Fillable 700-U Statement of economic intereStS PrinciPal inveStigatorS A (California State University, East Bay)

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700-U Statement of economic intereStS PrinciPal inveStigatorS A (California State University, East Bay)

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A. Are you a director, officer, partner, trustee, consultant,
employee, or do you hold a position of management in
the entity listed in Part 1? No
Yes
Title:
Initial (for new funding)
Date of initial funding:
/ /
Statement of economic intereStS
for
PrinciPal inveStigatorS
A Public Document
NAME (LAST) (FIRST) (MIDDLE)
ACADEMIC UNIT OR DEPARTMENT MAIL CODE
( )
TELEPHONE NUMBER
FPPC Form 700-U (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Name of Entity:
Address of Entity:
Principal Business of Entity:
Amount of Funding: $
Estimated
Actual
3. Filer Information
1. Information Regarding Funding Entity
(Use a separate Form 700-U for each funding entity.)
3. Filer Information - Cont.
E-MAIL ADDRESS
Date Received
Campus Use Only
Please type or print in ink.
700-U
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA
FORM
2. Type of Statement (Check at least one box)
Interim (for renewed funding)
Funding was renewed on: / /
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: / /
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
Campus:
ID No:
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
Date Disposed:
/ / , if applicable
Description and, if Gift, Travel Destination:
Amt: $ date(s): / / / /
(If gift)
Type of Payment: (check one) Gift Income
F. Has the entity in Part 1 paid for your travel during the
reporting period? No
Yes
– describe below.
4. Verication
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.)
The Form 700-U is for university use only.
This statement is a public record under Gov. Code Section 81008(a).
TITLE OF RESEARCH PROJECT
C. Have you received income of $500 or more from the
entity listed in Part 1 during the reporting period?
No
Yes
– amount is:
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000 Exceeds $100,000
Was this income received through your spouse or
registered domestic partner?
No Yes
Clear Page
Print
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. Loans
from commercial lending institutions made in the lender’s
regular course of business on terms available to members
of the public without regard to your official status are not
reportable. (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 those
provided in direct connection with your attendance at a
convention, conference, meeting, social event, meal, or
like gathering
• Rebates/discounts not made in the regular course of
business to members of the public without regard to official
status
• Wedding gifts
• An honorarium received prior to filing an “initial” statement.
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.)
FPPC Form 700-U (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Who Files Form 700-U?
This form must be filed 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 specific research project or for a specific
researcher) from a nongovernmental entity.
Reporting requirements are outlined in Regulation 18755.
This regulation provides that research funding by certain
nonprofit entities will not trigger disclosure. This regulation
is available on the FPPC website.
What is the Reporting Period?
For "initial" statements, before the final acceptance of the
contract, grant, or gift, the filer must report investments in
and business positions with the sponsor as of the date that
the award is made, and income and gifts received from
the sponsor within the 12 months prior to the date that the
award is made.
For "interim" statements, the filer must submit a statement
within 30 days after the contract, grant, or gift is renewed
that discloses reportable investments, income and
business positions that the filer held or received during the
period between the date the initial statement was filed and
the date the project contract, grant, or gift was renewed.
What is an Investment?
“Investment” means any financial interest in a business
entity in which you, your spouse or registered domestic
partner, or your dependent children have a direct, indirect,
or beneficial interest totaling $2,000 or more. Reportable
investments include stocks, bonds, warrants, and options,
including those held in margin or brokerage accounts.
(See Gov. Code Section 82034 and Regulation 18237.)
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 filer, 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 beneficially, 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.)
Instructions for Completing
Form 700-U
700-U
CALIFORNIA
FORM
• A travel payment that was received from a non-profit
entity exempt from taxation under Internal Revenue
Service Code Section 501(c)(3) for which you provided
equal or greater consideration, such as reimbursement
for travel on business for a 501(c)(3) organization for
which you are a board member.
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 file the required Statement of Economic Interests
or failure to report a financial interest may subject a
principal investigator to civil liability, including fines, as well
as University discipline. (See 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
18110-18997). 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
1102 Q Street, Suite 3000
Sacramento, CA 95811
(916) 322-5660
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. In addition, the travel destination must be
disclosed.
• 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 filer 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 $470 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, such as reimbursement for travel on agency
business from your government agency employer.
• Travel payments received from your employer in the
normal course of your employment.
Instructions for Completing
Form 700-U (continued)
700-U
CALIFORNIA
FORM
FPPC Form 700-U (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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700-U Statement of economic intereStS PrinciPal inveStigatorS A (California State University, East Bay)

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Completed 18 August 2020

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