Non-Grantmaking Tripsponsor Form - U.s. House Of Representatives Committee On Ethics
Download a blank fillable Non-Grantmaking Tripsponsor Form - U.s. House Of Representatives Committee On Ethics in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Non-Grantmaking Tripsponsor Form - U.s. House Of Representatives Committee On Ethics with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1U.S. House of Representatives
Committee on Ethics
NON-GRANTMAKING TRIP SPONSOR FORM
This form should be completed by a private individual or entity that provides funds, services, or in-kind donations to
another entity to underwrite, in whole or in part, a trip or an event, meal, or activity that will occur during a trip, or a
necessary expense that will be incurred during a trip, with express or implicit knowledge or understanding that one
or more House Members or employees may participate in or attend that trip or event, or otherwise may be
beneficiaries of the gift or donation. A Non-Grantmaking Sponsor that has a direct involvement in planning,
organizing, conducting, or participating in the trip must complete this form. Provide a copy of your completed
form to the primary sponsor of the trip.
NOTE: Willful or knowing misrepresentations on this form may be subject to
criminal prosecution pursuant to 18 U.S.C. § 1001. Failure to comply with the
Committee’s Travel Regulations may also lead to the denial of permission to sponsor future trips.
1. Name of your organization: _________________________________________________________
2. Name of Primary Trip Sponsor: ______________________________________________________
3. My organization has provided funds to the above-named Primary Trip Sponsor to pay all or part of
the expenses for a trip to (destination) _________________________________________________
on (date) _____________________________ that primarily is being organized or arranged by the
above-named Primary Trip Sponsor.
Yes
No
4. My organization has had a direct role in the organizing, planning, arranging, or will have a role in
conducting, the trip identified in response to Question 3 or an event that will occur during that trip.
Yes
No
5. Check one:
a.
My organization does not employ or retain a registered federal lobbyist or foreign agent or
b.
My organization employs a registered federal lobbyist or foreign agent, but their involvement
in planning, organizing, or arranging the trip was de minimis under the travel regulations.
6. I certify that I am not a registered federal lobbyist or foreign agent for any sponsor of this trip.
7. I certify by my signature that the information contained in this form is true, complete, and correct to
the best of my knowledge.
Signature: _______________________________________________________________________
Name: _______________________________________ Title: ____________________________
Organization: ____________________________________________________________________
Address: ________________________________________________________________________
Telephone number: ________________________________________________________________
Email Address: ___________________________________________________________________
If there are any questions regarding this form please contact the Committee at the following address:
Committee on Ethics
U.S. House of Representatives
1015 Longworth House Office Building
Washington, DC 20515
(202) 225-7103 (phone)
(202) 225-7392 (general fax)
Version date 4/2013 by Committee on Ethics
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal