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BEQUEST FOR APPROVAL OF OUTSIDE ACTIVITY" {Ref
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KWIBI R e v e r t ReviSea RBIUCK Runtswal Burwo.. Otvispiy

HHS Siapaart? of Conduct Regulauons)

2 ORGANIZATION UOCATION lOpewngOtwmn.

Browne, Douglas R.
3 TlTtE OF POSITION

NCIP/0VROA/RZB
« GRADE w D SALARV tFva$iW)

Deputy Branch Chief
-5 NAME. ADDRESS AfiO PvSlNESS OF PERSON Oft ORGANIZATION FOR WnOrt

GS14

$32,838

S M3CATION WrlERE SERVICES vUju. BE PERFORMEP

(b)(6)

(b)(6)
w*wis wvewvsxw to (•» poifamoa Smaif

7 rfATuftfi O F ACTIVITY fwoiesm IX^P tfatwifc c c . wan»»a w w w i a w e e « A « a s , «n<f g w tw? u«twpi»f» orsptaiK (fiwh/jowiow, tno rcuwwwqopysof I««I» ami«>«B>a»'c<aj , p»p«eq«ei!«iy v »'l" , Bps(ft«inBa>

(b)(6)

H ESTIMATED TIME MVOt-VEP PEWOPCOvgREO B ESTIMATED TOTW-TIME DEVOTED TO ACTtvlTr (iron a eflntorwnp8a5« p/r» BttmatKPtms paryoai)

FROM Q7/P1/2Q(H
m

TO 06730/2005

(b)(6)

> mnthi- a e n g B c n p m i n e«iT IPBI v fti <r<S,ng i tSi mt m a m w f i urn iBCT

(b)(6)
{ B pa YOUR QFFcCiAt. cuTiEs REPUTE m m* WAT TO THE PROPOSED ncrivmrT

(b)(6)
*10 F PROVIDING CONSULTATIVE OR PROFESSIONAl. SERVICES APS TOU R tA>0uUH?£ ASSOCIATES RECEIVING OR WILU T « E t SEES. A GRANT OR CONTRACT PROW AFEOEPAUASgNCrr

(b)(6)
>-« liETMnnnpnagiermrrmpcuigATinM 12 WILL COMPENSATION BEpERtVEP FROM A HHS GRANT OR COrfrRACT?

(b)(6)

(b)(6)

13 THIS BEQUEST IS M*BE WITH FUU. tfHOW-EPtSg OF DEPARTMENT AND OPERATING PI VISION POUCT AN)5 PROCEDURES ON OUTBlOH ACTIVITIES Tflg STATEMENTS 1 HAVE M A P E ARETOME.COMPLETE AND CDRRECTTO THE BEST OFfclTnNOW.EPt3B AND BEUEF (WIU. USE CDvERiUMENT-f INANCEDTlME. S O P P t ) ^ , FACULTIES OR EQUIPMENT ASSIGNED PR WANED TO ME FOR C O M P U S T I O N OF MT OFFICIAL DUTIES ONLV AS pERMfTTeO Br THE INFORMATION RESOURCES MANAGEMENT MANUAL G U I P E . CDC-8. JUKE S3, "EMPLOYEE uSE 0)= COC INFORMATION TECHNOLOGY RESOURCES " 14 SIGNATURE OF EMPL0TEE tS OATE

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/4cTfl«i deputy Bhics Counselor

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Computer Statement The following "computer statement" should be attached to or writtfin and signed on the Reverse of the H#S-52G, Bequest gj r Apptoval of Outside Activity. "1 wi|} use OavenraeW-fuianced tita^. supplier jgcUitjies, or equipment assigtted or Joaned to n» for cotDptetioaaf aiy official dunes only as permitted by The Infonuarion Resources Management Manual Guide, CDC-8, June89, and Empbyee Use of CDC Information Teclwmlogy Resource

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EXCERPTS FROM THE STANDAjSDS OF ETHICAL CONDUCT FOR BMPLOYEESOFT8E EXECPmm BRANCH AND THE DEPARTMENT O" HEALTH AND HUMAN SERVICES SUPPLEMENTAL AGENCY ETHICS REGULATIONS:
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DEPARTMENT OF HCAtTH & H U M A N SERVICES __ n

PuDi* Heaitn Service Centers far Disease Control ana Prevention (CPC)

Memorandum
Date June 25,2004
From

Acting Deputy Ethics Counselor Centers for Disease Control and Prevention, and Agency for Toxic Substances and. Disease Registry Outside Activity

Sypjeci

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Douglas Browne Deputy Branch Chief; DVRD, NC3D Through: Deputy Director, NCiD Your request, to serve on the Advisory Board of the National Save a Life Foundation, has been approved. fSyou wish TO condaue this activity beyond the period eovcret), yaw muse MtfrmU a revised or renewed request. Otherwise, your activity will be considered inactive after June 30,2005. You may perform this outside activity under the following conditions: 1. 2. it must not pre^te a real or apparent conflict of interest, You roust not participate in any action taken by the organization to endorse, encourage, or oppose the adoption of aformalpolicy or position of CDC, HHS, or the Federal Government. Government-financed time, supplies, facilities, or equipment assigned or loaned to you for completion of your official duties may be used for this outside activity only as permitted by the Information Resources Management IVfanual Guide, CDC-8, June 99, "Employee Use of CDC Information Technology Resources." You shall not use or permit the use of your Government position or title or any authority associated with your public office in a manner feat could reasonably be construed to imply that CDC or the Government sanctions or endorses your outside activity. You must not represent the organization before any Federal agency where the Federal Government has a substantial interest in the matter. You are prohibited from taking any action as a CDC employee that could be perceived as directly and predictably affecting the financial interests of this organization.

3.

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Page 2. Douglas Browne 7. You may not provide, for compensation, services on. behalf of this organization to prepare, or assist m the preparation of any grant applications, contract proposals, program reports, or other documents intended for submission to HfiS. You must not participate in lobbying activities. You may only participate in rundraising activities consistent with the Office of Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You may attend fundralsmg functions, and you may participate in discussions and planning of fundraising activities this outside organization is considering. However, you may not personally solicit funds or other support from a subordinate or a prohibited source, within the meaning of the OGE Standards at §2635J203(d).

8. 9.

for moire specific information concerning tnis outside activity, refer to Subpart H - Outside Aciivxtias. of the Office of Government Ethics Standards of Ethical Conduct for Employees of the Executive Branch, and Section 5501.106 of the HfiS Supplemental Standards of Ethical Conduct Please note that if this acrrviry is performed during normal working hours, you must be on approved leave. If you have questions Qrntsed additional information, please call Fran Collier, Ethics Program Activity, Office of the Chief Operating Officer, (404) 498-2857.

Carrion Duncan Attachment HHS-520

m^m
REQUEST FOR APPROVAL OF OUTSIDE ACTIVITY* (Ref^ HHS Standards of Conduct Regulations)
1 NAME (Last, First. Wat) O f/l InMat Request Renewal [ T j Revised Requcsl 2 ORGANIZATION LOCATION (Operating DMnfort, Bureau. Division)

Browne, Douglas R.
3 TITLE OF POSITION

NCID/DBMD
4 GRADE AND S A U R Y (Federal)

Deputy Director
•6 NAME, ADDRESS AND BUSINESS OF PERSON OR ORGANIZATION FOR WHOM OUTSIDE SERVICES WILL BE PERFORMED

QS15

$112,263

6 LOCATION WHERE SERVICES WILL BE PERFORMED

(b)(6)

(b)(6)
kpedly,

7 NATURE OF ACTIVITY (fttdfcale typ» ofaMy, e.g., ieachtog, consultative sendees, anil ghio fall description of specm suites orsarvioes K> B » penormm when possible, tits schedulBt) days of v/eek am) hours ot day proposed activity will fee peiformed.)

8 PERIOD COVERED

b ESTIMATED TOTAL TIME DEVOTED TO ACTIVITY (It on a continuing basis, estimated lime peryear)

FROM 07/01/2005 (b)(6)

TO 06/30/2I

(b)(6)

c WILL WORK BE PERFORMED ENTIRELY OUTSIDE USUAL WORKING HOURS?

o m v m II? n m r . m i . DUTIES RELATE IN ANY WAY TO THE PROPOSED ACTIVITY?

(b)(6)
'10 IF PROVIDING CONSULTATIVE OR PROFESSIONAL SERVICES. ARE YOUR WOULD-BE ASSOCIATES RECEIVING OR WILL THEY SEEK. A GRANT OR CONTRACT FROM A FEDERAL A6ENCY7

r

(b)(6)
if METHOD OR BASIS OF COMPENSATION 12 WILL COMPENSATION BE DERIVED FROM A HHS GRANT OR

(b)(6)

(b)(6)

13 THIS REQUEST IS MADE WITH FULL KNOWLEDGE OF DEPARTMENT ANlflOPERATING DIVISION POLICY AND PROCEDURES ON OUTSIDS ACTIVITIES ' THE STATEMENTS I HAVE MADE ARE TRUE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF I WILL USE GOVERNMENT-FINANCED TIME, SUPPUES, FACILITIES. OR EQUIPMENT ASSIGNED OR LOANED TO ME FOR COMPLETION OF MY OFFICIAL DUTIES ONLY AS PERMITTED BYTHE INFORMATION RESOURCES MANAGEMENT MANUAL GUIDE. CDC-Q. JUNE 99. "EMPLOYEE USE OF CDC INFORMATION TECHNOLOEY RESOURCES" ■ 15. DATE 16 ADDITIONAL INFORMATION ATTACHED

QYES
CTtON RECOMMENDED BY REVIEW1NS OFFICIAL C TITLE

0NO

(Describe) j j

Sharon Richardson Acting Director, NCiD/OAS
c. TITLE d DATE

Carlton Duncan Acting Deputy Ethics Counselor
•sue reverse of form CDC 0 520 (£). CDC Adobo Actobal 5.0 Electronic Version. B/2002

INSTRUCTIONS
Item 5 - Self-Employment If applicable, indicate self-employment, the type of service (as medical, legal, etc.), whether alone Dr with partners, giving their names, and, if providing professional services to a large number of clients or patients, estimate the total number rather than listing them separately. *lfem 10 - Federal Grants or Contracts Involved: Describe the Federal grants or contracts (type, granting or contracting department, etc) Full details must be provided on any aspect of professional and consultative services which involves, directly or Indirectly, the preparation of grant applications, contract proposals, program reports, and other material which are designed to become the subject of dealings between Institutions and government units and the Federal Government

*Item 16 - Attachments: Be sure to sign copies of all attachments submitted.
'ITEM 17 . CflMMFMTB HP REVIEWING OFFICIAL

•ITEM 18 - REASON FOR DISAPPROVAL '

"U S BPO: 1Bwm4W»1226

CDC 0 520 (E). CDC Adobe Acrobat 6 0 Electronic Vorelon. 8(2002

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service Centers for Disease Control and Prevention (CDC)

mt 21 2«5 Acting Deputy Ethics Counselor Centers for Disease Control and Prevention, and Agency for Toxic Substances and Disease Registry Outside Activity Douglas Browne Deputy Director, DBMD, NCTD Through; Director, NCLD (E51) Your request, to serve on the advisory board of the National Save a Life, has been approved. Pursuant to the latest version of the HHS Supplemental Standards of Ethical Conduct, which were effective February 3,2005, approval of an outside activity is effective for one year only. Employees must renew their request for approval annually if they desire to continue any long term outside activity. In addition, employees must submit a revised request for approval if they change positions within the agency or if a significant change occurs in the nature of the outside activity or in the scope of the employees' duties. Please note that the approval of this outside activity will be considered inactive after June 30,2006. You may perform this outside activity under the following conditions: 1. 2. It must not create a real or apparent conflict of interest. You must not participate in any action taken by the organization to endorse, encourage, or oppose the adoption of a formal policy or position of CDC, HHS, or the Federal Government Government-financed time, supplies, facilities, or equipment assigned or loaned to you for completion of your official duties may be used for this outside activity only as permitted by the Information Resources Management Manual Guide, CDC-8, June 99, "Employee Use of CDC Information Technology Resources." You shall not use or permit the use of your Government position or title or any authority associated with your public office in a manner that could reasonably be construed to imply that CDC or the Government sanctions or endorses your outside activity. You must not represent the organization before any Federal agency where the Federal Government has a substantial interest in the matter.

3.

4.

5.

forace

M.
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SURNAME

Gig« m
DATE OFFICE

SURNAME

PATg " 1

r??357

Page 2. Douglas R. Browne You are prohibited from taking any action as a CDC employee that could be perceived as directly and predictably affecting the financial interests of this organization. *•£»" 7You may not provide, for compensation, services on behalf of this organization to prepare, or assist in the preparation of any grant applications, contract proposals, program reports, or other documents intended for submission to HHS. You must not participate in lobbying activities. You may only participate in fund-raising activities consistent with the Office of Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You may attend fund-raising functions, and you may participate in discussions and planning of fund-raising activities this outside organization is considering. However, you may not personally solicit funds or other support from a subordinate or a prohibited source, within the meaning of the OGE Standards at §2635.203(d).

8. 9.

For more specific information concerning this outside activity, refer to Subpart H Outside Activities, of the Office of Government Ethics Standards of Ethical Conduct for Employees of the Executive Branch, and Section 5501.106 of the HHS Supplemental Standards of Ethical Conduct Please note that if this activity is performed during normal working hours, you must be on approved leave. If you have questions or need additional information, please call Fran Collier, Ethics Program Activity, Office of the Chief Operating Officer, OD, (404) 498-2857.

Cailton Duncan Attachment HHS-520 Outside Activity Notice & Regulatory Excerpts

iWKt,

j *

DEPARTMENT OF HEAtTH AND HUMAN SERVICES

V ***<nt

Z

REQUEST FOR APPROVAL OF OUTSIDE ACTIVITY
Standards of Ethical Conduct Regulation HHS Supplemental Ethics Regulation (6 CFR SS35.B03, 5 CFB 5501.108(d)) DATE FILED

| Q Initial Request

O Revised Request

0 Renewal

1- EMPLOYEE'S NAME (Last. First, Ml)

Browne, Douglas R.
2 AGENCY (Operatlng/SMI DMshn) HHS/CDC/CCID 3. TITLE OF POSITION (Subcomponent) NCZVED 4. GRADE/STEP 15/5 5. FEDERAL SALARY $119,367.00 7. FINANCIAL DISCLOSURE FILING STATUS Q Career SES Q Schedule C P I Other Q Commissioned Corps □ Public (SFS7B) 0 Conftdenlial fOGE -ISO) Q None

Management O f f i c i a l
6. APPOINTMENT TYPE Q PAS/PA PJ Non-Career SES f/lGS STREET n Title 42

8 OFFICE ADDRESS

1600 C l i f t o n R d . , NE
CITY

D-76
STATE GA ZIP

Atlanta
9 OFFICE CONTACT INFORMATION TELEPHONE

30333

FAX ( 404
EMAIL

( 404 )639-0274
CELL

)639-2780

( 678 ) 2 9 6 - 0 7 2 7
10. NAME OF IMMEDIATE SUPERVISOR

drb7@odc.gov
11. TITLE OF SUPERVISOR

R e g i n a l d R. Mebane
12. SUPERVISOR CONTACT INFORMATION TELEPHONE

Chief Management
FAX

Official

( 404 )639-2100
CELL

( 404 ) 6 3 9 - 2 1 7 0
EMAIL

( 404 )547-5743
AGENCY USE ONLY

rmebane@cdc.gov

i'h im

HHS-520 (1/06) (Previous Editions Obsolete)

PAGE 1 OF 16

I'JCHnlUAnHJMl-UMUW)

lip

Nature of Official Duties Describe the principal dulies and responsibilities ol your current position. You may attach a copy ol your position description In tieu ot providing the description unless you currently have significant duties or assignments that are not reflected In that document Q Position Description Attached

Management Official at the National Center fox Zoonotic, Vector-bourne and Enteric diseases (NCZVED), responsible for the administrative management of the Center, including personnel, budget, program and laboratory activities.

2, Relationship of Official Dultes to Outside Activity Describe any ottiolal duties Ihat relate in any way to the proposed activity II none, explain why.

Advice and assistance on matters of management are similar to those of: my official duties at CDC.

Effect of Official Duties on Outside Employer In performing your official duties, explain how your actions or the matters upon which you may be called upon to work could allecl the Interests ot the pBrson for whom or the organization tor which ths proposed activity will be porformed. If the exercise ol your official duties would not have such an effect, explain why.

They would have no effect as this is a not-for-profit entity with a dissimilar mission.

Assignments Involving Outside Employer
Describe any olficia! dulv assignments or other Interactions you have had Ihat Involve the parson forwhom or the organizaiion for which the proposed activity will be performed and Indicate when such assignments or Inlsraclions occurred. II none, explain

I have attended scheduled advisory meetings in the past. Foundation's staff and engaged in strategic planning.

I have met with the

5.

CERTIFICATION

Tha undersigned employee certifies Ihat the notices in Part VIII havo bean read and understood and that the statements made and information provided on this torm are true, complete, and correct to the best ot the Individual's knowledge EMPLOYEE SIGNATURE ^ ^ DATE

HHB-520 (1/OS) (Previous Editions Obsolete)

PAGE 6 OP 16

1. Summary of Applicable Law An employee cannot undertake an outside acHvliy lhat conflicts with the employee's official duties. An activity conflicts with official duties; (a) if It is prohibited by statute or regulation; or flj) It, under the standards in 5 CFR 2635.408 and 8635.502, it would require the employee's reousal from matters so centra) or critical lo the performance of his or her official duties that the employee's ability to perform the duties of his or her position would be materially Impaired- Such a reousal would Hkely arise where the outside activity involves a person or entity that Is regulated by, does business with, receives grants or other benefits from, or Is otherwise substantially Impacted by the programs, policies, and operations ol the employee's agency, and the employee riormally would be Involved personalty and substantially In such matters on a frequent basis or as a principal duty. In addition, an activity may be improper If the circumstances suggest lhat the employee received an outside business opportunity based on his or her official position or would create the appearance of using pubDc office tor the private gain of an outside entity. An employee also must endeavor to avoid any actions that create the appearance of a violation of law or the ethical standards. Special rules apply to activities involving fundrafeing, expert witness testimony, teaching. spaaklng, writing, or adding, and aclrvilles with foreign entities Certain categories ot employees, euch as those in FDA, NIH, and OSC. are subject to component specific rules on outside activities Refer to the Standards of Ethical Conduct, 5 CFR part 2635, subpart H, and thB HHS Supplemental Ethics Regulation, 5 CFR part 5501, 2. Supervisor's Statement Describe the extent lo which the employee's official dulles are related to the proposed outside activity.

The employee's official duties do not directly relate to this proposed outside activity. Employee has been informed that no official support or endorsement by CDC is intended by his involvement and that no CDC equipment will be used in the performance of this activity.

Recommendation The undersigned supervisor, identified In Part I, Hem 10, has reviewed the employee's responses, obtained additional Information where appropriate, and recommends the lollcwlng acUon: n Recommend Approval If this box is checked, the supervisor understands thai if the outside activity Is approved, the employee may be disqualified from performing ofliclat duties that involve or atfecl any outside entity with which the employee has an outside employment, consulting, or similar relationship. If the activity constitutes employment or sarvice as an oflicer, direolor, or trustee, or In another fiduciary role, the recusal obligation may extend not only to government matters that specifically Involve or aflect the outside entity, but to those matters thatalfect generally the Industry or economic sector In which the outside entity operates The supervisor concludes that any work assignments Involving specific or general matters from which the employee will be recused can be reassigned to another Individual and are not so central or critical to the performance of the employee's official duties that the employee's ablflty to perform the duties of his or her position would be materially Impaired. Q Recommend Disapproval If this box Is checked, explain the reason(s) In Ihe additional space provided on the last page of (his form.
SUPERVISOR SIGNATURE

DATE

^CQCCJAA>>^_.
HHS-520 (OT6) (Previous Editions Obsolete) PAGE 7 OF 16

8<UrP$

6

■MANAGEMErMCD 1. Name of Reviewer 2, Title of Reviewer

Frederick Pestorius
3. Reviewer Contact Information TELEPHONE

Management O f f i c i a l , ftCKDCID
FAX

( 404 )639-3788
CELL

(
EMAIL

)

(
4. Organization

)

Coordinating Center for Infectious Diseases
5- Committee
II Ihe reviewer acts on behal! ol a oommitlee, Identify the body and record any dissenting views In the "Comments" below

6. Review " . - ' ■ ' ■ ' ' ■ ' Review the employee's answers and Indicate whether you conour In the supervisor's recommendation Explain your reason(s) In the epace below. Sign and date the form In the space provided

HHS-S20 (V06) (Previous Editions Obsolete)

PAGE BOP 16

1. Name of Agency Ethics Official

2, Title of Agency Ethics Official

T e r e s a Walker-Mason
3. Agency Ethics Official Contact Information TELEPHONE

Stlal ce Program Manager
FAX

( 404 ) 6 3 9 - 5 0 0 3
CELL ( . > 4. Organisation

( 404 ) 6 3 9 - 0 6 2 1
EMAIL

bsg6@cdc.gov

Centers for Disease Control and Prevention, OD/OCOO, Atlanta, GA
5. Ethics Review Review Iha employee's answers and tho supervisor's recomttiendation. Consider iha assessment of any management official, committee, or other Intermediate reviewer. Based on Iha information provided and applying Ihe standard for approval prescribed In S CFR S501.106(d)(5), Indicate whether the activity can ba approved or permission must be denied. Explain your reason(s) in the space below and describe any actions deemed necessary to ensure compliance with applicable ethics laws. Sign and date the lorm In the space provided, 0 Bequest as described may be approved | Q Bequest may be approved subject to conditions noted In Comments Section f~] Request as described must be denied l~] Other disposition noted in Comments Section AGENCY ETHICS OFFICIAL SIGNATURE

6. Comments

AJTUJ/1

HHS-520 (t/OS) (Previous Editions Obsolete)

PAGE 9 OF 16

(;^tff^OESjG#^
1 . Name of Agency Deslgnae 2.' Title of Agency Deslgtiee

3. Agency Destgnee Contact Information TELEPHONE

FAX

(
CELL

) )

(
EMAIL

)

(
<t. Organization

B. Decision Based on the foregoing statements and any supporting documanlallon, the recommendations ol the supervisor and, If applicable, any management otllolal, committee, or other Intermediate reviewer, and the review by the agency ethics official, the disposition Indicated below constitutes my writtsn determination, pursuant to 5 CFR 2635.803 and 5 CFR 8501,106(d), that the request to engage hi the Identified outside activity Is; Q Approved V) Approved subject to conditions Q Dented AGENCY DESIGNEE (APPROVING OFFICIAL) SIGNATURE DATE

6. Specified Conditions (it any)

7. Comments

HHS-520 (1/06) (Previous Editions Obsolete)

PAGE 10 OF 18

APPROVAL OF AN OUTSIDE ACTIVITY DOES NOT RELEASE YOU FROM A CONTINUING LEGAL OBLIGATION TO DISQUALIFY YOURSELF FROM OFFICIAL ASSIGNMENTS AFFECTING YOUR OUTSIDE EMPLOYER OR THE ENTITY TO WHICH YOU ARE PROVIDING PERSONAL SERVICES. WHILE PERFORMING AN APPROVED OUTSIDE ACTIVITY, ANY ACTIONS TAKEN IN CONFLICT WITH APPLICABLE ETHICS LAWS MAY SUBJECT YOU TO CRIMINAL PROSECUTION OR DISCIPLINARY PROCEEDINGS. Caution. When you consult, leach, spaak, write, serve on a board, or work for a company, organization, or other entity outside your government Job, your relationship with that outside entity has certain legal and ethical consequences.ThB approval of an outside activity does not mean that you are free of conflicts of Interest. You must still follow all substantive ethics requirements after approval is granted. Consult the ethics regulations at 5 CFR 2635.802 and 5501.106(d)(5) which are reprinted below. Conlllcts Resolution. An approved HHS Form 520 does not signify that you need not be concerned about conflicts of Interest. Under the law, conflicts of Interest arising out of outside employment or service in a fiduciary position can be resolved In advance in only three ways: (1) you can inform your supervisor and disqualify yourself from participating in a conflicting government matter (often called a recusal); (2) you can seek, If certain legal requirements are satisfied, a separate legal document from your appointing official or designee that specifically permits you to work on the government matter (known as a waiver), or (3) you can resign from either your government or outside Job. Outside relationships that fall short of actual employment or a fiduciary role pose similar appearance concerns that must be addressed under procedures In 5 CFR 2635.502. Effect of Prior Approval. The outside activities prior approval process has very limited purposes. When a reviewer approves an HHS Form 520 for your outside activity, two fundamental assessments are being made, which are discussed below. You reasonably may rely on these specific determinations only if you provided all relevant Information on the iorm and the circumstances under review do not thereafter change. You remain responsible for the legal and ethical consequences of any change in personal or business affairs or a change in your government duties. First, based on the information which you provide, the reviewer determines whether your proposed activity Is plainly prohibited by applicable statutes or regulations, including the provisions of the ethical standards governing appearances of Impropriety. For example, il you want to lobby Federal agencies on behalf of a non-profit organization that employs you, prior approval will be denied because a criminal statute prohibits such representational activities. Second, assuming your proposed activity Is not specifically prohibited, the reviewer determines whether, under the circum­ stances, approval should be denied for other reasons specified under the law. For example, (he reviewer may deny approval if the facts show that you used your government position to obtain ah outside compensated business opportunity or II the activity would create the appearance that you are violating the law or the ethical standards. Another common reason for denying approval is that the outside activity may prevent you Irom handling work that Is expected of you Because the outside activity may cause you to have to disqualify yourself from a broad range of job assignments, or even a few crucial projects, that will affect your outside employer or the entity to which you provide personal services, It may be Impossible for you to discharge fully your government duties If, however, your outside activity Is approved, the reviewer has determined that the matters In which you will not be allowed to participate are not "so central or critical to the performance of Jyour] official duties" that your ability lo perform the duties of your position would be materially impaired. In other words, you cannot work on a government matter affecting your outside employer, but the reviewer expects that you will be able to stay away from these assignments and still do your Job. Recusal Obligations. When performing your Federal duties, you must not participate In any government matter that will affect your own self-interest In continuing your outside Job or activity. For example, you would have to disqualify yourself from participating in any official matter that might put your outside employer out of business or seriously affect Its finances, either positively or negatively, so that the odds of your remaining employed are also affected. In addition, when you work for an outside employer or serve in a fiduciary role with an organization, the financial interests of that company or organization are considered to be your own As a result, li the company or organization has a financial interest in how a government matter will be resolved, you cannot work on that matter, This means that you cannot work on a government matter that involves or affects your outside employer as a specific party, such as a contract, grant, audit, Investigation, or litigation, The law also requires you to stay away from government matters that are larger in scope, such as deliberations and decisions on developing, Implementing, or enforcing statutes, regulations, policies, studies, or proposals, that will have an elfect on a large class of employers like the one for which you work on the outside For example, If you were permitted to have an outside position as an employee ol a hospital, a drug company, or a nonprofit organization, you could not participate personally In any significant way in a policy decision that affects the financial interests of the Industry or organizational sector in which these employers operate. Under certain limited circum­ stances, a waiver tor such "particular matters of general applicability" can be considered, if you notify your appointing official In advance and receive a written determination. Outside relation­ ships that fall short of actual employment or a fiduciary role pose similar appearance concerns, but the recusal obligation is limited lo specific party matters. Scope of Recusal. Although many employees understand the need to disqualily themselves from participating in an official matter that affects their outside employer, they often believe erroneously that they can pick and choose among the various aspects of a particular matter and stay away only from the important decisions Such incomplete recusals will not protect you from a criminal conflict oi Interest violation- Unless a waiver, approved In advance, Identifies specific permitted activities, you must refrain entirely and absolutely from participating personally and substantially in a government matter that affects your own financial interest or that of an outside employer When you are involved significantly In proposing, planning, advising, deciding, or implementing some official action, and you do so individually or by actively directing subordinates, your participation is personal and substantial.

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EXCERPTS FROM THE STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPLEMENTAL AGENCY ETHICS REGULATIONS: TITLE S CODE OF FE § 2635,802 Conflicting outside employment and activities. An employee shall not engage In outside employment or any other outside activity that conflicts with his official duties. An activity confllcls with an employee's official duties: (a) II it Is prohibited by statute or by an agency supplemental regulation; or (b) If, under the standards set forth in §§ 2635.402 and 2636 502, it would require the employee's disqualification from matters so central or critical to the performance of his official duties that the employee's ability to perform the duties of his position would be materially impaired Employees are cautioned that even though an ouiside activity may not be prohibited under this section, It may violate other principles or standards set forth in this part or require the employee to disqualify himself from participation In certain particular matters undBr ellher subpart D or subpart E of this part Example 1: An emptoyee of the Environmental Protection Agency has just been promoted. His principal duty in his new position Is to write regulations relating to the disposal of hazardous waste. The employee may not continue to serve as president of a nonprofit environmental organization thai rouilnely submits comments on suoh regulations. His service as an officer would require his disqualification from duties criilcal to the performance of his official duties on a basis so frequent as to materially impair his ability to perform the duties of his position Example 2s An employee of the Occupational Safety and Health Administration who was and is expected again to be instrumental In formulating new OSHA safety standards applicable to manufacturers that use chemical solvents has been offered a consulling contract to provide advice to ah affeoted company in restructuring its manufacturing operations to comply with the OSHA standards. The employee should not enter Into the consulting arrangement even though he Is not currently working on OSHA standards affecting this industry and his consulting contract can be expeoted to be completed before he again works on such standards. Even though the consulting arrangement would not be a conflicting activity within the meaning of § 2635 802, It would create an appearance that the employee had used his official position to obtain the compensated outside business opportunity and it would create the further appearance of using his public office for the private gain of the manufacturer =RAL REGULATIONS § 5S01-106(d)(0) Standard for approval. Approval shall be granted only upon a determination that the ouiside employment or oiher outside activity is not expected to involve conduct prohibited by statute or Federal regulation, including 5 CFR part 2635 and this part. Note* The granting of approval for an outside activity does not relieve the employee of the obllgaUon to abide by all applicable laws governing employee conduct nor does approval constitute a sanction of any violation. Approval Involves an assessment that the general activity as described on the submission does not appear likely to violate any criminal statutes or other ethics rules. Employees are reminded that during the course of an otherwise approvable activity, situations may arise, or actions may be contemplated, that, nevertheless, pose ethical concerns. Example 1: A clerical employee with a degree in library science volunteers to work on the acquisitions committee at a local public library, Serving on a panel that renders advice'to a non-Federal entity is subject to prior approval. Because recommending books for the library collection normally would not pose a conflict wRh the typing duties assigned the emptoyee, the request would be approved. Example 2: While serving on the library acquisitions committee, the clerical employee in the preceding example is asked to help the library business office locale a missing book order. Shipment of the order Is delayed because the publisher has declared bankruptcy and its assets, including inventory in the warehouse, have been frozen to satisfy the claims of the Infernal Revenue Service and other creditors- The employee may not contact the Federal bankruptcy trustee to seek, on behalf ol the public library, the release ol the books. Even though the employee's service on the acquisitions committee had been approved, a criminal statute, 18 US,C. 205, would preclude any representation by a Federal employee of an outside entity before a Federal court or agency with respect to a matter In which the United States Is a party or has a direct and substantial interest.

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The Ethics in Government Act, 5 U.S.C. App. § 101, et seg, Executive Order 12674, as amended by Executive Order 12731, Sections 301 and 7301 oi Tltie 5 of the II .S Code, and Sections 2635.803 and 5501.106(d) of Title 5 of the Code of Federal Regulations authorize the collection of this Information Disclosure ol this Information is mandatory for employees seeking prior autnorteatlon from an agency deslgnee to pursue outside employment or activities pursuant to Sections 2635 803 and 5501.106(d) of Tille 6 of the Code of Federal Regulations Failure to provide all or part of the requested information may result In denial of the request for approval of the oulslde employment or activity. Falsification of information or failure to file or report Information required to be reported may subject the employee to disciplinary action. Knowing and. willful falsification of information required to be reported may subject the employee io criminal prosecution The primary use of this information is to allow HHS supervisors, management officials, and agency ethics officials to make necessary determinations concerning employee requests for prior approval of oulslde employment or acllvifles in order to prevent a conflict of Interest or other violations of the statutes, regulations, and executive orders governing employee conduct, ThB information Is also requested, pursuant to 5 C.F.R. §§ 2638 203(b)(9),(10), and (11), for the purpose of evaluating ethics program administration, as well as the Department's supplemental ethics regulations, to determine their continued adequacy and effectiveness In relation to ourreni agency responsibilities and to ensure that prompt and effeclive action is taken to remedy violations or potential violations, or appearances thereof, ol conflict of Interest and related ethics provisions. Additionally, this information may be disclosed to: (1) the Offioe of Personnel Management, Office of Government Ethics, Merit Systems Protection Board, Office oi the Special Counsel, Equal Employment Opportunity Commission, Federal Labor Relalione Authority, Federal Service Impasses Panel, Federal Mediation and Conciliation Service, and an arbitrator, In carrying out their functions; (2) a Federal, State, or locaf agency charged with Investigating or prosecuting violations of, or Implemeniing, the law, in the event there is an Indication of a violation or potential violation of civil, criminal or regulatory law; (3) a Federal, State, or local agency maintaining enforcement records or other pertinent records, such as current licenses, if necessary to obtain a record relevant to an agency decision concerning 1he hiring or retention of an employee, the Issuance of a security clearance, the Istting of a contract, or the Issuance of a license, grant or other benefit; (4) the National Archives and Records Administration or the General Services Administration in records management Inspections; (5) the Oflice oi Management and Budget during legislative coordination on privacy relief legislation; (6) Federal agencies with power to subpoena other Federal agencies' records; (7) a court or party In a court or Federal administrative proceeding If the Government Is a party or In order Io comply wllh a judge-Issued subpoena; (8) private firms with which the Department may contract for the purpose of collating, analyzing, aggregating or otherwise refining records; (9) a Member ol Congress or a Congressional office, pursuant to an inquiry made at the request of the individual who Is a subject of the record; (10) the Department ol Justice in defense of litigation; and (11) conlractors and other non-Government employees working for the Federal Government to accomplish a function related to an Office of Government Ethics Government-wide system ol records- This confidential report will not be disclosed to any requesting person unless authorized by law. See the OGEA30VT-2 Government-wide executive branch system of records.

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HHS-620 (1/06) (Previous Editions Obsolele)

PAGE 14 OF IS

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HHS-52D (1/OB) (Previous Editions Obsolete)

PAGE 15 OF 16

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Pubtlc Health Service Centers for DEsease Control and Prevention (CDC)

Date

From

J N «3 m A Deputy Ethics Counselor Centers for Disease Control and Prevention, and Agency for Toxic Substances and Disease Registry Outside Activity Douglas R. Browne Management Official, NCZVED, N T > CX Through: Director, NCED (A-45) Your renewal request, to serve on the advisory board of the National Save a Life, has been approved- Pursuant to the latest version of the HHS Supplemental Standards of Ethical Conduct, approval of an outside activity is effective for one year only, Employees must renew their request for approval annually if they desire to continue any long term outside activity. In addition, employees must submit a revised request for approval if they change positions within the agency or if a significant change occurs in the nature of the outside activity or in the scope of the employees' duties. Please note that the approval of this outside activity will be considered inactive after December 31,2007. You may perform this outside activity under the following conditions: 1. 2. It must not create a real or apparent conflict of interest. You must not participate in any action taken by the organization to endorse, encourage, or oppose the adoption of a formal policy or position of CDC, HHS, or the Federal Government. Government-financed time, supplies, facilities, or equipment assigned or loaned to you for completion of your official duties may be used for this outside activity only as permitted by the Information Resources Management Manual Guide, CDC-8, June 99, "Employee Use of CDC Information Technology Resources." You shall not use or permit the use of your Government position or title or any authority associated with your public office in a manner that could reasonably be construed to imply that CDC or the Government sanctions or endorses your outside activity. 5. You must not represent the organization before any Federal agency where the Federal Government has a substantial interest in the matter.

Subject To

Page 2. Douglas R. Browne 6. You are prohibited from taking any action as a CDC employee that could be perceived as directly and predictably affecting the financial interests of this organization. You may not provide, for compensation, services on behalf of this organization to prepare, or assist in the preparation of any grant applications, contract proposals, program reports, or other documents intended for submission to HHS. You must not participate in lobbying activities. You may only participate in fund-raising activities consistent with the Office of Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You may attend fund-raising functions, and you may participate in discussions and planning of fund-raising activities this outside organization is considering,. However, you may not personally solicit funds or other support from a subordinate or a prohibited source, within the meaning of the OGE Standards at §2635,203(dV

7.

8. 9.

For more specific information concerning this outside activity, refer to Subpart H — Outside Activities, of the Office of Government Ethics Standards of Ethical Conduct for Employees of the Executive Branch, and Section 5501.106 of the HHS Supplemental Standards of Ethical Conduct. Please note that if this activity is perfoimed during normal working hours, you must be on approved leave. If you have questions or need additional information, please call•Fran-eoHier, Ethics Program Activity, Office of the Chief Operating Officer, OD, (404) 639-5113.

invicr,

DEPARTMENT OF HEALTH AND HUMAN SERVICES

REQUEST FOR APPROVAL OF OUTSIDE ACTIVITY
Standards of Ethical Conduct Regulation HHS Supplemental Ethics Regulation (5 CFR S63S.803, 5 CFR 5501.106(d)) DATE FILED [^] Initial Request O Revised Request [ 7 ] Renewal

*4?0

02/26/08

EMPLOYEE INFORMATION 1 EMPLOYEE'S NAME (Las\, First, Ml)

Browne, D o u g l a s R.
2 AGENCY (Operating/Staff Division) (Subcomponent)

CDC/CCID/NCZVED
3 TITLE OF POSITION

OD
4 GRADE/STEP 5 FEDERAL SALARY

Management

Officer

15/6

$130,543.00
7 FINANCIAL DISCLOSURE FILING STATUS

6 APPOINTMENT TYPE 0 PAS/PA £ 3 Non-Career SES n Tilie 42 O Career SES O Other □ Schedule C Q Commissioned Corps

Public (SF278) □ None

[71GS

[7J Confidential (OGE 450)

8 OFFICE ADDRESS STREET 0>X6) CITY STATE GA ZIP

Atlanta
9 OFFICE CONTACT INFORMATION TELEPHONE FAX

30340-4813

( 404 ) 6 3 9 - 0 2 7 4
CELL

( 404 ) 6 3 9 - 7 0 9 0
EMAIL

( 678 ) 2 9 6 - 0 7 2 7
10 NAME OF IMMEDIATE SUPERVISOR

drb7@cdc.gov
11 TITLE OF SUPERVISOR

R e g i n a l d R.. Mebane
12 SUPERVISOR CONTACT INFORMATION TELEPHONE

C h i e f Management
FAX

Official

( 404 ) 6 3 9 - 2 1 0 0
CELL

( 404 ) 6 3 9 - 2 1 7 0
EMAIL

( 404 ) 5 4 7 - 5 7 4 3
AGENCY USE ONLY

rrnebane@cdc.. g o v

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HHS-520 (1/06) (Previous Editions Obsolete)

PAGE1 OF 16

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OFFICIAL DUTY INFORMATION 1. Nature of Official Duties Describe the principal duties and responsibilities of your current position You may attach a copy of your position description in lieu of providing the description unless you currently have significant duties or assignments that are not reflected in that document £ ] Position Description Attached

Management Officer - responsible for the administrative management of the National Center for Zoonotic, Vector-borne and Enteric Diseases.

2. Relationship of Official Duties to Outside Activity Describe any official duties that relate In any way to the proposed activity If none, explain why

Role of the board is to review foundation activities and advise Director on future directions. I also review Foundation's budget. There are some similarities in that I review the Center's budget and consult on management issues.

Effect of Official Duties on Outside Employer In performing your official duties, explain how your actions or the matters upon which you may be called upon to work could affect the interests of the person for whom or the organization for which (he proposed activity will be performed If 1he exercise of your official duties would not have such an effect, explain why

The Foundation has no current financial interests in CDC.

<l. Assignments Involving Outside Employer Describe any official duty assignments or other interactions you have had that Involve the person for whom or the organization for which the proposed activity will be performed and Indicate when such assignments or interactions occurred If none, explain

-H The Foundation had an I I S grant through CDC. 9. ,

I was the project officer in 1998-

5 .

CERTIFICATION

The undersigned employee certifies that the notices in Part Vlll have boon read and understood and thai the statements made and information provided on this form are true, complete, and correct to the best of the individual's knowledge EMPLOYEE SIGNATURE DATE

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HHS-520 (1/06) (Previous Editions Obsolete)

USW«—
PAGE 6 OF 16

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SUPERVISOR REVIEW

1. Summary of Applicable Law
An employee cannot undertake an outside activity that conflicts with the employee's official duties. An activity conflicts with official duties: (a) if it is prohibited by statute or regulation; or (b) If. under the standards in 5 CFR 2635 402 and 2635 502. it would require the employee's recusai from matters so central or critical to the performance of his or her official duties that the employee's ability to perform the duties of his or her position would be materially Impaired Such a recusai would likely arise where the outside activity involves a person or entity that is regulated by. does business with, receives grants or other benefits from, or is otherwise substantially impacted by the programs, policies, and operations of the employee's agency, and Ihe employee normally would be involved personally and substantially in such matters on a frequent basis or as a principal duly In addition, an activity may be improper if ihe circumstances suggest that the employee received an outside business opportunity based on his or her oflicial position or would create the appearance of using public olflce for the private gain of an outsldo entity An employee also must endeavor to avoid any actions that create the appearance of a violation of law or Ihe ethical standards Special rules apply to activities involving fundralslng, expert witness testimony, teaching, speaking, writing, or editing, and activities with foreign entities Certain categories ol employees, such as those in FDA, NIH. and OGC, are subject to component specific rules on oulside activities Refer to the Standards of Ethical Conduct. 5 CFR part 2635. subpart H, and Ihe HHS Supplemental Ethics Regulation. 5 CFR part 5501

2. Supervisor's Statement
Describe the extent to which the employee's official duties are related to the proposed outside activity

Recommendation
The undersigned supervisor, Identified in Part I, Item 10. has reviewed the employee's responses, obtained additional information where appropriate, and recommends the following action:

[ 2 Recommend Approval
If this box Is checked, the supervisor understands that II the outside activity is approved, the employee may be disqualified from performing official duties that involve or affect any outside entity with which the employee has an outside employment, consulting, or similar relationship If the activity constitutes employment or service as an olficer, director, or trustee, or in another fiduciary role. Ihe recusai obligation may extend not only to government matters that specifically involve or affect the outside entity, but to those matters that affect generally the industry or economic sector in which the oulside ontlty operates The supervisor concludes that any work assignments involving specific or general matters (rom which the employee will be recused can be reassigned to another individual and are not so central or critical to the performance of the employee's official duties that the employee's ability to perform the duties ol his or her position would be materially Impaired [ 3 Recommend Disapproval II this box Is checked, explain the reason(s) in Ihe additional space provided on the last page of this form SUPERVISOR SIGNATURE DATE

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.
PAGE 7 OF 16

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HHS-520 (1/06) (Previous Editions Obsolete)

1. Name of Reviewer

MANAGEMENT / COMMITTEE / OTHER INTERMEDIATE REVIEW 2. Title of Reviewer

Chuff -i^finR-yr^g^Jr offta'a-fr
lewer 3. Reviewer Contact Information TELEPHONE FAX

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5. Committee If Ihe reviewer acts on behalf of a committee, idanlify the body and record any dissenting views in Ihe "Comments" below

6. Review Review the employee's answers and indicate whether you concur in Ihe supervisor's recommondatlon Explain your reason(s) in Ihe space below Sign and date the form in Ihe space provided Q'Concur f~| Nonconcur REVIEWER SIGNATURE DATE

7. Comments

HHS-520 (1/06) (Previous Edilions Obsolete)

PAGE 8 OF 16

HIHHtMWliamill'JUiMMitwiiwnwurwBa

ime of Agency Ethics Official

2. Title of Agency Ethics Official

e r e s a Walker-Mason
jancy Ethics Official Contact Information ELEPHONE

Ethics Program Manager
FAX

( 404 ) 6 3 9 - 5 0 0 3
)ELL

( 404 ) 6 3 9 - 0 6 2 1
EMAIL

(
rganlzatlon

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bsg6@cdc. gov

Centers for Disease Control and Prevention, OD/OCOO, Atlanta, GA
thlcs Review evlaw Ihe employee's answers and Ihe suparvisor's recommendation, Consldor tho nssassmont of any manngamunl ollicial, commlitoe, or othar iteimodiato roviowsr. Basod on the information provided and applying Ihe standard lor approval prescribed in 5 CFR 5501 106(d)(5), indicate whalhor is activity can bo approved or permission must bo dented, Explain your renson(s) In tho space bolow and describe any actions deemed necessary to nsuro compliance with applicable ethics laws. Sign and date the form In the space provided. f7] Request as described may be approved 0 Request may be approved subject to conditions nolad In Comments Section

| Q Request as described must be donlod [H] Othor disposition noted In CornmonlsSection ZNCY ETHICS OFFICIAL SIGNATURE DATE

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APPROVAL OF AN OUTSIDE ACTIVITY DOES NOT RELEASE YOU FROM A CONTINUING LEGAL OBLIGATION TO DISQUALIFY YOURSELF FROM OFFICIAL ASSIGNMENTS AFFECTING YOUR OUTSIDE EMPLOYER OR THE ENTITY TO WHICH YOU ARE PROVIDING PERSONAL SERVICES. WHILE PERFORMING AN APPROVED OUTSIDE ACTIVITY, ANY ACTIONS TAKEN IN CONFLICT WITH APPLICABLE ETHICS LAWS MAY SUBJECT YOU TO CRIMINAL PROSECUTION OR DISCIPLINARY PROCEEDINGS. Caution. When you consult, teach, speak, write, serve on a board, or work for a company, organization, or other entity outside your government job, your relationship with that outside entity has certain legal and ethical consequences. The approval of an outside activity does not mean that you are free of conflicts of interest You must still follow all substantive ethics requirements after approval is granted Consult the ethics regulations at 5 CFR 2635 802 and 5501.106(d)(5) which are reprinted below Conflicts Resolution. An approved HHS Form 520 does not signify that you need not be concerned about conflicts of interest Under the law, conflicts of interest arising out of outside employment or service in a fiduciary position can be resolved in advance in only three ways: (1) you can inform your supervisor and disqualify yourself from participating in a conflicting government matter (often called a recusal); (2) you can seek, if certain legal requirements are satisfied, a separate legal document from your appointing official or designee that specifically permits you to work on the government matter (known as a waiver), or (3) you can resign from either your government or outside job Outside relationships that fall short of actual employment or a fiduciary role pose similar appearance concerns that must be addressed under procedures in 5 CFR 2635.502. Effect of Prior Approval. The outside activities prior approval process has very limited purposes When a reviewer approves an HHS Form 520 for your outside activity, two fundamental assessments are being made, which are discussed below You reasonably may rely on these specific determinations only if you provided all relevant information on the form and the circumstances under review do not thereafter change. You remain responsible for the legal and ethical consequences of any change in personal or business affairs or a change in your government duties. First, based on the information which you provide, the reviewer determines whether your proposed activity is plainly prohibited by applicable statutes or regulations, including the provisions of the ethical standards governing appearances of Impropriety For example, if you want to lobby Federal agencies on behalf of a non-profit organization that employs you, prior approval will be denied because a criminal statute prohibits such representational activities. Second, assuming your proposed activity is not specifically prohibited, the reviewer determines whether, under the circum­ stances, approval should be denied for other reasons specified under the law. For example, the reviewer may deny approval if the facts show that you used your government position to obtain an outside compensated business opportunity or if the activity would create the appearance that you are violating the law or the ethical standards. Another common reason for denying approval is that the outside activity may prevent you from handling work that is expected of you Because the outside activity may cause you to have to disqualify yourself from a broad range of job assignments, or even a few crucial projects, that will affect your outside employer or the entity to which you provide personal services, it may be impossible for you to discharge fully your government duties If, however, your outside activity is approved, the reviewer has determined that the matters in which you will not be allowed to participate are not "so central or critical to the performance of [your] official duties" that your ability to perform the duties of your position would be materially impaired. In other words, you cannot work on a government matter affecting your outside employer, but the reviewer expects that you will be able to stay away from these assignments and still do your job Recusal Obligations. When performing your Federal duties, you must not participate in any government matter that will affect your own self-interest in continuing your outside job or activity For example, you would have to disqualify yourself from participating in any official matter that might put your outside employer out of business or seriously affect its finances, either positively or negatively, so that the odds of your remaining employed are also affected In addition, when you work for an outside employer or serve in a fiduciary role with an organization, the financial Interests of that company or organization are considered to be your own As a result, If the company or organization has a financial interest In how a government matter will be resolved, you cannot work on that matter This means that you cannot work on a government matter that involves or affects your outside employer as a specific party, such as a contract, grant, audit, investigation, or litigation The law also requires you to stay away from government matters that are larger In scope, such as deliberations and decisions on developing, implementing, or enforcing statutes, regulations, policies, studies, or proposals, that will have an effect on a large class of employers like the one for which you work on the outside. For example, if you were permitted to have an outside position as an employee of a hospital, a drug company, or a nonprofit organization, you could not participate personally in any significant way in a policy decision that affects the financial interests of the industry or organizational sector in which these employers operate Under certain limited circum­ stances, a waiver for such "particular matters of general applicability" can be considered, if you notify your appointing official in advance and receive a written determination. Outside relation­ ships that fall short of actual employment or a fiduciary role pose similar appearance concerns, but the recusal obligation Is limited to specific party matters Scope of Recusal. Although many employees understand the need to disqualify themselves from participating in an official matter that affects their outside employer, they often believe erroneously that they can pick and choose among the various aspects of a particular matter and stay away only from the important decisions. Such incomplete recusais will not protect you from a criminal conflict of interest violation. Unless a waiver, approved in advance, identifies specific permitted activities, you must refrain entirely and absolutely from participating personally and substantially in a government matter that affects your own financial interest or that of an outside employer. When you are involved significantly in proposing, planning, advising, deciding, or Implementing some official action, and you do so individually or by actively directing subordinates, your participation Is personal and substantial

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NOTICES (continued) EXCERPTS FROM THE STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPLEMENTAL AGENCY ETHICS REGULATIONS: TITLE 5 CODE OF FEDERAL REGULATIONS § 2635.802 Conflicting outside employment and activities. An employee shall not engage in outside employment or any other outside activity that conflicts with his official duties, An activity conflicts with an employee's official duties: (a) If it Is prohibited by statute or by an agency supplemental regulation; or (b) If, under the standards set forth in §§ 2635.402 and 2635.502, it would require the employee's disqualification from matters so central or critical to the performance of his official duties that the employee's ability to perform the duties of his position would be materially impaired. Employees are cautioned that even though an outside activity may not be prohibited under this section, ft may violate other principles or standards set forth in this part or require the employee to disqualify himself from participation in certain particular matters under either subpart D or subpart E of this part. Example 1: An employee of the Environmental Protection Agency has just been promoted. His principal duty in his new position is to write regulations relating to the disposal of hazardous waste. The employee may not continue to serve as president of a nonprofit environmental organization that routinely submits comments on such regulations., His service as an officer would require his disqualification from duties critical to the performance of his official duties on a basis so frequent as to materially impair his ability to perform the duties of his position Example 2: An employee of the Occupational Safety and Health Administration who was and is expected again to be instrumental in formulating new OSHA safety standards applicable to manu­ facturers that use chemical solvents has been offered a consulting contract to provide advice to an affected company In restructuring its manufacturing operations to comply with the OSHA standards The employee should not enter into the consulting arrangement even though he Is not currently working on OSHA standards affecting this industry and his consulting contract can be expected to be completed before he again works on such standards. Even though the consulting arrangement would not be a conflicting activity within the meaning of § 2635.802, it would create an appearance that the employee had used his official position to obtain the compensated outside business opportunity and it would create the further appearance of using his public office for the private gain of the manufacturer. § 5501.106(d)(5) Standard for approval. Approval shall be granted only upon a determination that the outside employment or other outside activity Is not expected to involve conduct prohibited by statute or Federal regulation, including 5 CFR part 2635 and this part, Note: The granting of approval for an outside activity does not relieve the employee of the obligation to abide by all applicable laws governing employee conduct nor does approval constitute a sanction of any violation. Approval involves an assessment that the general activity as described on the submission does not appear likely to violate any criminal statutes or other ethics rules. Employees are reminded that during the course of an otherwise approvable activity, situations may arise, or actions may be contemplated, that, nevertheless, pose ethical concerns. Example 1 : A clerical employee with a degree In library science volunteers to work on the acquisitions committee at a local public library. Serving on a panel that renders advice to a non-Federal entity is subject to prior approval. Because recommending books for the library collection normally would not pose a conflict with the typing duties assigned the employee, the request would be approved Example 2: While serving on the library acquisitions committee, the clerical employee in the preceding example is asked to help the library business office locate a missing book order. Shipment of the order is delayed because the publisher has declared bankruptcy and its assets, Including Inventory in the warehouse, have been frozen to satisfy the claims of the Internal Revenue Service and other creditors. The employee may not contact the Federal bankruptcy trustee to seek, on behalf of the public library, the release of the books Even though the employee's service on the acquisitions committee had been approved, a criminal statute, 18 U.SC 205, would preclude any representation by a Federal employee of an outside entity before a Federal court or agency with respect to a matter in which the United States is a party or has a direct and substantial interest

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PRIVACY ACT STATEMENT The Ethics in Government Act, 5 U.S.C, App § 101, ei seq, Executive Order 12674, as amended by Executive Order 12731, Sections 301 and 7301 of Title 5 of the U.S. Code, and Sections 2635.803 and 5501 106(d) of Title 5 of the Code of Federal Regulations authorize the collection of this information. Disclosure of this information is mandatory for employees seeking prior authorization from an agency designee to pursue outside employment or activities pursuant to Sections 2635.803 and 5501.106(d) of Title 5 of the Code of Federal Regulations. Failure to provide all or part of the requested information may result In denial of the request for approval of the outside employment or activity. Falsification of information or failure to file or report information required to be reported may subject the employee to disciplinary action. Knowing and willful falsification of information required to be reported may subject the employee to criminal prosecution. The primary use of this information Is to allow HHS supervisors, management officials, and agency ethics officials to make necessary determinations concerning employee requests for prior approval of outside employment or activities In order to prevent a conflict of Interest or other violations of the statutes, regulations, and executive orders governing employee conduct The information is also requested, pursuant to 5 C.F.R §§ 2638 203(b)(9),(10), and (11), for the purpose of evaluating ethics program administration, as well as the Department's supplemental ethics regulations, to determine their continued adequacy and effectiveness in relation to current agency responsibilities and to ensure that prompt and effective action is taken to remedy violations or potential violations, or appearances thereof, of conflict of interest and related ethics provisions. Additionally, this information may be disclosed to: (1) the Office of Personnel Management, Office of Government Ethics, Merit Systems Protection Board, Office of the Special Counsel, Equal Employment Opportunity Commission, Federal Labor Relations Authority, Federal Service Impasses Panel, Federal Mediation and Conciliation Service, and an arbitrator, in carrying out their functions; (2) a Federal, State, or local agency charged with investigating or prosecuting violations of, or implementing, the law, In the event there Is an indication of a violation or potential violation of civil, criminal or regulatory law; (3) a Federal, State, or local agency maintaining enforcement records or other pertinent records, such as current licenses, if necessary to obtain a record relevant to an agency decision concerning the hiring or retention of an employee, the issuance of a security clearance, the letting of a contract, or the issuance of a license, grant or other benefit; (4) the National Archives and Records Administration or the General Services Administration in records management inspections; (5) the Office of Management and Budget during legislative coordination on privacy relief legislation; (6) Federal agencies with power to subpoena other Federal agencies' records; (7) a court or parly in a court or Federal administrative proceeding if the Government is a party or in order to comply with a judge-issued subpoena; (8) private firms with which the Department may contract for the purpose of collating, analyzing, aggregating or otherwise refining records; (9) a Member of Congress or a Congressional office, pursuant to an inquiry made at the request of the individual who is a subject of the record; (10) the Department of Justice In defense of litigation; and (11) contractors and other non-Government employees working for the Federal Government to accomplish a function related to an Office of Government Ethics Government-wide system of records. This confidential report will not be disclosed to any requesting person unless authorized by law See the OGE/GOVT-2 Government-wide executive branch system of records

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service Agency for Toxic Substances and Disease Registry

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Deputy Ethics Counselor Centers for Disease Control and Prevention, and Agency for Toxic Substances and Disease Registry Outside Activity Douglas R- Browne Management Official, NCZVED, NCID Through: Director, NCID (A-45) Your renewal request, to serve on the advisory board of the National Save a Life, has been approved. Pursuant to the latest version of the HHS Supplemental Standards of Ethical Conduct, approval of an outside activity is effective for one year only. Employees must renew their request for approval annually if they desire to continue any long term outside activity. In addition, employees must submit a revised request for approval if they change positions within the agency or if a significant change occurs in the nature of the outside activity or in the scope of the employees' duties. Please note that
the approval of this outside activity will be considered inactive after June .30, 2009.

You may perform this outside activity under the following conditions: 1. 2. It must not create a real or apparent conflict of interest. You must not participate in any action taken by the organization to endorse, encourage, or oppose the adoption of a formal policy or position of CDC, HHS, or the Federal Government. Government-financed time, supplies, facilities, or equipment assigned or loaned to you for completion of your official duties may be used for this outside activity only as permitted by the Information Resources Management Manual Guide, CDC-8, June 99, "Employee Use of CDC Information Technology Resources." You shall not use or permit the use of your Government position or title or any authority associated with your public office in a manner that could reasonably be construed to imply that CDC or the Government sanctions or endorses your outside activity. You must not represent the organization before any Federal agency where the Federal Government has a substantial interest in the matter.

3.

4.

5.

Page 2. Douglas R. Browne 6. You are prohibited from taking any action as a CDC employee that could be perceived as directly and predictably affecting the financial interests of this organization You may not provide, for compensation, services on behalf of this organization to prepare, or assist in the preparation of any grant applications, contract proposals, program reports, or other documents intended for submission to HHS. You must not participate in lobbying activities. You may only participate in fund-raising activities consistent with the Office of Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You may attend fund-raising functions, and you may participate in discussions and planning of fund-raising activities this outside organization is considering. However, you may not personally solicit funds or other support from a subordinate or a prohibited source, within the meaning of the OGE Standards at §2635.203(d).

7.

8. 9.

For more specific information concerning this outside activity, refer to Subpart H — Outside Activities, of the Office of Government Ethics Standards of Ethical Conduct for Employees of the Executive Branch, and Section 5501.106 of the HHS Supplemental Standaids of Ethical Conduct. Please note that if this activity is performed during normal working hours, you must be on approved leave. If you have questions or need additional information, please call Fran Collier, Ethics Program Activity, Office of the Chief Operating Officer, OD, (404) 639-5113.

arlion Duncan

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