OGE FORM 202 (rev. 10/16) Page 1 of 2
OGE FORM 202, PART 3
NOTIFICATION OF CONFLICT OF INTEREST REFERRAL
PART 3: CONSIDERATION OF CORRECTIVE ACTION
(to be filed by the DAEO of the employing agency or the DAEO’s designee)
File Part 3 of this form with the U.S. Office of Government Ethics (OGE) following the referral made to the
U.S. Department of Justice (DOJ), pursuant to 28 U.S.C. § 535, after all of the following have occurred:
(1) DOJ has (a) declined prosecution; (b) initiated prosecution or taken other legal action that is a matter
of public record; or (c) settled the matter through formal agreement;
(2) Investigation of the matter has concluded; and
(3) The referring office has made an adverse finding regarding the employee involved related to the
Standards of Ethical Conduct for Employees of the Executive Branch or any agency supplemental
standards of conduct.
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ubmit this form via email to referrals@oge.gov. OGE will confirm receipt.
Referring office tracking/investigation number:
OGE tracking number:
Name of agency employee involved:
Agency:
Name of Designated Agency Ethics Official:
Telephone:
Name of OGE point of contact:
1. Whether or not action is warranted, provide the name and title of the agency official who has authority to
take disciplinary or correction action with regard to the employee involved.
Name: Title:
2. Has disciplinary or other corrective action been either initiated (e.g., advance written notice issued pursuant
to 5 U.S.C. § 7513) or taken?
yes (describe action below, then skip to box 4) no
Describe any disciplinary action or other corrective action initiated or taken: