In today's fast-paced world, the intersection of public service and private generosity often requires a delicate balance, especially when it comes to accepting gifts or donations. The VA 0893 form embodies this confluence, serving as a critical tool for managing offers to donate travel support to employees of the Department of Veterans Affairs (VA). Designed to facilitate the acceptance of travel donations under specific U.S. statutes, this form ensures that such contributions are handled in a manner that aligns with both legal standards and the VA's protocols. By stipulating the necessary documentation and approval process, the VA 0893 form acts as a safeguard, ensuring that all parties uphold the highest standards of transparency and accountability. Moreover, it outlines the method for reporting the received travel support, thereby maintaining the integrity of the VA's operations and its employees' actions. It's important to note that this form does not replace the usual travel authorization documents but works in conjunction with the VA's current travel management system to offer a comprehensive framework for managing donated travel support. Through detailed instructions and a thorough review process involving various levels of VA's governance, from office heads to general counsel, the form exemplifies meticulous governance in managing the delicate matter of accepting travel gifts, thereby ensuring that these gestures of support further the VA's interests without compromising ethical standards.
| Question | Answer |
|---|---|
| Form Name | Va Form 0893 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | E-MAIL, 1st, VACO, VISN |
ADVANCE REVIEW OF OFFER TO DONATE SUPPORT FOR OFFICIAL TRAVEL
NOTE: This VA Form 0893 is to be used to accept a gift of travel under 31 U.S.C. §1353 or 5 U.S.C. §4111 and does NOT replace travel authorization documents.
USE THIS FORM IN CONJUNCTION WITH THE CURRENT VA TRAVEL MANAGEMENT SYSTEM.
INSTRUCTIONS: Please complete and have office head sign on page 2. Forward to Assistant General Counsel (023)(VACO) or Regional Counsel (Field). They will review and return form to you. You must then provide form to one of the officials with gift acceptance authority listed on the the bottom of page 2. Upon completion of your travel, this form (with all necessary signatures) must be included with your claim for reimbursement of travel expenses (travel voucher). Faxing a copy of this form to the current VA travel management system is acceptable.
INFORMATION ABOUT VA EMPLOYEE (TRAVELER)
NAME OF VA EMPLOYEE
DEPARTMENT/OFFICE
POSITION TITLE
DUTY STATION
INFORMATION ABOUT DONOR AND/OR HOST ORGANIZATION
NAME OF ORGANIZATION HOSTING THE EVENT |
NAME OF DONOR ORGANIZATION (If different from Host) |
||
|
|
|
|
HOST ORGANIZATION POINT OF CONTACT (POC) |
DONOR ORGANIZATION POINT OF CONTACT (POC) |
|
|
|
|
|
|
HOST POINT OF CONTACT |
DONOR POINT OF CONTACT |
|
|
|
|
||
HOST POINT OF CONTACT DAYTIME PHONE NUMBER |
DONOR POINT OF CONTACT DAYTIME PHONE NUMBER |
||
EXT: |
|
EXT: |
|
|
|
|
|
INFORMATION ABOUT MEETING OR EVENT SPONSORED BY (DONOR) HOST ORGANIZATION |
|||
|
|
|
|
NAME AND ADDRESS OF EVENT |
|
DATE OF EVENT |
TIME OF EVENT |
|
|
|
|
PURPOSE OF EVENT (Include 1, How this event will further VA's interests, and 2, how this event relates to your official duties) |
|
||
1. |
|
|
|
2. |
|
|
|
|
|
||
OTHER ENTITIES ATTENDING OR PARTICIPATING |
ROLE OF |
||
|
|
|
|
DID DONOR OFFER TO PAY COSTS FOR OTHER ATTENDEES SIMILARLY SITUATED (e.g. if you are going to be a speaker, did donor offer similar travel gifts to all
speakers at the event?) |
YES |
NO |
|
INSTRUCTIONS: Fill out dollar amount and appropriate Gift Code for each applicable category. Include amounts for spouse if donor has offered to support spouse travel.
|
GIFT |
|
NO. OF |
|
COST PER NIGHT |
|
|
|
|||
|
CODE |
NIGHTS |
|
|
|
|
|||||
|
|
|
|
|
|
|
|
||||
LODGING |
|
|
|
|
$ |
|
|
|
|
TOTAL LODGING |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SELF |
|
SPOUSE |
|
|
MEALS |
|
$ |
|
|
|
|
$ |
|
TOTAL MEALS |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
COACH |
|
|
|
COACH |
|
|
|
|
|
|
|
PREMIUM |
|
|
PREMIUM |
|
|
||
TRAVEL FARES |
|
|
|
1st CLASS |
$ |
|
1st CLASS $ |
TOTAL FARES |
$ |
||
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
GROUND |
|
$ |
|
|
|
|
|
|
TOTAL GROUND |
$ |
|
TRANSPORTATION |
|
|
|
|
|
|
|
TRANSPORTATION |
|||
EVENT FEES |
|
$ |
|
|
|
|
$ |
|
TOTAL FEES |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
OTHER |
|
$ |
|
|
|
|
$ |
|
TOTAL OTHER |
$ |
|
EXPENSES |
|
|
|
|
|
|
EXPENSES |
||||
|
|
|
|
|
|
|
|
|
|
||
|
GIFT CODE KEY |
|
|
|
GRAND |
$ |
|||||
1 - |
|
TOTAL |
|||||||||
|
|
||||||||||
2 - Check/other monetary instrument payable to VA
3 - Check/other monetary instrument payable to employee*
4 - Cash to employee*
*VA employees receiving cash or check payable to employee must confirm that donor is a
VA FORM 0893 OCT 2009
TO YOUR KNOWLEDGE, ARE THERE ANY PENDING CONTRACTS, PROPOSALS, REQUESTS FOR PROPOSALS, AFFILIATION AGREEMENTS, OR OTHER DECISIONS OR MATTERS INVOLVING VA AND DONOR?
NO
YES (If "YES", describe the pending matter in the REMARKS section below.)
DOES VA EMPLOYEE HAVE A ROLE IN VA ACTION ON ANY OF THE PENDING MATTERS?
NO
YES (If "YES," describe the VA Employee's role in the REMARKS section below.)
IF REIMBURSEMENT WILL BE BY CASH OR CHECK PAYABLE TO EMPLOYEE ANSWER THE FOLLOWING:
1. IS THE DONOR A
YES |
|
NO |
|
|
|
2. DID YOU RENDER SERVICE TO THE 501(c)(3) DONOR PRIOR TO THIS TRAVEL? (If yes, provide details in REMARKS sections below.)
YES |
|
NO |
|
|
|
REMARKS
CERTIFICATION: I certify that the answers above are truthful and correct. I further certify that if I directly receive a cash or check payment from the donor, I will use these funds only for the listed travel expenses and I will refund any unused portion of these funds to the donor.
SIGNATURE OF EMPLOYEE (Traveler)
DATE SIGNED
CERTIFICATION OF HEAD OF
CERTIFICATION: I certify that the travel relates to the employee's official duties and believe that the travel is in the interest of the Government. To the best of my knowledge, I believe that the answers above are truthful and correct.
SIGNATURE OF REQUESTING OFFICE HEAD OR NEXT HIGHER OFFICIAL IF REQUESTING HEAD IS TRAVELER (Print name and title)
DATE SIGNED
GENERAL COUNSEL REVIEW
REVIEW FINDINGS: Based upon facts above, VA could lawfully determine that accepting the offered travel support would be proper.
SIGNATURE OF ASSISTANT GENERAL COUNSEL (023) OR REGIONAL COUNSEL OR OTHER DEPUTY ETHICS OFFICIAL
DATE SIGNED
ACCEPTANCE OF GIFT BY AUTHORIZED OFFICIAL
I approve acceptance of the gift of travel support based on the facts provided above. I determine that the travel is in the interest of the Government and relates to the traveling employee's official duties and that the gift is not a reward for services to the donor prior to the event. I further determine that acceptance of the offered travel support would not cause a reasonable person with knowledge of all the relevant facts to questions the integrity of VA's programs, operations, or employee's. I have considered any impact the performance or nonperformance of the traveling employee's official duties might have on the donor.
LIST OF OFFICIALS AUTHORIZED TO MAKE DETERMINATION |
SIGNATURE OF APPROVING OFFICIAL (Print name and title) |
Secretary; Deputy Secretary, VA COS, VA Deputy COS,
Under Secretary, Deputy Under Secretary, Assistant
Deputy Under Secretary, Executive Assistant to the Under
Secretary, Assistant Secretary, Deputy Assistant
Secretary, Key Central Office Official and Deputy; VISN
Director and Deputy Director, VBA Area Director and
Deputy Director, Regional Counsel, NCA Memorial
Service Network Director and Deputy Director, Field
Facility Director and their Associate and Assistant
Directors (and Medical Center COS if authorized by
Medical Center Director).
DATE SIGNED
THIS COMPLETED FORM ALONG WITH TRAVEL VOUCHER MUST BE FAXED TO CURRENT VA TRAVEL MANAGEMENT SYSTEM AFTER TRAVEL IS COMPLETED.
VA FORM 0893, OCT 2009, PAGE 2