New Jersey Administrative Code › Title 19 - OTHER AGENCIES › STATE ETHICS COMMISSION › Chapter 61 - STATE ETHICS COMMISSION › Subchapter 6 - ATTENDANCE AT EVENTS, ACCEPTANCE OF HONORARIA, ACCEPTANCE OF COMPENSATION FOR PUBLISHED WORKS, AND ACCEPTANCE OF THINGS OF VALUE › Section 19:61-6.8 - Approval request form

Current through Register Vol. 56, No. 14, July 15, 2024
State officials shall use the following form to request
					 approval to attend events.
REQUEST FOR APPROVAL FOR
ATTENDANCE AT EVENT
DEPARTMENT OF
					 _________________________________________
Name _____________________ Division
					 ________________________
Title __________________ Telephone ___________ FAX
					 __________
E-mail address
					 ______________________________________________
Event
					 _____________________________________________________
Sponsor
					 ___________________________________________________
Is the sponsor an "interested party"? Yes ____ No ____
					 "Interested party" means: 1) any person or entity your institution regulates,
					 licenses or supervises; 2) any grantee or grantor to your institution and any
					 employee, representative or agent thereof; 3) any supplier/vendor to your
					 institution; 4) any advocacy group that advocates or represents the positions
					 of its members to your institution; 5) any organization a majority of whose
					 members fall under 1-4 above.
Is the State official a speaker, panel participant or
					 resource person?
Yes _____ No ____
Is the sponsor an agency of the federal government, one or
					 more other states or a political subdivision thereof? Yes _____ No _____
Is the sponsor a nonprofit organization? Yes ______No
					 ______
If Yes, is the employee or agency a member? Yes _____No
					 ____
Does the nonprofit organization have any contracts with the
					 State?
Yes _____ No ______
Location __________________________________ Date(s)
					 __________
Overnight accommodation required? Yes _______ No
					 _______
Out-of-state travel required? Yes _______No ________
Estimated total costs? $___________
Breakdown of Costs: Transportation $_______ Meals
					 $_____
Accommodations $____ Registration Fees $___
Agency to pay costs? Yes ________ No ________
Sponsor to pay costs? Yes _______ No ________
Employee to pay costs? Yes ________ No ________
Other person or entity to pay costs? Yes _____ No _____ If
					 yes, note name below:
__________________________________________________________
Reason for attendance:
					 _______________________________________
__________________________________________________________
__________________________________________________________
Will sponsor offer an honorarium or fee? Yes _______ No
					 _________
Check: _____ Copy of invitation letter attached.
_____ Copy of agenda or other description of event
					 attached.
____________________________________
					 _________________
Employee Signature Date
____________________________________
					 _________________
Supervisor's Signature and Approval Date
NOTE: Any substitutions or changes of circumstances must be
					 reported to your ELO.
*****************************************************
SPACE BELOW FOR ELO USE ONLY
Attendance approved Yes _______ No ______ Note: Acceptance
					 of honoraria or fees is not permitted.
Conditions:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature ________________________________ Date
					 ____________
Ethics Liaison Officer
_____ Sponsor is an interested party and employee will be
					 accepting event benefits as a speaker, panelist or resource person. A copy of
					 form will be forwarded to the State Ethics Commission pursuant to
					 19:61-6.4(f).