Fillable Form 802 (California State University Channel Islands)

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Form 802 (California State University Channel Islands)

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California
Form
Agency Report of:
1. Agency Name
Designated Agency Contact (Name,Title)
Date Stamp
E-mail
Division, Department, or Region (if applicable)
2. Function or Event Information
Verication
I have read and understand FPPC Regulations 18944.1 and 18942. I have veried that the distribution set forth above, is in accordance
with the requirements.
Signature of Agency Head or Designee Print Name
Comment:
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
(month, day, year)
802
(month, day, year)
For Ofcial Use Only
Area Code/Phone Number
Date of Original Filing:
Ticket(s)/Pass(es) provided by agency?
Was ticket distribution made at the behest
of agency ofcial?
Title
Ceremonial Role Events and Ticket/Pass Distributions
Face Value of Each Ticket/Pass $
Event Description:
If no:
If yes:
Amendment (Must Provide Explanation in Part 3.)
Provide Title/ Explanation
Name of Source
Ofcial’s Name (Last, First)
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
Name of Agency, Department or Unit
Name of Outside Organization
(include address and description)
Name of Individual
(Last, First)
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency’s policy
Identify one of the following:
Describe the public purpose made pursuant to the agency’s policy
Does the agency have a ticket policy?
No
No
Income
Other
Other
Ceremonial Role
Ceremonial Role
Income
No
Yes
Yes
Yes
Date(s) / /
/ /
3.
A.
B.
C.
4.
A Public Document
Recipients
Use Section A to identify the agency’s department or unit. Use Section B to identify an individual. Use Section C to identify an outside organization.
• • •
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This form is for use by all state and local government
agencies. The form identies persons that receive
admission tickets and passes and describes the public
purpose for the distribution. This form was prepared by
the Fair Political Practices Commission (FPPC) and is
available at www.fppc.ca.gov.
General Information
FPPC Regulation 18944.1 sets out the circumstances
under which an agency’s distribution of tickets to
entertainment events, sporting events, and like occasions
would not result in a gift to individuals that attend the
function. In general, the agency must adopt a policy which
identies the public purpose served in distributing the
admissions. The Form 802 serves to detail each event
and the public purpose of each ticket distribution. FPPC
Regulation 18942 lists exceptions to reportable gifts,
including ceremonial events, when listed on this form.
When the regulation procedures are followed, persons,
organizations, or agencies who receive admissions
are listed on a Form 802. Agency ofcials do not report
the admissions on the ofcial’s Statement of Economic
Interests, Form 700, and the value of the admission is not
subject to the gift limit.
The Form 802 also informs the public as to whether the
admissions were made at the behest of an agency ofcial
and whether the behested tickets were provided to an
organization or to specic individuals.
Exception
FPPC This form is not required for admission provided to a
school or university district ofcial, coach, athletic director,
or employee to attend an amateur event performed by
students of that school or university.
Reporting and Public Posting
Ticket Distribution Policies: An agency must post its
ticket policy on its website within 30 days of adoption or
amendment and e-mail a link of the website location to
FPPC at form802@fppc.ca.gov.
Form 802: The use of the ticket or pass under the policy
must be reported on Form 802 and posted on the agency’s
website within 45 days of distribution. A link to the website
location of the forms must be e-mailed to FPPC at
form802@fppc.ca.gov.
The FPPC will post on its website the link to each agency’s
policy and completed forms. It is not necessary to send
an e-mail each time a new Form 802 is posted. It is
only necessary to submit the link if the posting location
changes.
This form must be maintained as a public document.
Privacy Information Notice
Information requested by the FPPC is used to administer
and enforce the Political Reform Act. Failure to provide
information may be a violation subject to administrative,
criminal, or civil penalties. All reports are public records
available for inspection and reproduction. Direct questions
to FPPC’s General Counsel.
Instructions
Part 1. Agency Identication:
List the agency’s name. Provide a designated agency
contact person, their phone number, and e-mail address.
Mark the amendment box if changing any information on
a previously led form and include the date of the original
ling.
Part 2. Function or Event Information:
Conrm that your agency has a policy for ticket
distribution. Unless the ceremonial role or income box in
Part 3, Section B, is marked, this form is only applicable if
your agency has a policy.
Complete all of the other required elds that identify the
ticket value, description of event, date(s) and whether the
ticket was provided by the agency or an outside source. If
an agency ofcial behests the tickets, the ofcial’s name is
also required. Use the comment eld or an attachment to
explain in full.
Part 3. Ticket Recipients:
This part identies who uses the tickets. The identication
requirements vary depending upon who received the
tickets and are categorized into three sections. Each
section must list the number of tickets received. Use the
comment eld or an attachment to explain in full.
Section A. Report tickets distributed to agency staff,
other than an elected ofcial or governing board member,
pursuant to the agency’s policy. It is not necessary to list
each employee’s name, but identify the unit/department for
which the employee works. The agency must describe the
public purpose associated with the ticket distribution. A
reference to the policy is permissible.
Section B. Report: 1) any agency ofcial who performs
a ceremonial role; 2) any agency ofcial who reports the
value as income; or 3) tickets used by elected ofcials and
governing board members (including those distributed
pursuant to the agency’s policy).
Section C. Report tickets provided to an organization.
The organization’s name, an address (website url is
permissible), and a brief description of the public purpose
are required.
California
Form
802
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
A Public Document
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
California
Form
802
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
A Public Document
Continuation Sheet
Agency Name
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
Name of Agency, Department or Unit
Name of Individual
(Last, First)
Name of Outside Organization
(include address and description)
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency’s policy
Identify one of the following:
Describe the public purpose made pursuant to the agency’s policy
Income
Income
Other
Other
Other
Other
Ceremonial Role
Ceremonial Role
Ceremonial Role
Ceremonial Role
Income
Income
3.
A.
B.
C.
Recipients
Use Section A to identify the agency’s department or unit. Use Section B to identify an individual. Use Section C to identify an outside organization.
• • •
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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Form 802 (California State University Channel Islands)

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Completed 22 July 2020

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