Conflict of Interest Checklist

Authority: 41 C.F.R. 304-1.5

Standard: "Payment from a non-Federal source shall not be accepted if the authorized agency official determines that acceptance under the circumstances would cause a reasonable person with knowledge of all the facts relevant to a particular case to question the integrity of agency programs or operations."

Name of Traveler:

Dates of Travel:

The authorized agency official should be guided by all relevant considerations, including, but not limited to:

1) The identity of the non-Federal source

2) The purpose of the meeting

3) The identity of other expected participants.

4) The nature and sensitivity of any matter pending at the agency affecting the interests of the non-Federal source. (If a Government contract is involved, check for any procurement integrity issues - 48 C.F.R. Part 3.104.)

5) The significance of the employee's role in any matter listed in (4).

6) The monetary value and character of the travel benefits offered by the non-Federal source.

Conclusion:

_____ No Conflict-of-Interest Identified

_____ Possible/Actual Conflict-of-Interest Identified (describe below)

Reviewer's Initials: