Request for Guidance Regarding Travel Expenses Paid By Non-State Entities

Gifts of travel may raise potential issues under the Gifts and Fair Treatment laws, especially if the person or entity paying for the travel has official business before you or your state agency (e.g., vendor, lobbying relationship, regulated business, etc.).

Instructions: Please complete this form if you would like to receive ethics guidance regarding an offer from a non-state entity to pay for your travel-related expenses. Required fields are marked with (Required). Please attach your travel itinerary, program agenda, as well as any relevant information regarding the offering entity and the purpose of your trip.

Guidance issued by Commission staff is based upon the factual information and specific circumstances involved. Therefore, to ensure accurate advice, it is important that you respond to each question and provide detailed information regarding your trip.

Multiple Travelers for the Same Trip? If you have multiple travelers that do not have special circumstances, you can list their names on this form below. One guidance letter can then be issued for all travelers. Otherwise, you may submit a separate form.

I. Contact Information of Person Completing Travel Questionnaire

Please enter your contact information and indicate whether you are submitting this form on behalf of someone else (as a staff member or assistant):

Contact Title

Mr.

Mrs.

Ms.

Other

Contact's Name(Required)

First Last

Contact's Position(Required)

Contact's Department/Agency(Required)

Contact's Division

Contact's Email(Required)

Enter Email Confirm Email

Contact's Work Phone(Required)

Contact's Work Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you submitting this form for someone else?(Required)

YES

NO

II. Traveler Information

Please enter the contact information for the person who will be traveling (“Traveler”):

Contact Title

Mr.

Mrs.

Ms.

Other

Traveler's Name(Required)

First Last

Traveler's Position/Job Title(Required)

Traveler's Department/Agency(Required)

Traveler's Division

Traveler's Email(Required)

Enter Email Confirm Email

Traveler's Phone(Required)

Traveler's Address(Required)

Same as Contact's Address

Street Address Address Line 2 City State ZIP Code

Are you requesting guidance for additional state travelers on this same trip?(Required)

YES

NO

Please enter each traveler's full name, state position/job title, and contact information:

Full Name

Position/Job Title

Email

III. Name of Entity Offering To Pay For Travel

Name of Entity

Entity's Contact Person

Entity's Email

Entity's Phone

IV. Conference, Event & Meeting Information

Name of Event

Event Start Date

Event End Date

Event Organizer/Host

Brief description of event

V. Travel Itinerary & Estimated Costs

Destination (where are you going)

When are you leaving?

When are you returning?

What is the total cost of your trip?

Include all estimated costs, regardless of who will be paying for the travel

Is your "State Agency" paying for any portion of your travel costs?(Required)

YES

NO

Paid by the Offering Entity

Paid by Your State Agency

Total Cost (automatic calculation)

Airfare

Airfare Paid by Offering Entity

Airfare Paid by State Agency

Total Cost: Airfare

Airfare class(Required)

Hotel/Lodging

Hotel/Lodging Paid by Offering Entity

Hotel/Lodging Paid by State Agency

Total Cost: Hotel/Lodging

Meals

Meals Paid by Offering Entity

Meals Paid by State Agency

Total Cost: Meals

Ground Transportation

Transportation Paid by Offering Entity

Transportation Paid by State Agency

Total Cost: Ground Transportation

Registration/Fees

Registration/Fees Paid by Offering Entity

Registration/Fees Paid by State Agency

Total Cost: Registration/Fees

Miscellaneous Paid by Offering Entity

Miscellaneous Paid by State Agency

Total Cost: Miscellaneous

Describe any miscellaneous costs that will be paid by the offering entity or state agency(Required)

Total Cost (automatic calculation)

Total Cost Paid by Offering Entity

Total Cost Paid by State Agency

Total Cost

Any relatives/guests accompanying you on the trip?

YES

NO

If "YES", identify their names and relationship to you, and who will pay for their travel expenses(Required)

Do you plan to extend your trip?

YES

NO

If "YES", where do you plan to go and who will pay for the additional costs?(Required)

VI. Nature of Relationship With Offering Entity

Describe any official business that the entity has with your state agency, including any contract(s) that the entity has either solicited or obtained, or is reasonably likely to solicit or obtain in the near future (whether as part of a competitive process or otherwise)

For legislators and legislative staff only: Does the offering entity lobby before the legislature?

YES

NO

If "YES", describe(Required)

Do you take any action that may affect the entity or the entity’s business interests (e.g., permit, procurement, etc.)?

YES

NO

If "YES", describe(Required)

Are your travel expenses being paid as part of a contract or grant awarded to your state agency?

YES

NO

If "YES", describe(Required)

Have you accepted prior travel payments from this entity?

YES

NO

If "YES", describe(Required)

VII. State/Business Purpose

Describe the purpose of the trip

Specifically describe your official duties and how the purpose of the trip relates to your duties (i.e., what is the state benefit associated with your participation in the travel)

Have you received prior ethics guidance about this trip?

YES

NO

If "YES", please identify the staff member and the date of the discussion (if you recall)

VIII. Attachment(s)

Please attach your trip itinerary, program agenda, and any relevant information regarding the donor or entity offering to pay for your travel-related expenses and the purpose of the trip.

Drop files here or

Accepted file types: doc, docx, xls, xlsx, ppt, pptx, pdf, jpg, gif, png, heic, txt, Max. file size: 2 GB.

Travel Questionnaire Submittal

Instructions: Please click SUBMIT after you have completed your form. To complete and submit your form at a later time, click SAVE AND CONTINUE LATER to get a link to your saved form.

Email Confirmation: Only the designated contact will receive an Email confirmation once the Travel Questionnaire has been submitted.