Code of Federal Regulations Title 10. Energy 10 CFR Pt. 1050, App. II—Foreign Travel Statement

1.

Name of Employee

2.

Date

3.

Division

4.

Position

5.

Name of Recipient

6.

Relationship to Employee

7a.

Description of Transportation Provided:

7b.

Description of Other Travel Provided:

Approximate Value

$_______

Approximate Value

$_______

8.

Date of Acceptance

9.

Total Value of Transportation and Expenses Provided

$_______

10.

Nature of Employee's Official Business Related to Travel:

11.

Circumstances Justifying Acceptance:

12.

Foreign Government Donor

13a.

Name of Individual Responsible for Payment of Travel or Travel Expenses

13b.

Position of Individual Responsible

Signature of Recipient

Date

Item 1.

This statement is to be filed pursuant to the provisions of the Foreign Gifts and Decorations Act (5 U.S.C. 7342, as amended by Pub. L. 95-105, August 17, 1977) and DOE implementing regulations at 10 CFR part 1050. These provisions apply to travel or travel expenses for travel entirely outside of the United States ¹ tendered to or accepted by Federal employees and their spouses and dependents. The name of the employee should always be indicated in item 1; if the employee is the recipient of the travel or travel expenses, then items 5 and 6 should be marked N/A-not applicable; if the recipient is a spouse or dependent, then the appropriate information should be included in items 5 and 6.

Item 2.

Self explanatory.

Items 3 and 4. The Office or Division of the employee should be indicated here regardless of whether the recipient is the employee or a spouse or dependent.

Items 5 and 6. See above, Item 1.

Item 7a.

Indicate the location and mode of transportation and approximate value in U.S. dollars, if possible. Attach itinerary if available.

Item 7b.

Indicate nature and location of travel expenses provided and approximate value in U.S. dollars, if possible. Attach itinerary if available.

Item 8.

Indicate dates of travel.

Item 9.

Self explanatory.

Item 10.

Travel and travel expenses may be accepted in accordance with DOE regulations where the travel is official agency business. Spouses and dependents may accept such travel and expenses only when accompanying the employee. Item 10 therefore should be completed to identify the employee's official business whether the recipient is an employee or a spouse or dependent.

Item 11.

Identify in this item any treaty or diplomatic custom that related to acceptance of the travel or expenses, and any circumstances indicating that acceptance would be consistent with the interests of the U.S. Also provide information regarding any prior approval of the acceptance.

Items 12, 13a, and 13b. Self explanatory.