Class A (GSSQX)

Yes

3

Motorola Solutions Defined Benefit Plan
(value not readily ascertainable)

N/A

4

CREF Stock R1

Yes

$100,001 $250,000

$5,001 - $15,000

5

CREF Stock R2

Yes

$50,001 $100,000

$2,501 - $5,000

6

TIAA Traditional

N/A

$50,001 $100,000

Interest

$2,501 - $5,000

7

Spouse IRA

No

7.1

Intel Corporation (INTC)

N/A

$1,001 - $15,000

Dividends
Capital Gains

$201 - $1,000

7.2

Comcast (CMCSA)

N/A

$1,001 - $15,000

Dividends
Capital Gains

$1,001 - $2,500

$100,001 $250,000

$5,001 - $15,000

$100,001 $250,000

$5,001 - $15,000
Retirement
Payments

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

7.3

AT&T Inc. (T)

N/A

$1,001 - $15,000

Dividends
Capital Gains

$1,001 - $2,500

8

Spouse Roth IRA

No

8.1

Exxon Mobil Corporation (XOM)

N/A

$1,001 - $15,000

None (or less
than $201)

8.2

Schwab Investor Money Fund (SWRXX)

Yes

$1,001 - $15,000

None (or less
than $201)

VALUE

INCOME TYPE

INCOME
AMOUNT

Dividends

$201 - $1,000

6. Other Assets and Income
#

DESCRIPTION

EIF

1

Joint Brokerage Account

No

1.1

AT&T Inc (T)

N/A

$1,001 - $15,000

1.2

Alphabet Inc. Class A (GOOGL)

N/A

$15,001 $50,000

None (or less
than $201)

1.3

Amazon.com, Inc. (AMZN)

N/A

$15,001 $50,000

None (or less
than $201)

1.4

Apple Inc. (AAPL)

N/A

$15,001 $50,000

1.5

Biomarin Pharmaceutical (BMRN)

N/A

$1,001 - $15,000

1.6

Boeing Co. (BA)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.7

Bristol-Myers Squibb (BMY)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.8

Caterpillar Inc. (CAT)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.9

JP Morgan Chase & Co. (JPM)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

Dividends

$201 - $1,000
None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1.10

Expedia, Inc. (EXPE)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.11

Gilead Sciences Inc. (GILD)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.12

Honeywell Intl Inc. (HON)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.13

Intel Corp. (INTC)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.14

Johnson & Johnson (JNJ)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.15

Lockheed Martin Corp. (LMT)

N/A

$15,001 $50,000

None (or less
than $201)

1.16

Nike Inc. Class B (NKE)

N/A

$1,001 - $15,000

None (or less
than $201)

1.17

PNC Financial Services (PNC)

N/A

$1,001 - $15,000

Dividends

$201 - $1,000

1.18

Procter & Gamble (PG)

N/A

$1,001 - $15,000

Dividends

$201 - $1,000

1.19

Rockwell Automation Inc. (ROK)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.20

Splunk Inc. (SPLK)

N/A

$1,001 - $15,000

1.21

Starbucks Corp (SBUX)

N/A

$1,001 - $15,000

Dividends

$201 - $1,000

1.22

UnitedHealth Group Inc. (UNH)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.23

Wal-Mart Stores Inc. (WMT)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

1.24

Bexar County, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.25

City of Carrollton Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.26

City of San Antonio, Texas (Bond)

N/A

$15,001 $50,000

None (or less
than $201)

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

1.27

City of Irving, Texas Waterworks (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.28

City of Killeen, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

1.29

City of Kyle, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

1.30

City of Levelland, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

1.31

McKinney, Texas Independent School
District (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.32

Shavano Park, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.33

Starwood Hotels (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

1.34

Tarrant Regional Water District, Tarrant
County, TX (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

1.35

Cash Account - US Bank

N/A

$15,001 $50,000

1.36

ConocoPhillips (COP)

N/A

None (or less
than $1,001)

2

Individual Brokerage Account 1

No

2.1

YUM China Holdings (YUMC)

N/A

$1,001 - $15,000

2.2

YUM Brand Inc. (YUM)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.3

3M Company (MMM)

N/A

$50,001 $100,000

Dividends
Capital Gains

$50,001 $100,000

2.4

General Electric (GE)

N/A

$100,001 $250,000

Dividends
Capital Gains

$15,001 $50,000

2.5

IBM Common Stock (IBM)

N/A

$100,001 $250,000

Dividends
Capital Gains

$15,001 $50,000

None (or less
than $201)
Capital Gains
Dividends

$1,001 - $2,500

None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

2.6

United Health Group Inc. (UNH)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.7

Rockwell Automation (ROK)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.8

AT&T Inc. (T)

N/A

$1,001 - $15,000

Dividends

$201 - $1,000

2.9

Nike Inc. Class B (NKE)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.10

Procter & Gamble (PG)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.11

Splunk Inc. (SPLK)

N/A

$15,001 $50,000

2.12

Starbucks (SBUX)

N/A

$15,001 $50,000

2.13

Expedia Inc. (EXPE)

N/A

$15,001 $50,000

None (or less
than $201)

2.14

Lockheed Martin Corp (LMT)

N/A

$15,001 $50,000

None (or less
than $201)

2.15

Apple (AAPL)

N/A

$15,001 $50,000

2.16

Alphabet Inc. Class A (GOOGL)

N/A

$15,001 $50,000

2.17

Gilead Sciences Inc. (GILD)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.18

Wal-Mart Inc (WMT)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.19

Johnson & Johnson (JNJ)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.20

Honeywell International Inc. (HON)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.21

Boeing Co. (BA)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

None (or less
than $201)
Dividends

Dividends

$201 - $1,000

$201 - $1,000
None (or less
than $201)

 #

DESCRIPTION

EIF

VALUE

INCOME TYPE

INCOME
AMOUNT

2.22

Amazon.com Inc. (AMZN)

N/A

$15,001 $50,000

2.23

Bristol-Myers Squibb (BMY)

N/A

$15,001 $50,000

Dividends

$201 - $1,000

2.24

Bexar County, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.25

City of Carrollton, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.26

City of College Station, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.27

City of Denton, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.28

Frisco Independent School District, Texas
(Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.29

Irving, Texas Waterworks (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.30

City of Keller, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.31

City of Kyle, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.32

City of Levelland, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.33

City of Shavano Park, Texas (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.34

Smith County, Texas (Bond)

N/A

$15,001 $50,000

Interest

$201 - $1,000

2.35

Texas State University (Bond)

N/A

$15,001 $50,000

Interest

$1,001 - $2,500

2.36

Schwab Value Advantage Money Fund
(SWVXX)

Yes

$15,001 $50,000

2.37

Bank of America Corp. (BAC)

N/A

None (or less
than $1,001)

None (or less
than $201)

$1,001 - $2,500
Capital Gains

$15,001 $50,000

 #

DESCRIPTION

EIF

VALUE

2.38

Tweedy Browne Global Value Fund (TBGVX)

Yes

None (or less
than $1,001)

3

Family Trust 1

No

3.1

Oil & Gas Lease, Lasalle County, TX Chesapeake Operating LLC, Oklahoma City,
OK

N/A

$50,001 $100,000

Rent or
Royalties

$15,001 $50,000

3.2

Oil & Gas Lease, McMullen County, TX Carrizo Oil & Gas Inc., Houston TX

N/A

$1,001 - $15,000

Rent or
Royalties

$5,001 - $15,000

3.3

Ranch Land - Brewster County, TX

N/A

$1,000,001 $5,000,000

Rent or
Royalties

$5,001 - $15,000

3.4

Cash Account - US Bank

N/A

$250,001 $500,000

Interest
Capital Gains

$201 - $1,000

3.5

Schwab US Broad Market ETF (SCHB)

Yes

$50,001 $100,000

$1,001 - $2,500

3.6

Schwab Money Market Fund (SWMXX)

Yes

$100,001 $250,000

None (or less
than $201)

4

Ranch Land in Brewster County, TX

N/A

$1,000,001 $5,000,000

Rent or
Royalties

$15,001 $50,000

5

Oil & Gas Lease, Karnes County, TX - Murphy
Oil Corp., El Dorado AR

N/A

$500,001 $1,000,000

Rent or
Royalties

$100,001 $1,000,000

6

Oil & Gas Lease, Karnes County, TX Conoco-Phillips, Bartlesville OK

N/A

$100,001 $250,000

Rent or
Royalties

$100,001 $1,000,000

7

Oil & Gas Lease, Karnes County, TX Marathon Oil Co., Tulsa OK

N/A

$100,001 $250,000

Rent or
Royalties

$50,001 $100,000

8

Oil & Gas Lease, Karnes County, TX - Phillips
66, Bartlesville OK

N/A

$1,001 - $15,000

Rent or
Royalties

$1,001 - $2,500

9

Life Insurance Policy - Northwestern Mutual
Whole Life Policy

No

$50,001 $100,000

Dividends

$2,501 - $5,000

10

Ohio (College Advantage) Direct 529 Savings
Plan

No

10.1

Vanguard Growth Index Portfolio

Yes

$50,001 $100,000

INCOME TYPE

INCOME
AMOUNT
$15,001 $50,000

$5,001 - $15,000

 #

DESCRIPTION

EIF

VALUE

11

Cash Account 1 - US Bank

N/A

$250,001 $500,000

12

Money Market Account - US Bank

N/A

$500,001 $1,000,000

13

Kasita Inc. (Manufacturer of modular
housing units - not publicly traded)

N/A

$100,001 $250,000

14

Family Trust 2

No

14.1

Ranch Lands - Brewster County, TX

N/A

$1,000,001 $5,000,000

15

Cash Account 2 - US Bank

N/A

$15,001 $50,000

7. Transactions
(N/A) - Not required for this type of report

8. Liabilities
None

9. Gifts and Travel Reimbursements
(N/A) - Not required for this type of report

Endnotes

INCOME TYPE

INCOME
AMOUNT
None (or less
than $201)

Interest

$201 - $1,000
None (or less
than $201)

Rent or
Royalties

$5,001 - $15,000
None (or less
than $201)

 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 that (1) ended the reporting period with a value greater than $1,000 or (2)
produced more than $200 in income 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.
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 that (1) ended the reporting period with a value greater
than $1,000 or (2) produced more than $200 in income 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, that (1) ended the reporting period with a value greater than $1,000 or (2) produced more than $200 in investment
income 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 of income was produced). 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
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 federal 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 (limitations apply for PAS filers); (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:
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●

Gifts totaling more than $375 that the filer, the filer's spouse, and dependent children received from any one source during the reporting period.
Travel reimbursements totaling more than $375 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 $150 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.

 Privacy Act Statement
Title I of the Ethics in Government Act of 1978, as amended (the Act), 5 U.S.C. app. § 101 et seq., as amended by the Stop Trading on Congressional Knowledge Act of
2012 (Pub. L. 112-105) (STOCK Act), and 5 C.F.R. Part 2634 of the U. S. Office of Government Ethics regulations require the reporting of this information. 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 sections 105 and 402(b)(1) of the Act 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 another Federal
agency, court or party in a court or Federal administrative proceeding when the Government is a party or in order to comply with a judge-issued subpoena; (4) to a
source when necessary to obtain information relevant to a conflict of interest investigation or determination; (5) to the National Archives and Records Administration or
the General Services Administration in records management inspections; (6) to the Office of Management and Budget during legislative coordination on private relief
legislation; (7) to the Department of Justice or in certain legal proceedings when the disclosing agency, an employee of the disclosing agency, or the United States is a
party to litigation or has an interest in the litigation and the use of such records is deemed relevant and necessary to the litigation; (8) to reviewing officials in a new
office, department or agency when an employee transfers or is detailed from one covered position to another; (9) to a Member of Congress or a congressional office in
response to an inquiry made on behalf of an individual who is the subject of the record; (10) 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 an OGE Government-wide system of records; and (11)
on the OGE Website and to any person, department or agency, any written ethics agreement filed with OGE by an individual nominated by the President to a position
requiring Senate confirmation. 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 three 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), Suite 500, 1201 New York Avenue, NW., Washington, DC 20005-3917.
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).