Form For Disclosing Gifts From Foreign Governments Or International Organizations - House Committee On Ethics
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1
2Form For Disclosing Gifts From
Foreign Governments or International Organizations
Pursuant to 5 U.S.C. § 7342 (FGDA)
1. NAME OF RECIPIENT: ___________________________________________________________
2. POSITION OF RECIPIENT: _______________________________________________________
3. NAME AND POSITION OF PERSON COMPLETING FORM (if different from recipient):
Name: ______________________________ Position: ____________________________________
4. DONOR GOVERNMENT OR INTERNATIONAL ORGANIZATION (use a separate form
for each government or organization):
_________________________________________________________________________________
5. NAME AND POSITION OF THE INDIVIDUAL WHO PRESENTED THE GIFT,
AWARD, OR TRAVEL:
Name: ______________________________ Position: ____________________________________
6. WHAT WAS RECEIVED (check and complete appropriate subsection or subsections)
Note: For the years 2017-2019, “minimal value” is defined as $390.
a.
Tangible gifts, decorations, or awards of more than minimal value (describe):
______________________________________________________________________________
______________________________________________________________________________
Estimated value in U.S. at time of acceptance: ________________________________________
Disposition or current location: ____________________________________________________
Note: If you wish to retain an item of more than minimal value for official use, you must
separately write to the Committee with that request.
b.
Travel or travel expenses of more than minimal value paid for or provided directly by
the foreign government or international organization (including transportation, food,
lodging, and entertainment) (describe):
______________________________________________________________________________
______________________________________________________________________________
Last Updated 1/2017
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