Ethics Forms and Deadlines

The following ethics forms are provided to assist employees to obtain advance approval where required, and manage real and apparent conflicts of interest. Descriptions are provided to help identify when to use each form. For questions regarding the forms or when they are required, contact your IC's ethics official. If you have questions regarding Acrobat, please seek assistance from your computer support group.

Deadlines for Ethics Actions Requiring Review by the NIH Ethics Office (NEO) and Determination by the NIH Deputy Ethics Counselor (DEC). ALL submissions must use the current version of the form.

Deadlines for Ethics Actions Requiring Review by the NIH Ethics Office (NEO)
and Determination by the NIH Deputy Ethics Counselor (DEC)

Coverage: 
 * 
Outside Activities under NEAC jurisdiction
 *  Awards under NEAC jurisdiction or requiring pre-screening
Coverage: 
 * 
Official Duty Activities
 *  Widely Attended Gatherings
 * Awards (non-NEAC review)
 *  Honorary Degrees

DEADLINE FOR SUBMISSION TO NEO:  Minimum of 6 weeks in advance of activity or associated travel. If  less than 6 weeks prior to proposed start date, it must be received in NEO within 5 business days of the employee's receipt of the invitation.

NEAC Meeting Dates

DEADLINE FOR SUBMISSION TO NEO:  Minimum of 4 weeks in advance of activity or associated travel. If  less than 4 weeks prior to proposed start date, it must be received in NEO within 5 business days of the employee's receipt of the invitation.


Any actions received by NEO within 5 business days of the activity must have all of the following requirements:
 * 
Must have IC Director approval (or designee in his/her absence) prior to submission to NEO;
 *  Must be determined to be a critical and essential activity; AND
 *  Must be accompanied by a last minute invitation or notification.

The NEO will not guarantee that actions received later than the deadlines can be processed.  Unless advance approval is obtained, the employee may not conduct the activity.

Outside Activities

   
The following forms are used as indicated to request approval to engage in an outside activity (personal, outside work).
1.

The HHS-520 form, Request for Approval of Outside Activity, is used within the Department of Health and Human Services (DHHS) to request approval of proposed Outside Activities (activities which are totally outside regular official duties, and with outside organizations). Required for all Outside Activities. NIH policy requires electronic submission of the HHS-520 using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/.

HHS-520 (1/06), Request for Approval of Outside Activity: The following link to the Acrobat* version of the form is provided only to permit viewing the form to see its arrangement and text while using NEES to submit a request. Detailed instructions documents below are helpful for employees and reviewers to determine appropriate responses to the questions. Form HHS-520 Outside Activity (pdf, 16 pages)

Instructions for Submitting an HHS-520 Instructions for Reviewing an HHS-520
2. NIH-2657 (4/98), Supplemental Information to the HHS-520 (fillable Acrobat* format, 2 pages). This NIH form is used to provide additional information for certain Outside Activities.  Required for consulting for industry (complete Part B), legal consulting/testimony (complete Part C), and Professional Practice for physicians, nurses, and allied health care professionals (Complete Part D).
3. NIH Policy Regarding Supervisory Review of Outside Activities: (Acrobat* format, 4 pages)
This memorandum, dated February 16, 2004, from the NIH Deputy Director/NIH Deputy Ethics Counselor to all supervisors details supervisory and management responsibilities for reviewing the HHS-520 Request for Approval of Outside Activity.
4. Form HHS-521 (1/06), Annual Report of Outside Activities, is used to submit a report of all Outside Activities in which you engaged during the previous calendar year, including activities for which you should have obtained advance approval but did not do so. The report is due on February 28th each year. NIH policy requires electronic submission of the form HHS-521 using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/. You will be notified when it is time to submit the Annual Report.

Form HHS-521 (1/06), Annual Report of Outside Activities: The following link is provided only to permit viewing the form to see its arrangement and text while using NEES to submit a report. Instructions below provide assistance in providing appropriate responses to the questions on the form. Form HHS-521 Annual Report of 520s (pdf, 10 pages)

Detailed Instructions for Completing and Reviewing the HHS-521 (Acrobat* format)

5. Clinical Fellows: HHS-520 Request for Approval of Outside Activity: For use ONLY for Outside Professional Practice for Clinical Fellows.
Activities Involving Foreign Entities
HHS-697, Foreign Activities Questionnaire (4/02)  (pdf, 1 page)
Use this form for activities involving a foreign entity or organization. Also for use by SGEs (special Government employees).

Official Duty Activities

Memo to Request Approval of Official Duty Activity
An official duty memo is used to request approval of certain activities involving outside organizations which are outside your regular official duties but will be performed as part of your official duties. Four samples are provided, as described below.

1.
2.
Requests from NIH Senior Employees (Top 5), and DECs, to the NIH DEC (Rev 1/11).
3.

Blanket Official Duty Request Memo (7/07). June 1, 2007, memo from NIH DEC to IC Directors. (PDF, 1 page).

4.
*NEW* Request for Approval of Participation in a Leadership Position of a 501(c) Nonprofit Professional Organization (10/14, PDF) . Request for Approval of Participation in a Leadership Position of a 501(c) Nonprofit Professional Organization (10/14, MS Word)
Publication Copyright and Public Access Issues: An employee working in an official capacity is working on behalf of the NIH, not in a personal capacity. Without appropriate authority, employees may not sign legal documents which bind the NIH. Employees may NOT sign any forms from publishers or other outside entities, but must use the approved NIH forms and follow the NIH Procedure for Complying with the NIH Public Access Policy (pdf, 2 pages), which was distributed by OIR on May 15, 2008. The procedure and public access policy documents are maintained on the NIH Office of Intramural Research Source Book web site. Use the above link for access to the various documents.

Presentation Disclosure Form: Some organizations require speakers to sign a form for the organization to confirm the speaker has permission to use copyrighted material in the presentation, or for the speaker to declare financial interests, if any, in a commercial organization with an interest in the topic of the presentation. When giving an official speech, employees must use the NIH Presentation Disclosure Form (pdf, 1 page) unless the organization requires the employee to use their own form. In that case, the organization's form must be reviewed by the appropriate official in each IC, often in the Technology Transfer Office, before the employee signs and returns it to the organization.

Gift Exceptions (Permission to Accept Certain Gifts)
1.

NIH-2854 Request for Approval to Accept Gifts Associated with an Award from an Outside Organization (08/09): This form is used to request permission to accept gifts associated with an award from an outside entity, such as a professional association. NIH policy requires electronic submission of the form NIH-2854 using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/.

The following link to the Acrobat* version of the form is provided only to permit viewing the form to see its arrangement and text to assist with submission of your request while using NEES to submit a request. Form NIH-2854 Award (pdf, 3 pages)

Awards with cash (or equivalent) gifts require prior review and confirmation that the award meets the regulatory criteria before NIH employees may accept a cash prize. See information on the Awards topic page. Ethics officials will follow the detailed procedure for submission of the review request package, including use of the current summary review form.

2. NIH-2855 Request for Approval of An Honorary Degree (08/09) (pdf, 3 pages): Use this form to obtain advance approval to accept an honorary degree. Your Deputy Ethics Counselor will determine the permissibility of an honorary degree.

3.

NIH-2803 Request to Accept Free Attendance Under the Widely Attended Gathering (WAG) Exception (12/11): This form is used to request permission to accept free attendance at a Widely Attended Gathering, e.g., receptions or dinners, where you are not presenting or otherwise participating, other than as an attendee. NIH policy requires electronic submission of the individual form NIH-2803 using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/. Blanket WAG requests will use the paper form (see link below).

The following link to the Acrobat* version of the form is provided for use with Blanket WAG requests. For blanket WAGs, provide names, titles, or group identification for all who will be covered by the blanket request. Individuals may use this link to view the form to assist with electronic submission of individual requests using NEES. Form NIH-2803 WAG (Fillable pdf, 4 pages).

Protocol COI Statement (3/08)
The protocol Conflict of Interest (COI) statement is used to request conflict of interest clearance of a protocol by the IC Deputy Ethics Counselor (DEC) for all investigators. This link goes to the form, procedures and instructions for clearing the protocol.

Managing Real and Apparent Conflicts of Interests
1. Ethics Agreement: An ethics agreement is typed on plain paper. Insert the employee's name, title, IC and date. Add the facts which cause a real or apparent conflict and explain how the conflict will be managed. For example, an employee new to NIH may have to agree to resign from certain activities. Provide details and the final date of recusal, or authorize employee continue as fits the situation. Sample ethics agreements are available from the NIH Ethics Office.

2. Waiver of Actual Conflict of Interest [18 USC Section 208(b)(1)] (Word format): This is the standard waiver format used to manage an actual (real) conflict of interest under 18 USC 208(b)(1), the governing statute. A waiver permits the employee to participate in certain official matters involving outside entities even though the employee has a conflict of interest as defined in 208(b)(1). For additional information, see the HHS Policy (1/09) (HHS Access) regarding granting waivers.

3. Waiver of Actual Conflict for Officers or Directors [18 USC Section 208(b)(1)] (Word format): This is the waiver format used to manage conflict of interest issues for employees serving as an officer of director of an outside organization when such service is done as part of their official duties. The waiver permits the employee to serve in an official capacity despite the real conflict of interest. For additional information, see the HHS Policy (1/09) (HHS Access) regarding granting waivers.

4. Authorization to Participate [5 CFR 2635 Section 502] (Revised 3/06) (Word format):  This is the standard authorization format used to manage appearances of conflicts of interest (vs. real conflicts which use a waiver, above). The authorization permits the employee to participate in official matters involving certain outside entities despite the appearance of a conflict of interest as defined in 5 CFR 2635.502.

5. Recusal/Disqualification: This is the standard format used to identify and obtain approval to be disqualified from certain official duties with outside organizations with which you have another ongoing personal relationship, such as an outside activity entity or company in which you have a financial interest (i.e., stock), or with which you may be seeking employment.
Employees other than IC Directors (Word format) IC Directors (Word format)
6.

STOCK Act Job Negotiation and Recusal Form: The STOCK Act requires public filers (employees required to file the OGE-278 Public Financial Disclosure Report), to file a statement notifying their agency ethics official of any negotiation for or agreement of future employment or compensation with a non-federal entity within three business days after commencement of the negotiation or agreement (does not apply to outside activities). Use the Notification of Post-Government Employment or Compensation Negotiation or Agreement and Recusal Statement form, available in:

Financial Disclosure Forms

Follow the links below to obtain details, forms and resources.
1.

Public Financial Disclosure Report (OGE-278) (12/2011) for senior level (SES, ST, SL, O-7 and above, and others in identified positions). NIH policy is to submit the OGE-278 electronically using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/. Information is available on the Public Financial Disclosure Report information page.

2.

Public Financial Disclosure Periodic Transaction Report (OGE-278-T) (01/2013) for public filers to report their reportable transactons, e.g., stock purchase, sale, or exchange. Available in:

3. Confidential Financial Disclosure Reports (OGE-450) (12/2011) for employees in designated positions with relevant responsibilities. NIH policy is to submit the OGE-450 electronically using the NIH Enterprise Ethics System (NEES) at https://nees.nih.gov/. Information is available on the Confidential Financial Disclsoure Reports information page.
4.

Confidential Report of  Financial Interests in Substantially Affected Organizations for Employees of the NIH (HHS-717-1) (8/11) Required of all public and confidential filers, and all clinical investigators. Use this form to submit the report of your financial interests in SAOs, i.e., when you become a filer or clinical investigator and when you acquire a financial interest in an SAO (e.g., purchase, gift). See information about SAOs, including lists of SAOs and non-SAOs. Submission and review procedures for the employee, supervisor, and ethics officials are available on the procedures page.

Referral of Employees for Non-Compliance with Ethics Requirements
1.
2.
3.
4.
Procedure for Completing NIH-2802 (pdf, 2 pages, Rev 1/12)

IC Ethics Officials' Management Reports

HHS Co-Sponsorship Policy Memoranda and Model Agreement

Semiannual Report of Payments Accepted from a Non-Federal Source

SF 326 - Main form
SF 326A - Continuation Sheet  (Acrobat Format*)

*Adobe Acrobat software required to open pdf documents.

Updated: 10/28/14