California Form 700 U – Fill Out and Use This PDF

Instructions for Completing Form 700-U

CALIFORNIAFORM 700-U

Who Files Form 700-U?

This form must be iled by all persons employed by UC or CSU who have principal responsibility for a research

project if the project is to be funded or supported, in

whole or in part, by a contract or grant (or other funds earmarked by the donor for a speciic research project or for a speciic researcher) from a nongovernmental entity.

Reporting requirements are outlined in Regulation 18755.

This regulation provides that research funding by certain nonproit entities will not trigger disclosure. This regulation is available on the FPPC website.

What is an Investment?

“Investment” means any inancial interest in a business entity in which you, your spouse or registered domestic

partner, or your dependent children have a direct, indirect, or beneicial interest totaling $2,000 or more. Reportable investments include stocks, bonds, warrants,

and options, including those held in margin or brokerage accounts and investment funds. Common examples of investment funds are index funds, exchange-traded funds, and venture capital funds. (See Gov. Code Section 82034.)

What is Income?

“Income” means a payment received, including but not limited to any salary, wage, advance, dividend, interest, rent, proceeds from any sale, gift, including any gift of food

or beverage, loan forgiveness or payment of indebtedness received by the iler, reimbursement for expenses, per diem,

or contribution to an insurance or pension program paid by any person other than an employer, and any community property interest in income of a spouse or registered domestic partner. Income also includes an outstanding loan. Income of an individual also includes a pro rata share of any income of any business entity or trust in which the

individual, spouse, or registered domestic partner owns directly, indirectly, or beneicially, a 10% interest or greater.

Income includes your gross income and your community property interest in your spouse’s or registered domestic partner’s gross income totaling $500 or more. Gross income is the total amount of income before deducting expenses, losses, or taxes. (See Gov. Code Section 82030.)

What is a Loan?

Loans received or outstanding are reportable if they total $500 or more from a single lender. Your community property interest in loans received by your spouse or registered domestic partner also must be reported. (See Gov. Code Section 82030(a).)

What is a Gift?

A gift is anything of value for which you have not provided equal or greater consideration to the donor. A gift is reportable if its fair market value is $50 or more. In addition, multiple gifts totaling $50 or more received from a reportable source must be reported.

It is the acceptance of a gift, not the ultimate use to which it is put, that imposes your reporting obligation. Therefore you must report a gift even if you never used it or if you gave it away to another person.

If the exact amount of a gift is not known, you must make a good faith estimate of the item’s fair market value. Listing the value of a gift as “over $50” or “value unknown” is not adequate disclosure.

Commonly reportable gifts include:

•Tickets/passes to sporting or entertainment events

•Tickets/passes to amusement parks

•Parking passes

•Food, beverages, and accommodations, including that provided in direct connection with your attendance at a convention, conference, meeting, social event, meal, or like gathering, where you did not give a speech, participate in a panel or seminar, or provide a similar service

•Rebates/discounts not made in the regular course of

business to members of the public without regard to oficial status

•Wedding gifts

•An honorarium. You may report an honorarium as income rather than as a gift if you provided services of equal or greater value than the payment received.

•Transportation and lodging

•Forgiveness of a loan received by you

(See Gov. Code Section 82028.)

CALIFORNIA 700-U FORM

FAIR POLITICAL PRACTICES COMMISSION

Please type or print in ink.

STATEMENT OF ECONOMIC INTERESTS

FOR

PRINCIPAL INVESTIGATORS

Date Received

Campus Use Only

Campus:

ID No:

1. Information Regarding Funding Entity:

(Use a separate Form 700-U for each funding entity.) Name of Entity:

Address of Entity:

Principal Business of Entity:

Amount of Funding: $

Estimated		Actual

2.Type of Statement (Check at least one box) Initial (for new funding)

Date of initial funding:

/

/

Interim (for renewed funding)

Funding was renewed on:

/

/

3.Filer Information

A.Are you a director, oficer, partner, trustee, consultant, employee, or do you hold a position of management in

the entity listed in Part 1?		No		Yes
Title:

B.Do you, your spouse or registered domestic partner, or

your dependent children have an investment of $2,000 or more in the entity listed in Part 1 above?

No				Yes		– value is:
		$2,000 - $10,000						$10,001 - $100,000
		$100,001 - $1,000,000						Exceeds $1,000,000

If you have sold or divested yourself of investments:

Date Divested:		/		/

C.Have you received income of $500 or more from the entity listed in Part 1 during the reporting period?

No Yes

	$500 - $1,000		$1,001 - $10,000
	$10,001 - $100,000		Exceeds $100,000

Was income received through your spouse or registered

domestic partner?		No		Yes

3. Filer Information - CONT.

D.Have you received loans from the entity in Part 1 for which the balance exceeded $500 during the reporting period?

No				Yes			– highest balance:
		$500 - $1,000							$1,001 - $10,000
		$10,001 - $100,000							Exceeded $100,000

If you checked “yes,” was the loan:

	Secured		Unsecured Interest rate:		%

Was the loan entirely repaid within the last 12 months?

	No		Yes

E.Have you received gifts from the entity listed in Part 1 within the last 12 months valued at $50 or more?

No

Yes

– describe below.

Description:

Value: $

Date Received:

/

/

F. Has the entity in Part 1 paid for your travel?

No

Yes

– describe below.

Type of Payment: (check one)

Gift

Income

Amt: $

date(s):

/

/

/

/

(If applicable)

Description:

4. Veriication

I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date Signed

(month, day, year)

Signature

(File the originally signed statement with your university.)

Instructions for Completing Form 700-U (continued)

CALIFORNIAFORM 700-U

What is a Travel Payment?

Travel payments include advances and reimbursements for travel and related expenses, including lodging and meals.

•Travel payments are gifts if you did not provide services which were equal to or greater in value than the payments received. You must disclose gifts totaling $50 or more from a single source during the period covered by the statement. Gifts of travel are reportable without regard to where the donor is located.

When reporting travel payments which are gifts, you must provide a description of the gift and the date(s) received.

Effective August 15, 2008, Regulation 18946.6 provides new valuation methods for gifts of air transportation.

•Travel payments are income if you provided services which were equal to or greater in value than the payments received. You must disclose income totaling $500 or more from a single source

during the period covered by the statement. The iler has the burden of proving the payments are

income rather than gifts.

When reporting travel payments as income, you must describe the services you provided in exchange for the payment. You are not required to disclose the date(s) for travel payments which are income.

Gifts of travel may be subject to a $420 gift limit. In

addition, certain travel payments are reportable gifts, but are not subject to the gift limit. See the FPPC fact sheet entitled “Limitations and Restrictions on Gifts, Honoraria, Travel, and Loans,” which can be obtained from the FPPC at www.fppc.ca.gov.

You are not required to disclose:

•Travel payments received from any state, local, or federal government agency for which you provided services equal or greater in value than the payments received

•Travel payments received from your employer in the normal course of your employment

•Payments or reimbursements for transportation within California in connection with an event at which you gave a speech, participated in a panel or seminar, or performed a similar service

•Food, beverages, and necessary accommodations received directly in connection with an event held inside or outside California at which you gave

a speech, participated in a panel, or provided a similar service (note that payments for transportation outside of California are reportable)

•A travel payment which was received from a nonproit entity exempt from taxation under IRS Code Section 501(c)(3) for which you provided equal or greater consideration

Check the box to indicate if the payment was a gift or income, report the amount, and disclose the date(s) if applicable.

Violations

Failure to ile the required Statement of Economic Interests or failure to report a inancial interest may

subject a principal investigator to civil liability, including ines, as well as University discipline. (Gov. Code Sections 81000-91014)

Privacy Information Notice

Information requested on all FPPC forms is used by the FPPC to administer and enforce the Political Reform Act (Gov. Code Sections 81000-91014 and Regulations 18109-18997). All information required by these forms is mandated by the Political Reform Act. Failure to provide all of the information required by the

Act is a violation subject to administrative, criminal or civil prosecution. All reports and statements provided are public records open for public inspection and reproduction.

If you have any questions regarding this Privacy Notice

or how to access your personal information, please

contact the FPPC at:

General Counsel

Fair Political Practices Commission 428 J Street, Suite 620 Sacramento, CA 95814

(916) 322-5660