Oge Form 450 PDF Details

The OGE Form 450, a critical document under 5 CFR Part 2634, Subpart I, mandates certain employees within the Executive Branch to file a Confidential Financial Disclosure Report. This obligation is designed to identify and mitigate any potential conflicts of interest between an employee's official duties and their private financial interests or affiliations. As part of the reporting process, individuals are required to disclose a comprehensive range of financial details, including, but not limited to, assets, income sources, liabilities, outside positions, agreements or arrangements, and in certain cases, gifts or travel reimbursements. This form serves multiple purposes: facilitating transparency, safeguarding the integrity of governmental operations, and ensuring that employees conduct themselves in compliance with ethical standards. The document stipulates clear deadlines for submission, varying for new entrants to a position and annual filers, and outlines the reporting period relevant to each. It also highlights the significance of accuracy in the information provided, underlining that misinformation or non-disclosure may lead to disciplinary actions, or in severe cases, criminal prosecution. The Privacy Act Statement included in the form emphasizes the confidentiality with which this information is handled, specifying the circumstances under which it might be disclosed. Additionally, the form contains specific instructions on how to complete it, offering guidance on distinguishing between reportable and non-reportable items and detailed descriptions of how to accurately report various forms of financial interests. Ultimately, the OGE Form 450 is a fundamental tool in the endeavor to maintain ethical conduct within the Executive Branch, ensuring that employees' actions are not unduly influenced by their private financial matters.

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Form NameOge Form 450
Form Length7 pages
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Avg. time to fill out1 min 45 sec
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OGE Form 450, 5 CFR Part 2634, Subpart I U.S.

Form Approved

Office of Government Ethics (January 2017)

OMB No. 3209-0006

(Replaces June 2015 edition)

 

CONFIDENTIAL FINANCIAL DISCLOSURE REPORT

Executive Branch

Why Must I File?

When Must I File?

What is the Reporting Period?

What if I Have Questions?

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.

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.

New Entrants: Report the required information for the 12 months preceding your filing of this form.

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 official or go to the Office of Government Ethics web site at www.oge.gov and select OGE Form 450: Confidential Financial Disclosure Report 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 ithe 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 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; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; (6) to the Department of Justice or in certain legal proceedings when OGE, an employee of OGE, 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; (7) to reviewing officials in a new office, department or agency when an employee transfers from one covered position to another; (8) 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; and (9) 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. 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 one hour. 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.

OGE Form 450, 5 CFR Part 2634, Subpart I U.S. Office of Government Ethics (January 2017) (Replaces June 2015 edition)

Date Received by Agency

Use arrow keys to read all text. Tab to complete form.

 

 

Form Approved OMB No. 3209-0006

Page Number

CONFIDENTIAL FINANCIAL DISCLOSURE REPORT

Executive Branch

 

Employee’s Name (Print last, first, middle initial)

 

 

E-mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position/Title

 

 

 

 

 

 

 

 

Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency

 

 

Branch/Unit and Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone

 

Reporting Status

 

If New Entrant, Date of Appointment to Position

 

 

 

 

New Entrant

Annual

(mm/dd/yy)

 

 

 

Check box if Special

An SGE is an executive branch officer or employee who is retained, designated, appointed, or

 

Government Employee (SGE)

employed to perform temporary duties either on a full-time or intermittent basis, with or without

 

 

 

compensation, for a period not to exceed 130 days during any consecutive 365-day period.

 

If an SGE, Mailing Address (Number, Street, City, State, ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 1: Read the instructions for Parts I through V on the following pages.

 

 

 

 

 

 

Step 2: For each statement below, check Yes or No to describe your situation.

 

 

 

 

 

 

 

 

 

 

 

I. I have reportable assets or sources of income for myself, my spouse, or my dependent

 

Yes

No

 

 

children.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. I have reportable liabilities (debts) for myself, my spouse, or my dependent children.

 

Yes

No

 

 

III. I have reportable outside positions for myself.

 

 

 

 

 

Yes

No

 

 

IV. I have reportable agreements or arrangements for myself.

 

 

 

 

Yes

No

 

 

NOTE: Statement V is for annual filers only. It does not apply to new entrants and SGEs.

 

Yes

No

 

 

V. I have reportable gifts or travel reimbursements for myself, my spouse, or my dependent

 

 

 

 

children.

 

 

 

 

 

 

 

 

 

 

Step 3: If you selected Yes for any statement, you must describe the reportable interests that you have in the corresponding Part (I, II, III, IV, or V) of the form.

Step 4: Sign and date the form.

Step 5: Submit the completed form to your ethics office.

I certify that the statements I have made on this form and all attached statements are true, complete, and correct to the best of my knowledge.

Signature of Employee

FOR REVIEWERS’ USE ONLY:

Date (mm/dd/yy)

On the basis of information contained in this report, I conclude that the filer is in compliance with applicable laws and regulations, except as noted in the “comments” box below.

Signature and Title of Supervisor/Other Intermediate Reviewer (if required by the agency)

Date (mm/dd/yy)

E-mail Address

Phone Number

Signature and Title of Agency’s Final Reviewing Official

Date (mm/dd/yy)

Comments of Reviewing Officials

(Check box if continued on additional page )

OGE Form 450, 5 CFR Part 2634, Subpart I U.S. Office of Government Ethics (January 2017) (Replaces June 2015 edition)

Employee’s Name (Print last, first, middle initial)

Form Approved OMB No. 3209-0006

Page Number

Part I: Assets and Income

Report for Yourself, Spouse, and Dependent Child:

Do Not Report:

• Assets held for investment with a value greater than $1,000 at

• Federal Government retirement benefits

the end of the reporting period OR assets held for investment

•

Thrift Savings Plan

which produced more than $200 in income during the

• Certificates of deposit, savings or checking

reporting period, including but not limited to:

 

accounts

- Assets such as stocks, bonds, annuities, trust holdings,

•

Term life insurance

partnership interests, life insurance, investment real

• Money market mutual funds and money market

estate, or a privately-held trade or business

 

accounts

- Sector mutual funds: those funds invested in a particular

• Your personal residence, unless you rent it out

industry, business, or location such as ABC Electronics

• Diversified mutual funds, such as ABC Equity

Fund or XYZ Canada Fund (report the full name of the

 

Value Fund or XYZ Large Capital Fund

fund, not just the general family fund name)

 

• U.S. Government Treasury bonds, bills, notes, and

- Holdings of retirement plans, such as 401(k)s or IRAs,

 

savings bonds

investment life insurance, or variable annuities (list

 

• Money owed to you, your spouse, or dependent

each holding except diversified mutual funds)

 

child by a spouse, parent, sibling, or child

- Defined benefit pension plans provided by a former

 

 

employer (include the name of the employer)

 

 

 

 

 

 

Also Report:

Do Not Report:

• For yourself: (1) all sources of salary, fees, commissions, and

• Dependent child’s earned income

other earned income greater than $200, (2) honoraria greater

•

Veterans’ benefits

than $200, and (3) other non-investment income such as

•

Federal Government salary

scholarships, prizes, and gambling income greater than $200

•

Social Security benefits

• For your spouse: (1) all sources of salary, fees, commissions,

 

 

and other earned income greater than $1,000, and (2)

 

 

honoraria greater than $200

 

 

Important Definitions

Diversified Mutual Fund – A mutual fund that does not have a stated policy of concentrating its investments in one industry, business, or single country other than the United States.

Sector Mutual Fund – A mutual fund that concentrates its investments in an industry, business, single country other than the United States, or bonds of a single state within the United States.

Dependent Child – A son, daughter, stepson or stepdaughter who is either unmarried and under age 21 and living in the filer’s house, or considered dependent under the U.S. tax code.

Reportable Information – Go to the last page to see examples of how to report assets and income.

Specific stock, bond, sector mutual fund, type/location of real estate, etc. (Indicate the full name of each

No longer

specific asset or investment. You may add the ticker symbol to the full name.)

held

Name of Employer or Business; Source of Fees, Commissions, or Honoraria (Include brief description.)

 

You may distinguish any entry for a family member by preceding it with S for spouse, DC for dependent child,

 

or J for jointly held.

 

1

 

 

 

2

 

 

 

3

 

 

 

4

 

 

 

5

 

 

 

OGE Form 450, 5 CFR Part 2634, Subpart I U.S. Office of Government Ethics (January 2017) (Replaces June 2015 edition)

Employee’s Name (Print last, first, middle initial)

Form Approved OMB No. 3209-0006

Page Number

Part I: Assets and Income

Continuation Page

Specific stock, bond, sector mutual fund, type/location of real estate, etc. (Indicate the full name of each

No longer

specific asset or investment. You may add the ticker symbol to the full name.)

held

Name of Employer or Business; Source of Fees, Commissions, or Honoraria (Include brief description.)

 

You may distinguish any entry for a family member by preceding it with S for spouse, DC for dependent child,

 

or J for jointly held.

 

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

OGE Form 450, 5 CFR Part 2634, Subpart I U.S. Office of Government Ethics (January 2017) (Replaces June 2015 edition)

Employee’s Name (Print last, first, middle initial)

Form Approved OMB No. 3209-0006

Page Number

 

Part II: Liabilities

 

 

Report for Yourself, Spouse, and Dependent

Do Not Report:

Child:

 

• A liability over $10,000 owed at any time

• Any liability, such as a mortgage, a student loan, or a credit card

during the reporting period, other than a

account, from a financial institution or business entity granted on

loan from a financial institution or business

terms made available to the general public

entity granted on terms made available to

• Loans secured by automobiles, household furniture, or appliances,

the general public

unless the loan exceeds the purchase price of the item it secures

• A loan over $10,000 from an individual,

• Liabilities that you owe to your spouse or to the parent, sibling, or

such as a friend or a business associate

child of you, your spouse, or your dependent child

Reportable Information – Go to the last page to see examples of how to report liabilities.

Name of creditor (include city and state

Type of liability (personal loan, margin account, etc.)

where creditor is located)

 

1

 

 

 

2

 

 

 

Part III: Outside Positions

Report for Yourself:

Do Not Report:

• All positions outside the U.S. Government held at any time during the

• Any position with a

reporting period, whether or not you were compensated and whether or not

-

Religious entity

you currently hold that position. Positions include an officer, director,

-

Social entity

employee, trustee, general partner, proprietor, representative, executor, or

-

Fraternal entity

consultant of any of the following:

-

Political entity

- Corporation, partnership, trust, or other business entity

• Any position held by your spouse

- Non-profit or volunteer organization

or dependent child

- Educational institution

• Any position that you hold as part

- State or Local Government

of your official duties

Reportable Information – Go to the last page to see examples of how to report outside positions.

Organization

Type of organization

Position

No longer

(include city and state where organization is located)

 

 

held

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

OGE Form 450, 5 CFR Part 2634, Subpart I U.S. Office of Government Ethics (January 2017) (Replaces June 2015 edition)

Employee’s Name (Print last, first, middle initial)

Form Approved OMB No. 3209-0006

Page Number

Part IV: Agreements or Arrangements

Report Your Agreements or Arrangements for:

Do Not Report:

• Continuing participation in an employee pension or benefit plan maintained

• Any agreement or arrangement

by a former employer

related to your employment by the

• A leave of absence

Federal Government

• Future employment, including date you accepted employment offer

• Spouse’s and dependent child’s

• Continuation of payment by a former employer (including severance

agreements or arrangements

payments)

 

Reportable Information – Go to the last page to see examples of how to report agreements and arrangements.

Entity with which you have an agreement Terms of Agreement or Arrangement or arrangement (include city and state

where entity is located)

1

2

3

4

Part V: Gifts and Travel Reimbursements

Fill out this part only if you are filing an Annual Report. If you are a new entrant or an SGE, skip this part.

Report for Yourself, Spouse, and Dependent Child:

Do Not Report:

•

Travel-related reimbursements (items such as lodging,

• Anything received from relatives, the U.S.

 

transportation, and food) totaling more than $390* from any one

Government, D.C., state, or local governments

 

source during the reporting period; include where you traveled,

• Bequests and other forms of inheritance

 

the purpose, and date(s) of the trip

• Gifts and travel reimbursements given to your

•

Any other gifts totaling more than $390* from any one source

agency in connection with your official travel

 

during the reporting period

• Gifts of hospitality (food, lodging,

*If you received more than one gift from one source:

entertainment) at the donor’s residence or

personal premises

1.

Determine the value of each item you received from that source

• Anything received by your spouse or

2.

Ignore each item valued at $156 or less

dependent child totally independent of their

3.

Add the value of those items valued at more than $156; if the total

relationship to you

 

is more than $390, then you must list those items on this form

 

Reportable Information – Go to the last page to see examples of how to report gifts and travel reimbursements.

Source

1

Description

2

3

OGE Form 450, 5 CFR Part 2634, Subpart I U.S.

Form Approved

Office of Government Ethics (January 2017)

(Replaces June 2015 edition)

OMB No. 3209-0006

EXAMPLES

Part I: Assets and Income

Specific stock, bond, sector mutual fund, type/location of real estate, etc. (Indicate the full name of

No longer

each specific asset or investment. You may add the ticker symbol to the full name.)

held

Name of Employer or Business; Source of Fees, Commissions, or Honoraria (Include brief

 

description.)

 

You may distinguish any entry for a family member by preceding it with S for spouse, DC for dependent

 

child, or J for jointly held.

 

XYZ Japan Fund (Example of sector mutual fund)

 

OGE Energy (Example of stock that produced more than $200 in capital gains)

 

(S) OGC Communications (Example of stock held in a 401(k) plan)

 

ABC Healthcare Fund (Example of sector fund held in a variable annuity)

 

Rental Condo, Anchorage, AK (Example of investment real estate)

 

Bryggadune University – former employer

 

(S) Express Medical Clinic – employer

 

Association of Accountants – honoraria

 

Part II: Liabilities

Name of creditor (city and state)

Type of liability (personal loan, margin account, etc.)

John Jones (Denver, CO)

Personal loan from a friend

ANW Investment Company (San Francisco,

Margin account

CA)

 

Part III: Outside Positions

Organization

Type of organization

Position

No longer

(city and state)

 

 

held

Bryggadune University

Educational institution

Professor

 

(Memphis, TN)

 

 

 

ISK Family Trust

Family Trust

Trustee

 

(Boynton Beach, FL)

 

 

 

Scenic Rivers Association

Non-profit environmental

Member, Board of

 

(Nashville, TN)

organization

Directors

 

Part IV: Agreements or Arrangements

Entity with which you have an agreement

Terms of Agreement or Arrangement

or arrangement (include city and state

 

where entity is located)

 

Dee, Jones & Smith

Will receive pension benefits (defined benefit plan) (Example of continuing

(San Diego, CA)

participation in an employee pension or benefit plan by a former employer)

 

 

Hartford & Brown

Employment agreement with Hartford & Brown. Starting work as attorney in

(San Diego, CA)

July 2012. Entered into agreement in October 2011. (Example of

 

agreement for future employment)

Part V: Gifts and Travel Reimbursements

Source

Description

Dee, Jones & Smith

Leather briefcase

 

(Example of a gift totaling more than $390 from one source)

CGH Culinary Institute

Airline ticket, hotel room, and meals incident to culinary seminar in Tokyo,

 

Japan from May 1-5, 2011 (Example of travel reimbursement)

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CONFIDENTIAL FINANCIAL DISCLOSURE, Form Approved OMB No Page Number, and Check box if Special Government inside oge financial online

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