Advisory Board Service in Employee's Official Capacity: Request for Approval

212 FW 4
Exhibit 1, 212 FW 4, 11/9/2017


To:                   (Supervisor)

Through:          (Servicing Ethics Counselor)

From:               (Employee)

Subject:           Appointment to the Advisory Committee for the (name of non-Federal organization)

This memorandum requests your approval to participate as a member of the advisory board for the (name of non-Federal organization) as part of my official duties.  I anticipate that I will use approximately (number) hours of official time for this purpose each month.  The term of service will begin on (date) and end on (date). 

he (name of non-Federal organization) is a nonprofit organization whose mission is (describe mission).  The advisory board consists of (describe number of members, etc.).  My role, as an advisory board member, will be to (describe or list basic duties).  (Provide link to website, if available.)

Participation on this advisory board as part of my official duties will provide a unique opportunity for the U.S. Fish and Wildlife Service (Service) to (describe benefit to the Service of your participation on the advisory board).  

I understand that as a member of this advisory board I am subject to the following requirements in paragraph 4.7A in 212 FW 4, Participation with non-Federal Organizations in a Personal or Official Capacity.

I understand that while serving as an advisory committee member, I may:

1)     Accept travel expenses from the non-Federal organization only if I am on an official travel authorization and have received supervisor and Ethics Office approval in advance on Form DI 2000 to attend meetings or other similar events for the organization (see 212 FW 3 - now 265 FW 13). 

2)     Use official time in coordination with my supervisor to perform my officially assigned duties and responsibilities with the non-Federal organization. I do not have to take annual leave to conduct these duties.

3)     Use Government equipment, supplies, services, and staff to carry out officially assigned duties with non-Federal organizations.

4)     Use my official title as a reference, identifier, or to promote attendance at a public meeting or presentation when participating in an official capacity. (I may not use my official title to imply endorsement of the non-Federal organization or its products or services, if any.) 

5)     Communicate verbally or in writing on behalf of the Service regarding Service programs, operations, or activities if I comply with the requirements in 115 FW 1 and 115 FW 2 on official communications. If the Service has taken an official position or established official policy on an issue, my statements must be consistent with that position or policy. If the Service has not taken an official position or established an official policy on an issue, I may state my professional opinion if I include a disclaimer to that effect with my statement. 

I understand that while serving as an advisory committee member, I may not:

1)     Participate in any management activities of the non-Federal organization, including voting on organizational administrative matters or on organizational policy decisions, or rendering advice or making decisions regarding contracts or finances of the organization.

2)     Represent the interests of the non-Federal organization to any officer or employee of the executive or judicial branches of the Federal Government, consistent with 18 U.S.C. 203 and 205. This does not prohibit me when serving on an advisory board from presenting information about the positions and views of the non-Federal organization to the Service as part of my official duties.

3)     Receive a salary or any compensation or supplementation of my Federal salary from anyone other than the United States for performing my official duties. (See 18 U.S.C. 209)

4)     Accept gifts from a prohibited source or given because of my official position, unless an exception listed in the Standards of Ethical Conduct for Employees of the Executive Branch, 5 CFR 2635.204, applies.

5)     Use any appropriated funds, official time, or Government equipment to instigate or generate lobbying activity on any issue pending before or of interest to the Congress or an official of any government, consistent with 18 U.S.C. 1913.    

6)     Be involved in an official capacity in any fundraising activities of the non-Federal organization. (See 5 CFR 2635.808

7)     Disclose non-public information or allow its improper use to further the interests of the non-Federal organization. (See 5 CFR 2635.703)

8)     Use official Government postage, stationery, envelopes, or labels for anything other than official Government business. (See 18 U.S.C. 1719)

If I have any questions regarding my participation, I will consult with you and/or a Service Ethics Counselor.


_________________________________                __________________________________

Supervisor Name                                                        Date


(Employee and servicing Ethics Counselor should keep a copy for their records.)