**Manual Chapter 2300-735-4, Appendix 1**

**SAMPLE 1**: **Standard 208 (b)(1) Waiver**

\[Date\]

[MEMORANDUM]{.underline}

TO: Name of Employee\'s Appointing Authority\]

FROM: \[Name of the Employee or Deputy Ethics Counselor\]

SUBJECT: Conflict of Interest Waiver for \[Employee's Name\]

The purpose of this memorandum is to request that you grant a waiver
from the provisions of the conflict of interest law, 18 U.S.C. 208(a),
for \[**name of employee**\]. The need for a waiver is discussed below.

Section 208 prohibits federal Executive Branch employees from
participating personally and substantially as Government employees in
matters in which any of the following individuals or organizations has a
financial interest: (1) the employee; (2) the employee\'s spouse; (3)
the employee\'s minor child; (4) an organization in which the employee
serves as an officer, director, trustee, partner, or employee; or (5) a
person or organization with which the employee is negotiating for
prospective employment or has an arrangement for prospective employment.
Pursuant to Section 208(b)(1), however, a waiver may be granted by you
after disclosure of the interest by \[**the employee**\], if you
determine that \"the interest is not so substantial as to be deemed
likely to affect the integrity of the services which the government may
expect from\" \[**the employee**\].

***[\[Insert here a paragraph describing the facts in this
case]{.underline}*.*\]***

**Example for employment negotiations**: Dr. Doe is working on a CRADA
with Company A. Dr. Doe has indicated that he is interested in
initiating discussions with Company A regarding possible employment
opportunities with Company A. Dr. Doe cannot, under Section 208, begin
such discussions unless he first obtains a waiver. Without a waiver, Dr.
Doe would be subject to criminal liability under the statute. *(See
Appendix 4 for information concerning conflicts associated with
employment negotiations.)*

**Example for other financial interests**: Dr. Doe is an extramural
employee approving grants to Universities including the Massachusetts
Institute of Technology \[MIT\]. Dr. Doe\'s wife formerly worked for MIT
and still has a pension plan with MIT. \[In this situation, one could
reasonably say that Dr. Doe\'s service to the government will not be
impaired by the fact that his spouse has a pension plan with MIT.\]

***CHOOSE APPROPRIATE PARAGRAPH***

I believe that it would be appropriate for you to grant \[**employee
name**\] a waiver under Section 208(b)(1) to enable him to continue to
work on the research end of the CRADA and at the same time pursue
employment negotiations with \[Company A\].

[OR]{.underline}

I believe that it would be appropriate for you to grant \[**employee
name**\] a waiver under Section 208(b)(1) to enable him to continue to
approve and administer grants to universities, including MIT, despite
the conflict created by his wife's pension plan with MIT.

DECISION

Waiver granted based on my determination, made in accordance with 18
U.S.C. Section 208 (b)(1) that the interest is not so substantial as to
be deemed likely to affect the integrity of the services which the
government may expect from \[**employee name**\].

Waiver denied.

\[Appointing Authority\] \[Date\]

Confirmed and Acknowledged:

\[Employee or Deputy Ethics Counselor\] \[Date\]

cc: HHS OGC Ethics Division

WAV-208.WPD (4/02)