Attachment to LA-13-06: Notification Format and Recusal Statement

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 NOTIFICATION OF POST-GOVERNMENT EMPLOYMENT
OR COMPENSATION NEGOTIATION OR AGREEMENT
AND RECUSAL STATEMENT
 

Section 17 of the Stop Trading on Congressional Knowledge Act of 2012 (STOCK Act) requires certain employees to file a statement notifying their agency ethics official of any negotiation for, or agreement of, future employment or compensation with a non-federal entity within three business days after commencement of the negotiation or agreement. An employee who files a notification statement also must file with the agency’s ethics official a recusal statement whenever there is a conflict of interest or appearance of a conflict of interest with the entity, unless the employee obtains a written waiver as discussed in 5 C.F.R. § 2635.402(d), obtains an authorization as discussed in 5 C.F.R. § 2635.502(d), or qualifies for a regulatory exemption pursuant to 18 U.S.C. § 208(b)(2).

NOTIFICATION OF POST-GOVERNMENT EMPLOYMENT OR COMPENSATION NEGOTIATION OR AGREEMENT 

Name of Employee  

 

Agency/Office 

 

Date Negotiation or Agreement Commenced 

 

Name(s) of Non-Federal Entity or Entities
Disclose each non-federal entity with which you are negotiating for, or have an agreement of, future employment or compensation. 

 

 

RECUSAL STATEMENT 

For as long as I am negotiating for, or have an agreement of, employment or compensation with any entity listed above, I will comply with all applicable recusal obligations under 5 C.F.R. part 2635 and, where applicable, 18 U.S.C. § 208. I understand that it is my responsibility to consult an agency ethics official if I have questions regarding these recusal obligations.

Employee Signature 

Date Submitted 

 

 

Agency Ethics Official Signature 

Date Received