Instructions for Filing Financial Disclosure Statement
Please note the following changes in effect for the 2008 filing year:
Pursuant to the Chapter 14 of the Laws of 2007 (Public Employees Ethics Reform Act) penalties for violations of Public Officers Law §73-a increased from a maximum of $10,000 to $40,000.
Notices of Delinquency for failure to file the financial disclosure statement for calendar year 2007 will be posted on the Commission's website. Again this year, the Commission will assess penalties for filings received after the statutory deadline. To avoid late fines, your form must be received no later than May 15, 2008. New employees required to file must do so within 30 days of commencing employment.
Public Disclosure
The Public Employees Ethics Reform Act of 2007, made important changes to the law regarding the public availability of financial disclosure statements filed with the Commission on Public Integrity. First, in addition to making them available for public inspection, the Commission on Public Integrity is now required to make all filed financial disclosure statements available for copying by the public. In addition, under Executive Law §94(17)(a)(1), as amended, ALL information set forth in financial disclosure statements filed with the Commission on Public Integrity is available for public inspection and copying with ONLY TWO EXCEPTIONS, as follows:
1. All categories of value or amount; and
2. Any specific information reported on the statement that is pending review by or approved by the Commission on Public Integrity to be exempt from reporting or deleted from public inspection.
Executive Law §94(9)(h), the Commission on Public on Integrity permits any person who is required to file a financial disclosure statement to request the Commission to delete one or more items of information from the copy of his or her financial disclosure statement made available for public inspection and copying. The Commission will permit such deletion only upon a finding by the Commission that the information at issue will have no material bearing on the discharge of the reporting person’s official duties. If you would like to request that certain information be deleted from your financial disclosure statement for purposes of inspection/copying (e.g., home address, names of unemancipated children, account numbers), please submit a request to the Commission. For a form and further instructions on how to do, see "Deletion/Exemption from Filing" below.
Who Must File
You are required by Public Officers Law Section 73-a to file a financial disclosure statement if you serve in a job title with an annual salary rate in excess of the job rate of SG24, or are designated a policymaker by your State agency, or are an official required by statute to file. The salary rate is the rate as of April 1 in the year a statement is due and is posted on the Commission on Public Integrity website, http://www.nyintegrity.org. If you have any questions about your status as a designated filer, you should contact your State agency or appointing authority.
How to File
ELECTRONICALLY. You may use the Commission’s secure program to file your annual statement using the Internet, from any compatible computer. We send each filer a Password and User Identification in separate sealed letters. You may work on your form over several days or from several locations and can print for your records a copy that states your form was submitted electronically. You will also be sent an e-mail receipt. For further information, consult our website at http://www.nyintegrity.org.
PAPER.To insure that the address label on your form is correctly identified as being yours, please fill out the back of the form. Mail to the New York State Commission on Public Integrity, 540 Broadway, Albany NY 12207.
When to File
OFFICIALS AND EMPLOYEES except academic employees of CUNY and SUNY file on or before May 15 each year. Persons who commence employment and serve in a job title with an annual salary rates in excess of SG24, who are designated policymakers or become political party chairs after May 15 must file within thirty (30) days after commencing employment, being designated a policymaker or becoming a party chair. The information required is for the calendar year preceding the filing deadline unless otherwise specifically asked in the question. Application for extension of time to file must be received by May 5. For further information, consult our website at http://www.nyintegrity.org.
ACADEMIC EMPLOYEES of the City University and the State University of New York file on or before November 15 each year unless holding a policy making position. CUNY and SUNY policymakers file by May 15 as in the paragraph above. Academics who commence employment and serve in a job title with an annual salary rate in excess of SG24 after November 15 must file within thirty (30) days of commencing employment. The information required is for the calendar year preceding the November 15 deadline unless otherwise specifically asked in the question. Application for extension of time to file must be received by November 5.
General Information
1. Print carefully or type all responses with blue or black ink. Sign and date the statement at the end.
2. Answer each and every part of every question. Do not leave any items blank. If a question does not pertain to you, indicate by checking the "none" box. If you are unable to answer part of a question because the information is unavailable, then state your lack of knowledge and the reason for the lack of knowledge or unavailability of the information. If information concerning your spouse is required and you are unable to answer because your spouse declined to provide you the information, then you must contact the Commission for information about filing an affidavit.
3. If two or more questions require the same response or information, provide the same responses for both questions. For example, if you are a State employee with an outside law practice, you should report this information in both Questions 5 and 8.
4. If you need additional space for an answer, complete it on extra sheets of paper following the same format as the disclosure statement. Start your response with the question number. Attach the extra sheets to the back of he statement. Extra sheets attached to a statement are subject to public inspection.
5. When reporting a value or amount, use the letter from the table. Categories are A through F as follows:
Category A (under $5,000)
Category B ($5,000 to under $20,000)
Category C ($20,000 to under $60,000)
Category D ($60,000 to under $100,000)
Category E ($100,000 to under $250,000)
Category F ($250,000 or over)
The information provided regarding the categories of value or amount is for use only by the Commission. It is not available for public inspection.
Extension of Time to File
Two types of extensions may be granted:
1. Justifiable cause or undue hardship. You must request an extension of time to file a late statement on the ground of justifiable cause or undue hardship at least ten (10) days before your disclosure statement is due.
2. Internal Revenue Service automatic extension of time. If you ask the Internal Revenue Service for an automatic extension of time to file your individual income tax return, you must file a partial financial disclosure statement on time. Your financial disclosure statement must be completed within seven days after your income tax extension expires.
The partial financial disclosure statement which you file must (1) report all those items not subject to the automatic Internal Revenue Service extension; (2) indicate those items subject to the automatic extension of time, and (3) include a copy of the Internal Revenue Service extension application.
Personal Privacy Law
The Commission on Public Integrity is authorized to request the information sought by the financial disclosure statement pursuant to Public Officers Law §73-a and Executive Law §94. The purpose of the law is to maintain the public’s trust and confidence in government through the prevention of corruption, favoritism, undue influence and abuses of official position.
Public Inspection
Under Executive Law §94(17), information set forth in a financial disclosure statement is available for public inspection except:
All categories of value or amount.
Filer’s residential address appearing on the label affixed to the statement.
Any specific information reported on the statement which is pending review by the Commission on Public Integrity or approved by the Commission to be exempt from reporting or deleted from public inspection. See "Deletion/Exemption from Filing" below.
Violations and Penalties
The Commission reviews each statement for compliance.
If you fail to file a statement or if you file a deficient statement, the Commission will notify you and your appointing authority in writing of the deficiency and the penalties which will be assessed for continued non-compliance. A copy of this notice will be posted on the Commission website.
If, following written notice by the Commission, you knowingly and willfully fail to file a financial disclosure statement, or knowingly and willfully with intent to deceive make a false statement or give information which you know to be false on your financial disclosure statement, you are subject to a civil penalty up to $40,000. A hearing will be scheduled to determine the penalty.
In lieu of a civil penalty, the Commission may refer a violation to the appropriate prosecutor. If convicted, you may be punished with up to one year of imprisonment.
Your appointing authority may also take disciplinary action against you for failure to file or filing a false statement.
Deletion/Exemption from Filing
The Executive Director of the Commission on Public Integrity will review requests from filers seeking to: (1) delete information from the copy made available for public inspection, or (2) request an exemption from reporting one or more items of information. For procedures on filing this request, refer to the enclosed application.
Question by Question Instructions
A reference sheet listing specific items may be found below
Question 1 – Name
Report your complete name including middle name or initial.
Question 2 – State position
Report the State government position you hold and information about it.
2(a) Report both official title and functional title of your State position if they are different.
2(b) Report the department or agency you work for or are appointed to.
2(c) Report your complete State office address including city, state and zip code.
2(d) Report your complete office telephone number and area code.
Question 3 – Family
3(a) Report your marital status as "married," "single", "separated" or "divorced, " and the name of your spouse. Separated means living apart with intent to divorce, or separated by judicial decree, order or a binding separation agreement. Report the name but no other information about a separated spouse.
3(b) "Unemancipated child" means a son, daughter, stepson, or stepdaughter who was under age 18 and who was unmarried and living in your household.
Question 4 – Outside activities
Report outside offices and positions. 4(a) refers to you and 4(b) refers to your spouse and unemancipated child.
Report
- Each paid or unpaid position in a firm, corporation (whether a for-profit or not-for-profit), association, general partnership or other organization, including director, president, vice president, secretary, treasurer, member of a board, executive committee or other committee.
- Elected or appointed positions with government entities other than the State of New York, such as town boards and school boards.
Identify by name any State or local agency when either the organization is licensed or regulated by a State or local agency or the organization had matters before, or did business with, a State or local agency, as a regular and significant part of the organization’s business, unless the matters before the agency were ministerial. If you do not know whether the organization was licensed or regulated by a State or local agency, or if you do not know whether the organization did business with or had matters before a State or local agency, state that you do not know. Do not leave that part of the question unanswered
Do not report
- Mere membership in an organization when you hold no office or position in the organization.
- Uncompensated honorary positions.
- Political party and political organization positions. Report these in Question 7.
- Limited partnerships. They are reported in Question 16. However report general partnerships in this question.
Question 5 – Outside employment
Report other occupations and employment. 5(a) refers to you, 5(b) refers to your spouse or unemancipated child.
5(a) Report and briefly describe all employment, occupations, trades, businesses or professions in which you engaged during the previous calendar year. Report such employment even if it is not regulated by the State.
- Report the names of all State agencies which license or regulate the activity, employment or business.
- If the entity involved did regular and significant business with the State, indicate that and the name of the agency.
- Do not report the State agency, employment, or appointment described in question 2.
5(b) Report employment, occupations, trades, businesses or professions, engaged in by your spouse or unemancipated child only if the activity, employment or business was licensed or regulated by the State, or had matters before any State or local agency as a regular and significant part of the business or activity. Identify the agency.
Question 6 – Contracts
Report contracts exceeding $1,000 which you have with a State or local government agency. Report any ownership, right, claim or legal share in a contract with a State or local agency when the value or amount owned exceeds $1,000 and the contract is owned or controlled by either:
- You.
- Your spouse.
- Your unemancipated child.
- A partnership of which you, your spouse, or your unemancipated child is a member (whether general or limited partner).
- A corporation in which you, your spouse or unemancipated child own or control ten (10%) percent or more of the stock.
Do not report
- A contract on which final payment was made during the reporting year and all obligations were fully performed.
- A contract awarded by a local agency by competitive bidding or a process for competing requests for proposals. However, all State contracts must be reported.
- Bonds or notes. Report these in Question 16.
Question 7 – Political activities
List any positions you held as an officer, director, board member, district leader or committee member of any political party or organization.
Do not report
- Positions in groups with no partisan affiliation.
- Campaign or election committees.
Question 8 – Profession and business
8(a) If you practice law, are licensed as a real estate broker, or practice a profession licensed by the Department of Education,1 identify the license. Give a general description of the principal area of practice but do not list individual clients, customers or patients. If you did not actually engage in such practice, report the license and state that you did not engage in such practice.
8(b) Report any business activities in which you or your spouse had an investment of $1,000 or more. List the business name and address and briefly describe the nature of the business.
Do not report
- Interest in real property. Report interests in Question 17.
- Investments in stocks or other securities. Report them in Question 16.
Question 9 – Gifts
Report gifts to you, your spouse or your child when the gift is valued at more than $1,000. Report the recipient, the name and address of the donor, briefly describe the gift, and report its value or amount by category. In calculating the value of a gift, aggregate the value or amount of all gifts from a single donor to a single recipient during the calendar year.
Do not report
- An inheritance.
- Gifts from relatives.
- Campaign contributions.
Question 10 – Reimbursements
Reimbursement means a payment in excess of $1,000 by non-governmental sources, for travel-related expenses for activities related to your official duties. In excess of $1,000 means one or a combination of reimbursements from a single source which totals more than $1,000. Report reimbursements for speaking engagements, conferences or fact-finding events that are related to official State duties.
Do not report
- Gifts reported in Question 9.
- Campaign expenditures.
- Expenditures reimbursed by your State agency.
Question 11 – Retirement plans, trusts and estates
Interest means a right, claim or legal share in a trust or estate, or any other beneficial interest. The fact that you are not receiving benefits now or that you may not have exercised your rights under the trust or estate does not exempt the reporting of the interest. Identify the asset. Report its value or amount if the value or amount is reasonably ascertainable.
Report
- Ownership or interest in retirement plans, trusts or estates in which your interest is more than $1,000.
- The State deferred compensation plan.
- Out-of-state pensions or deferred compensation plans, including plans established by yourself or a former employer.
- Individual retirement accounts (IRA(s), Keogh retirement plans and annuities.
- 401K, 403(b) and 457 plans.
Do not report
- The State retirement plan.
- TIAA-CREF.
- Interests in a trust or estate for, or in the estate of, a relative.
- Deferred income in the nature of delayed compensation, including deferred or future income from the practice of a profession. Report it in Question 14.
Question 12 – Employment agreements
12(a) Report the parties and terms of any contract, promise or other agreement to employ you after you leave your State position.
12(b) Report the parties and terms of any agreements providing you continuing payments or benefits in excess of $1,000, established by a former employer other than the State.
Question 13 – Non-state income
Report all income to you or your spouse, from any source, in excess of $1,000, other than your State employment. For further information on specific items, see enclosed Reference Sheet.
Question 14 – Income due
Report any income due you in excess of $1,000 from any outside employment during the reporting year, and the source. Report income from real estate or other sales made during the reporting year which will not be paid until the next reporting year.
Do not report retirement income or pension plans. Report them in Question 11.
Question 15 – Assignment of income or transfer of assets
Assignment of income is a gift, to another person, of income or a right to the income. Report assignments of income of more than $1,000. Report transfers of interest in trusts, estates, securities, real property or other benefits, to any person or entity other than a relative, when the amount is:
- More than $1,000 and
- Less than fair consideration of the interest.
Question 16 – Investments
Report securities and investments held by you or your spouse when the investment’s value or amount at the end of the year exceeds $1,000. Include the name of the entity, the issuer or fund name, and type of investment.
Report
- Stocks.
- Savings and other bonds, notes, warrants, certificates of deposit, treasury notes and zero coupon bonds.
- Mutual funds.
- Mortgages.
- Obligations, investment interests in partnerships, and those debt instruments and certificates of interest which are usually referred to as securities.
Report percentage of ownership when you or your spouse hold over 5% of publicly traded stock or 10% of stock that is not publicly traded.
If you held less than the above percentages, you must report the security but are not required to report the percentage.
Do not report
- Assets held under the Uniform Gift to Minors Act.
- Securities you hold that are issued by a professional corporation.
See reporting examples below:
EXAMPLES B QUESTION 16
| Self/ Spouse | Issuing Entity | Type of Security | Percent Owned Or Controlled |
Category Of Value |
| Spouse | AT&T | Common Stock | A | |
| Self & Spouse | XYZ, Inc. | Preferred Stock | 6% | D |
| Spouse | Ginnie Mae | Notes | B | |
| Spouse | 1st National Bank | Certificates of Deposit | B | |
| Self | Fidelity Magellan | Mutual Fund | B | |
| Spouse | City of New York | Bonds | A | |
| Self | ABC Limited | S Corp Stock | 50% | C |
EXAMPLE for SECURITIES HELD IN TRUST
| Self/Spouse | Issuing Entity | Type of Security | Percent Owned Or Controlled | Category Of Value |
| Self |
AT&T | Common stock held in trust by Trustco Bank |
Question 17 – Real estate
In most cases you do not need to report your primary or secondary residence. Real estate that must be reported includes, but is not limited to, vacant land, cooperatives, condominiums, income property and property held in trust.
Report property
- Owned by either you or your spouse.
- Owned jointly by you and your spouse.
- Held in a trust under which you or your spouse is the beneficiary.
- Owned by a partnership or any entity other than a corporation when one of the partners or members is you and/or your spouse.
- Your primary or secondary residence when you have a co-owner who is not a relative.
Do not report
- The income from rental property. Report that in Question 13.
Question 18 – Money due
Report money owed to you when it is more than $1,000, unless it is owed by a relative.
Question 19 – Debts
Report
- Liabilities in excess of $5,000 as of the date of filing this statement for you and your spouse unless the debt is to a relative. Total all debts to one creditor.
- The name of any individual guaranteeing a debt.
- A revolving charge account with a balance in excess of $5,000 at the time of filing.
Do not report
- Mortgage or improvement loans issued by a financial institution for a primary or secondary residence.
- Loans issued by a financial institution for education, purchase of an automobile for personal use, or household furniture or appliances.
- Liabilities to a relative.
- Liabilities incurred in the ordinary course of you or your spouse’s trade, business or professional practice.
- Maintenance paid in connection with a matrimonial action, alimony or child support.
Application to the Commission on Public Integrity For:
Deletion of Specific Information from Public Inspection or
Exemption from Reporting Certain Information Regarding Spouse and/or Child
NAME ________________________________________________________________
NUMBER AND STREET __________________________________________________
CITY_____________________________
STATE_______ ZIP CODE ___________
AGENCY ___________________________________
NUMBER AND STREET ___________________________________________________
CITY_____________________________
STATE_______ ZIP CODE ___________
JOB TITLE ________________________________________________
"X" type of application:
___ Application for deletion of specific information from public inspection (information may pertain to applicant and/or family members)
___ Application for exemption from reporting certain information pertaining to spouse and/or child.
Applicant information cannot be exempted.
The following information/documentation must be attached or your application will not be considered:
1) Your personal written statement of the specific nature of the duties of your job or position.
2) Your most recent performance standards, if applicable and available, containing the job duties and objectives of your position.
3) A written statement of reasons in support of your request, stating specifically why you seek to have such information deleted from public inspection or exempted from reporting, and why you believe that information has no material bearing on the official duties of your job or position (a mere statement that no such material bearing exists will not be accepted).
4) A completed financial disclosure statement with all the information to be deleted or exempted from reporting highlighted.
NOTE: Prepare two document packages to the Commission on Public Integrity.
1) Assemble the original application and all attachments (1 through 4 above) together and mark them to the attention of the Commission on Public Integrity. The financial disclosure statement must be complete.
2) Assemble a copy of the application cover sheet and a copy of the financial disclosure statement. If your application is for exemption from reporting information regarding your spouse or child, all information except the specific information requested to be exempted from reporting must be filed with the Commission on Public Integrity. If your application is for deletion of information from public inspection, the copy of the financial disclosure statement must be complete.
Mail the completed document sets to:
NYS Commission on Public Integrity540 Broadway
Albany, New York 12207
Where to report information on the Annual Statement of Financial Disclosure. Numbers refer to the question on the form. Unless otherwise indicated, do not report holdings unless they are in excess of $1,000. (NR indicates items that are Not Reported.)
401K, 403(b) and 457 plans, filer ....................................11
401K, 402(b) and 457 plans, spouse ....................................16
Accounts receivable ....................................................18
Alimony/maintenance ................................................... NR
Annuities ............................................................11
Assignments of income other than from a relative ....................15
Bank and bond interest ....................................................13
Bonds ....................................................................16
Business income ....................................................13
Buy out agreements ....................................................12(b)
Campaign or political party fund-raising committee ................... NR
Capital gains ............................................................13
Car loans from a financial institution..................................... NR
Certificates of deposit ............................................16
Child support ........................................................... NR
Children, under 18, living at home and not married......................... 3(b)
Clinical practice income ........................................... 5 & 13
College Savings Program ....................................................16
Compensation owed from prior or current employment..........................14
Condominiums, cooperatives ............................................17
Consulting fees ....................................................13
Contracts with government agencies..........................................6
Contractual arrangements, income from.......................................13
Credit card debt in excess of $5,000 ....................................19
Debts owed to you...........................................................18
Debts you owe to others.....................................................19
Deferred compensation, State plan...........................................11
Directorships...............................................................4(a), 13
Dividends...................................................................13
Elected local office ....................................................4
Employment, after leaving State ....................................12(a)
Employment, other than State position ....................................5
Employment, State position ............................................2
Estates ............................................................11
Expense reimbursement from source other than
State of New York ...............10
Fiduciary positions, compensated ................................... 13
Gifts from relatives ................................................... NR
Gifts not from relatives ............................................ 9
Gifts under UGMA ................................................... NR
Grants ................................................................... 13
Home. See Residence
Home purchase, improvement loans from financial institution ................NR
Home purchase, improvement loans from other than a
financial institution ....19
Honorary positions, not compensated ....................................NR
Honoraria ............................................................13
Income, generally ....................................................13
Interest received from banks and bonds ....................................13
Investments other than securities or real property ....................8(b)
Investments, real property ............................................17
Investments, securities ............................................16
IRAs , filer ............................................................11
IRAs, spouse ............................................................16
Keogh Plans ............................................................11
Lecture fees ............................................................13
Liabilities over $5,000 ............................................19
Loans owed to you ....................................................18
Loans you owe ............................................................19
Local public office ................................................... 4
Money Market Accounts ................................................... NR
Mortgage on income property ............................................19
Mortgage on primary and secondary residence ........................... NR
Mortgage you hold ....................................................16
Mutual funds in IRA ....................................................11
Mutual funds not in IRA ............................................16
Notes (investments) ........................................................16
Notes (owed by you) ....................................................19
Outside employment ................................................... 5(a),13
Partnerships, limited ....................................................16
Partnerships, general ....................................................4(a)
Pensions ............................................................11
Political party campaign or fund-raising committee ....................NR
Political party committees and offices ....................................7
Professional practice ....................................................8
Profit sharing ....................................................12(b)
Real estate ............................................................17
Rental income ............................................................13
Rental property.............................................................17
Research foundation income..................................................5 & 13
Research grants.............................................................13
Residence, income producing ................................................17
Residence, primary or secondary ....................................NR
Retirement plans other than State or City of New York ....................11
Savings bonds ..............................................................16
Securities .................................................................16
Severance agreement ........................................................12(b)
Salary, other than State ...................................................5,13
Salary, State ............................................................NR
Spouse: 3(a) Also see instruction for Question 3 in
regard to separated spouses.....3(a)
Spouse’s income ....................................................13
Social Security income .....................................................NR
Stocks ....................................................................16
TIAA-CREF ..................................................................NR
TIAA-CREF, Supp Retirement Plan ............................................11
Teaching income ....................................................13
Travel reimbursement paid by source other
than the State of New York ....10
Treasury notes ............................................................16
Trusts, blind ............................................................11
Trusts, family ............................................................NR
Trust income ............................................................13
Trusteeships................................................................4(a)
Uniform Gift to Minors, UTMA................................................NR
Warrants....................................................................16
Zero coupon bonds ....................................................16
1 Professions are medicine, physician(s assistant and specialist assistant, chiropractic, dentistry, dental hygiene, veterinary medicine, animal health technology, physical therapy and physical therapy assistant, pharmacy, nursing, professional midwifery, podiatry, optometry, ophthalmic dispensing, engineering, land surveying, architecture, landscape architecture, public accountancy, shorthand reporting, psychology, social work, massage therapy, occupational therapy, dietetics and nutrition, speech-language pathology, audiology, acupuncture, interior design, athletic trainer, respiratory therapy and respiratory therapy technician.