A. Privacy Act Statement
Sections 105 and 402(b)(1) of the Ethics in Government Act, as amended (5 U.S.C. app. 101) and 5 C.F.R. § 2634.603 authorize the
solicitation of the information requested in this form. The primary use of the information on this form is to permit officials of the recipient agency
to consider and process requests for inspection or receipt of copies of the OGE Form 278e Executive Branch Personnel Public Financial
Disclosure Report and OGE Form 278-T Periodic Transaction Report, or other covered records to which you seek access. Furnishing the
requested information is voluntary. However, failure to furnish this information will result in the recipient agency’s inability to allow access to,
or to provide a copy/copies of, the financial disclosure report(s) or other record(s) requested. Information on the form itself may be publicly
disclosed pursuant to a proper request under section 105(b) of the Ethics in Government Act or as otherwise authorized by law.
Additional dis
closures of the information on this form may be made pursuant to the routine uses set forth in the OGE/GOVT-1
Privacy Act
system of records:
(1) to any requesting person, in accordance with sections 105 and 402(b)(1) of the Ethics in Government Act of 1978, 5 U.S.C. app.101
as amended;
(2) to any requesting person, subject to the limitation contained in section 208(d)(1) of title 18, any determination granting an exemption
pursuant to sections 208(b)(1) and 208(b)(3) of title 18;
(3) to a Federal, State, or local law enforcement agency if the disclosing agency becomes aware of violations or potential violations of law
or regulation;
(4) to another Federal agency, court or party in a court or Federal administrative proceeding when the Government is a party or in order
(5) to a source when necessary to obtain information relevant to a conflict of interest investigation or determination;
(6) to
the National Archives and Records Administration or the General Services Administration in records management inspections;
(8) to the Department of Justice or in certain legal proceedings when the disclosing agency, an employee of the disclosing agency, or the
United States is a party to litigation or has an interest in the litigation and the use of such records is deemed relevant and necessary to
the litigation;
(9) to reviewing officials in a new office, department or agency when an employee transfers or is detailed from one covered position to another;
(10) to a Member of Congress or a congressional office in response to an inquiry made on behalf of an individual who is
the subject of the record;
(11) to contractors and other non-Government employees working on a contract, service or assignment for the Federal Government when
necessary to accomplish a function related to an OGE Governmentwide system of records; and
(12) on the OGE Website and to any person, department or agency, any written ethics agreements filed with OGE by an individual nominated
by the President to a position requiring Senate confirmation.
See also the Privacy Act system of records OGE/GOVT-1
Executive Branch Personnel Public Financial Disclosure Reports and Other Name-
Retrieved Ethics Program Records.
B. Public Burden Information
Public burden reporting for this collection of information is estimated to take approximately ten minutes per response, including time for
reviewing instructions, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Program
Counsel, U.S. Office of Government Ethics, Suite 500, 1201 New York Avenue, NW., Washington DC 20005-3917. Do not file this form with
this official; rather, file it with the appropriate office of the executive branch department or agency from which you are seeking access to a
financial disclosure report or other covered records.
Pursuant to the Paperwork Reduction Act, as amended, an agency may not conduct or sponsor, and no person is required to respond to, a
collection of information unless it displays a currently valid OMB control number (that number, 3209-0002, is displayed here and in the lower
right-hand corner of the front page of this OGE Form 201).
III. Other Covered Records
In addition to requests for access to public OGE Form 278/SF 278 and OGE Form 278-T reports, this form can also be used to request access
to certain other agency records which are covered under the access procedures of section 105 of the Ethics in Government Act and the
implementing OGE regulations ("covered records"). Such other covered records are: (1) certificates of divestiture; (2) Ethics in Government Act
qualified blind trust and qualified diversified trust instruments (other than those provisions which relate to the testamentary disposition of the
trust assets), the list of assets transferred to such trusts (and of assets sold in the case of a qualified blind trust), as well as, in the case of trust
dissolution, the report thereon and the list of trust assets at that time, and the certificates of independence and compliance with respect to
qualified trusts; (3) 18 U.S.C. § 208(b)(1) & (b)(3) waivers granted by the recipient agency (after deletion of any material withholdable pursuant
to the Freedom of Information Act, 5 U.S.C. § 552 (see 18 U.S.C. § 208(d)(1)); (4) other OGE Form 201 requests for access; (5) cover letters
for approved gifts reporting waiver requests; and (6) cover letters for approved public reporting waiver requests for certain less than 130-day
special Government employees. If you seek access to any such additional record(s), check the second box in Part I.5 on the front page and
specify the record(s) sought.
OGE Form 201
January 2017
to comply with a judge-issued subpoena;
(7) to the Office of Management and Budget during legislative coordination on private relief legislation;
