The Employee S Attendance at the Event Is in the Agency S Interest Because It Will Further

Exhibit (700)-30-2

INVITATION QUESTIONNAIRE
Please submit the completed form, a copy of the invitation, and other relevant information or documentation
related to the invitation to *TIGTA Counsel Office.
PART I –Employee INFORMATION
Name: / Office: CounselIG Front OfficeI&EOAOIOITOMS
Position: / Date:
Part II –EVENT INFORMATION
1.Name of event: / 2.Host/sponsor of event:
3. Location of event: / 4.Date of event:
5.What is the purpose of the event (e.g., educational, social, fundraising, etc.)?
6.Has the sponsor or non-sponsor offered a gift of free attendance at the event, including food and refreshments?
Yes;Sponsor Yes; Non-Sponsor No
7.What is the market value of the gift of free attendance (e.g., per person cost, face value of the ticket)?
7.1How was the value determined?
8.Is the gift offered by a lobbyist or an organization that employs lobbyists? YesNo
8.1If “Yes”, please provide name and address. Name:
Address:
9.How many attendees are expected at the event? 1- 5051 - 100101 - 200201 - 300301 - 400401 or more
10.Identify categories of other invitees (e.g., Members of Congress, industry representatives, other Federal employees, state or local officials, the media, etc.)?
11. What is the employee’s role in the event, if any? Board serviceConsultantFund raisingGuestHonoreeSpeakerStudentTeacher
12.Is the employee giving a speech or participating in a panel/discussion? Yes No
12.1If so, what is the subject matter of the speech?
12.2If giving a speech, has the Office of Communications approved the remarks? Yes No
12.3If giving a speech, will there be a demonstrable financial effect on a former employer or client of the employee?
Yes No
There is a demonstrable financial effect if the sponsor/host of the event is a former employer or client of the employee that is either: (1) charging an admission fee for the event; (2) using the event as a fundraiser; or (3) using the event as a business development activity.
If “Yes”, please provide an explanation:
12.4If the event at which the employee is speaking is a multi-day conference, does the employee intend to attend the event on any day other than the day on which employee is speaking? Yes No
13.Will other Treasury and/or TIGTA employees be in attendance? Yes No Unknown
13.1If known, please identify:
14.How would the employee’s attendance further TIGTA’s programs and operations?
15.Is the invitation from someone other than the event sponsor? Yes No
15.1If yes, please provide the name and address of who has extended the invitation:
Name:
Address:
16.To your knowledge, are there any pending TIGTA matter(s) (e.g., contract/procurement, audit, investigation, etc.)
that would affect the interests of the sponsor/host of the event or the source of the travel expense offer?
Yes No
16.1If yes, what is the employee’s role in the matter?
17.Does the invitation include attendance by the employee’s spouse or other guest? Yes No Not sure
NOTE: If you selected"not sure" butwould like your spouse to attend, DO NOT reach out
to the host/sponsor directly. This could be interpreted as soliciting a gift in violation
of 5 C.F.R. § 2635.202. Instead, let the Office of Chief Counsel know and we can inquire on your behalf.
17.1If yes, will others in attendance generally be accompanied by a spouse or other guest? Yes NoNot sure
18Is the event a fundraiser? Yes No
18.1If yes, identify the candidate, entity, etc., who is the beneficiary of the fundraiser.
19.Is there additional information you would like to add?
Note: If the employee is a financial disclosure report filer, he or she may be required to report the gift of free attendance. The employee should refer to the instructions for Part 9 of the OGE Form 278e (Public Financial Disclosure Report) or Part V of the OGE Form 450 (Confidential Financial Disclosure Report).
POINT OF CONTACT FOR FURTHER QUESTIONS
Name:
Phone: / E-mail:
FUNCTION REVIEW
NOTE: TIGTA Operations Manual, section (700)-30.6.1.1.8 requires functional review at the Executive level
for widely attended gatherings (WAGs).
I have determined:

The employee’s attendance at the event is in the agency’s interest because it will further agency programs or operations; and
The agency’s interest in the employee’s attendance outweighs the concern that the employee may be, or may appear to be, improperly influenced in the performance of official duties.

Select one: Employee must take leave if event is during official duty hours.
Employee is authorized to have excused absence to attend event during official duty hours.
Name:
Recommendation: Approval Disapproval Let’s discuss
Comments:
Signature:
/ Date:
FOR OFFICIAL USE
Office of Chief Counsel Approving Official
Name:
Is the event a widely attended gathering? Yes No
Determination: Approval Disapproval Let’s discuss
Comments:
Signature:
/ Date:
PRIVACY ACT STATEMENT
This notice is furnished in accordance with the provisions of the Privacy Act of 1974. The information collected on this form isprimarily used in addressing the question of invitation acceptance; however, the complete listing of routine uses for this form maybe found in the DO .309-TIGTA Chief Counsel Case Files systems of records and includes use in administrative or judicial proceedings affecting employee’s personnel rights, and in a criminal prosecution.
The information requested on this form is mandatory and required to address ethics issues related to gift acceptance. Failure to provide complete information may result in a determination that the invitation may not be accepted.

Last updated: June, 2018