Liaison Agreement Template

212 FW 4

(Template for liaison/representative to non-Federal organization)

Add your Regional Letterhead before signing.


To:                   (Supervisory Directorate Member (e.g., Assistant Director/Regional Director))

Through:          Servicing Ethics Counselor

From:               (Supervisor title)

Subject:           Memorandum of Understanding for (employee name) to Serve as an Official Representative/Liaison to the (name of non-Federal organization)

The attached Memorandum of Understanding (MOU) is an agreement between the U.S. Fish and Wildlife Service (Service) and the (organization name) for (employee name) to serve in an official capacity as a (representative/liaison) to the (organization name).  This MOU has been reviewed and approved by the servicing Ethics Counselor.  I am providing it to you for signature/approval before I request the signature from a representative of the non-Federal organization.

(Note: If the organization has an abbreviation, please use the organization’s full name once in the first paragraph, and the abbreviation after that.)

Memorandum of Understanding between the U.S. Fish and Wildlife Service

and the (organization name)

1.     This Memorandum of Understanding (MOU) sets forth the agreement between the U.S. Fish and Wildlife Service (Service) and the (organization name) (abbreviation) concerning the service of (employee name), as a (representative/liaison) of the Service to the (organization name) as a part of (his/her/their) official Government duties.

2.     The intent of this agreement is for the Service to be the primary beneficiary of (employee name)’s service as a Service (representative or liaison) to (organization name). We expect that the benefits to the Service will include, but not be limited to the following:

a.     Acquisition of state-of-the-art technical information about (subject matter);

b.     Knowledge about organizational arrangements and relationships of organizations with which the Service interacts in order to enhance the working relationships between the Service and such other organizations;

c.      Improved understanding of current issues in the (name the field of endeavor) that concern the Service missions and operations;

d.     Use of professional networks and channels to disseminate information relevant to the accomplishment of the Service mission; and

e.     Use of other mechanisms to facilitate accomplishment of the Service missions, function, and processes, such as meetings, conferences, symposia, and publications.

3.     To avoid the possibility of an appearance of a lack of impartiality, or the apparent use of public office for private gain, when (employee name) uses official time to serve as a liaison or representative to the (organization name), the following principles will apply:

a.     (Employee name) will not participate in any management activities for (organization name), including voting on organizational administration matters or on organizational policy decisions, or rendering advice or making decisions regarding (organization name) contracts or finances;

b.     (Employee name) will not represent the interests of (organization name) back 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 (employee name) from presenting the positions taken by the (organization name) over which (he/she/they) has an official responsibility to assess and report back to the Department of the Interior (DOI) as part of (his/her/their) official duties;

c.      If (employee name)’s participation in a project undertaken in conjunction with the (organization name) was done as part of (his/her/their) official duties, (employee name) is prohibited from receiving any supplementation of (his/her/their) Federal salary (18 U.S.C. 209). 

d.     If the (organization name) wishes to pay for (employee name)’s travel and travel-related expenses to attend (organization name)’s meetings, (employee name) must submit a completed DI-2000 form to request and receive authorization to accept such payment.

e.     (Employee name) is prohibited from using 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 (18 U.S.C. 1913).

f.       (Employee name) is prohibited from being involved in fundraising activities of the (organization name).

g.     Unless a gift rule exception found at 5 CFR 2636.201 applies, (employee name) will not receive any form of compensation or gratuities from the (organization name) provided in connection with the (employee name)’s official participation with (organization name).

4.     The relationship between the (organization name) and the Service addressed in this document is intended to enhance service to the American public through more efficient applications of Service programs. All actions should be directed toward attainment of that mutually beneficial goal.

5.     We do not intend for this agreement to impose on the (organization name) any obligations or restrictions, other than those above. The (organization name) has an obligation to respect the limitations described above on the activities and function of (employee name) and benefits which may be received by the Service. This agreement does not constitute a representation or warranty by the (organization name) as to the benefits which the Service will receive from (employee name)’s service as a (liaison/representative) to the (organization name). Nor does the (organization name) assume any obligation to inquire into or enforce (employee name)’s compliance with paragraph 3 above.

________________________________________                            __________________

(Supervisory Directorate Member)                                                      Date

U.S. Fish and Wildlife Service                        

________________________________________                            __________________

(Name)                                                                                                Date


(Organization name)

PDF/downloadable template/other resource
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