ML21313A007
ML21313A007 | |
Person / Time | |
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Issue date: | 11/03/2021 |
From: | NRC/OCIO |
To: | |
Shared Package | |
ML21313A005 | List: |
References | |
FOIA, NRC-2022-000007 | |
Download: ML21313A007 (5) | |
Text
NOTIFIC ATION OF CONFLICT OF INTEREST RE FE RRAL PART 1: INITIAL NOTIFICATION (to be filed l?J the refeni11g office)
File Part 1 of this form with th e U.S. Office of Government Ethics (OGE) upon any r eferra l mad e to the U.S. D epartment o f Ju stice (DOJ ), pursuant to 28 U.S.C. § 535, involv ing :
(1) A poss ible vio lation under sect ion 203,205,207,208, and /or 209 of title 18, United States Code; (2) A c ivil o r criminal matt er related to th e filing o r non - filing o f a financial di sclo sure r ep o rt und er app li cab le leg al authorities (e.g., 5 U.S.C. app. § 104 o r 18 U.S.C. § 1001) ; or (3) A civil matter invo l vin g outside earned income under 5 U.S.C. ap p. § 501 or out sid e activities under 5 U.S.C. app. § 502.
Submit this form v ia email to re fe rral s@oge.gov. OGE will confirm receipt and notify the referring office o f the OGE trackin g number assigned.
- 3. P oint of co ntact at th e referring o ffice:
Name: _l(b-)(J_ )(_C) ____ _
- 5. D epa rtm ent of Ju stice office to which the matt e r was r e fe rre d:
I vlPub lic In tegrity Sectio n, Crimina l D ivisio n
u.s. Attorney (.rpecijj1 dishict)
Other D O J offi ce (specify office)
O GE use o nl y
OGE FORM 202 ( rev. 10/16)
NOTIFICATION OF CONFLICT OF INTEREST REFERRAL PART 2: DISPOSITION OF REFERRAL (to be filed l?J the refeni11g office)
File Par t 2 of this form with the U.S. Office of Government Ethics (OGE) following the refe rral made to the U.S. D epartme nt of Ju stice (DOJ ), pursuant to 28 U.S.C. § 535, after both o f t he follow ing have occurre d:
(1) D OJ ha s (a) declined prosecution; (b) initiated prosecution or taken othe r legal ac tion that is a matte r of pub li c r ecord ; or (c) settled the matter through fo rm al agreement; and (2) Inv estigatio n of the matter ha s concluded.
Submit this form via email to referra ls@oge.gov. OGE will confirm receipt.
- 2. P oint of contact at the referring office:
Na me:... l(b _)(7_)(C_ l ____ _,
7 Telephone:... l(b _l(_ l(_c _) _____ _,
- 5. Statutes invo l ved in the matter (mark all that app!J) :
18 u.s.c. § 203 18 U.S.C. § 100 1 (in connection //Jith financial disclomre orother ethits domments on!Y) 18 u.s.c. § 205 D 5 U.S.C. app. § 104 (/i11a11cial di.rclos11re) 18 u.s.c. § 207 D 5 U.S.C. app. § 501 (outside eam ed i11co111e)
~ 18 u.s.c. § 208 D 5 U.S.C. app. § 502 (011/side actil!ifies) 18 u.s.c. § 209 D Oth er (specify) :
OGE FORM 202 ( rev. 10/16) Pagc 1 o f 2
- 6. Dispos i tion of the referral to DOJ:
DOJ Public Integrity Section (PIN) declined prosecution of the matter.
- 7. Has there b een an adverse finding regarding the emp loyee involved related to the Standards of Ethical Conduct for Employees o f th e Executive Branch (5 C. F.R. p art 2635) o r agency supp lem e ntal st andard s o f conduct?
@ yes (complete boxes 8-12 be/0111) 0 no (do 110! complete the rest of this jin711)
If the res onse in box 7 is "yes," com Jete boxes 8-12, below.
10. H as the em p loying agency considered taking corrective action against the em ployee?
Qunk no wn
- 11. H ave yo u elec ted to atta ch ei the r a r ep ort of investigation or sum mary?
- 12. (optionc,~ P rovide any other information you consider p er tinent:
l(b)(7)(C) I no further ac tion was taken.
OGE FO RM 202 (rev. 10/16) Page 2 of2 OGE FORM 202, P A RT 3 NOTIFICATION OF CONFLICT OF INTEREST REFERRAL PART 3: CONSIDERATION OF CORRECTIVE ACTION (to he filed 1:)1 the DAEO ef the e111plq)'ing age1191 or the DAEO 's designee)
File P art 3 of thi s form with the U.S. Office of Gov e rnm ent Ethics (OGE) follo wing the re ferral mad e t o the U.S. Department of Justice (DOJ), pursuant to 28 U.S.C. § 535, after all of the following have occurred:
(1) DO] h as (a) declin ed p rosecution ; (b) initiat ed p rosecution or taken othe r legal action that is a matter of public r ecor d; or (c) se ttled th e matt er through formal agree m e nt; (2) Investig ation of the matter has concluded; and (3) The refe rring offi ce h as made an adverse finding regarding th e emplo ye e invo lve d related t o th e Stand ard s of Ethica l Conduct for Emp loyees of th e Exe c utive Branch or any agency su pplem ental st andard s of conduct.
Submit this form via email to referrals@oge.gov. OGE will confirm rec eipt.
OGE use o nly
Referring office tracking/investigation number: OGE tracking number:
Name of agency employee involved: Agency:
Name of Designated Agency Ethics Official: Te lephone:
Name of OGE point of contact: Te lephone:
- 1. Whether or not act io n is wa rran ted, provide the n am e a nd title of the agency officia l w h o ha s aut h o rity to take disci Llnar or co rrection action with regard to th,_e _e m __ __ p_lo~' ~'e_e _in_v_o_lv_e_d_. ____________ _,
Name: (b)(?)(C) Titl e : r_.... )(?-)(-C) ______________ ____.
- 2. Has disciplinary or o ther corrective action been e ither initiate d (e.g., advanc e writt en notice issue d pur suant to 5 U.S.C. § 7513) or taken?
Qyes (clesc,ibe action be/01v, then skip to box 4)
D escribe a n y d isciplin ary actio n or other corrective action initiated or taken :
No disciplinary or corrective action was taken.
OGE FORM 202 (rev. I 0/16) Page 1 of 2
- 3. If disciplinary or other corrective action has not been initiated or taken, did the official identified in box 1,
above, active ly consider whether suc h action was warranted before affirmative ly d eciding not to take actio n?
{!) yes Ono (e>..plain 1111?)1 not be/0111)
If the response in box 3 is "no," exp lain why n ot:
M ark this bo x if additional shee ts or docum e nts are attach ed.
Attachments
- 4. Name, title and contact in formation of DAEO or D AEO's d esignee signing this fo rm:
Name: Ca rrie Safford
Title:
A ssis tan t General Co un se l, Legal Co u nsel, Legislation, and Special Projects
Tele phone : 301-287-9181 Email : carrie.safford@nrc.gov
- 5. I certi fy that I have exercised due dilige nc e in gathe ring the requ este d i nformation a nd that t he in formation provided in this form is accurate and comp lete to the best of m y information and belief.
Carrie M. Safford Digitally signed by1 Carrie M. Safford Date: 2021.04.26 09:42:41 -04'00' Signature D ate
OGE FORM 202 (rev. I 0/16) Page 2 of 2