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FBI Files Matter – Personal Data Statements [2]
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Case Number: 2006-1066-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the Clinton Presidential
Library Staff.
Folder Title:
FBI Files Matter - Personal Data Statements [2]
Staff Office-Individual:
Counsel's Office-Nemetz, Miriam
Original OA/ID Number:
CF 446
Row:
Section:
Shelf:
Position:
Stack:
20
2
9
2
V
THE WHITE HOUSE
WASHINGTON
July 31, 1996
BY HAND DELIVERY
Michael A. Superata, Oversight Counsel
Committee On Ways And Means
U.S. House of Representatives
1102 Longworth Bldg.
Washington, D.C. 20515-6348
Dear Mr. Superata:
Enclosed are copies of White House records we
understand you requested from the FBI; specifically, the contents
of a folder provided by the White House to the FBI on June 6,
1996, labeled "IRS Returned March-April 1993." These documents
bear Bates Numbers WM 000001-000006.
Sincerely yours,
The Sursume
Jane C. Sherburne
Special Counsel to the President
cc: Janice Mays
Minority Chief Counsel (w/encl)
THE WHITE HOUSE
WASHINGTON
MEMORANDUM FOR PROSPECTIVE WHITE HOUSE STAFF
FROM:
EOP SECURITY OFFICE
RE:
DIRECTIONS FOR COMPLETING THE SECURITY PACKET
Before a final decision on your employment can be made, certain
background investigations and conflict-of-interest reviews must
be completed. Accordingly, you are being provided with the
enclosed package of security clearance forms and questionnaires
for your completion. The FBI cannot begin its full-field
investigation until we receive your forms TYPED, completed, and
signed.
A completed package should consist of:
ITEM
NUMBER OF COPIES NEEDED
1.
Questionnaire for
One original and THREE copies,
Sensitive Positions
all with original signatures.
(SF-86) plus any
NOTE: the SF-86 requires two
attachments
signatures
2.
Memorandum of
Two copies signed with original
Consent to the FBI
signatures
3.
Tax Cheek Waiver
Two copies signed with original
signatures. Please review the terms
on the reverse side before signing.
NOTE: If no terms are listed on
reverse side, DO NOT SIGN.
4.
Personal Data
one original copy
Statement
THESE FORMS MUST BE TYPED, COMPLETED, AND SIGNED WITHIN 30
DAYS OF ARRIVING ON DUTY AT THE WHITE HOUSE. PLEASE RETURN THESE
FORMS TO THE EOP SECURITY OFFICER, ROOM 4026, NEOB.
Please pay close attention to the attached instructions. If you
need assistance or wish to discuss any of these matters, please
contact the EOP Security Office at (202) 395-6206.
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
OFFICE OF THE COUNSEL TO THE PRESIDENT
As part of the clearance procedures for your prospective
position, please answer all of the following questions (Please do
not respond "Not Applicable" or "N/A" if your answer is "No" or
"None"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, as it is not
subject to public disclosure, are confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date the attachment.
Because your appointment cannot be finalized until all necessary
reviews have been completed, and because our review begins with
the receipt of your paperwork, please supply this information
within 30 days to Craig Livingstone, Director White House
Security, at OEOB 84, Washington DC, 20500.
If you have any questions or need assistance in responding to
this questionnaire, please contact Cliff Mauton, White House
Counsel's Office at (202) 456-6229. Thank you for your
cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and phone number; date and place of birth;
citizenship; and social security number.
2. Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3. Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4. Please list each high school, college, and graduate school
you attended; the dates of your attendance; and degrees awarded.
5. Please furnish a copy of your resume and a brief
biographical statement.
6. Please chronologically list activities, other than those
listed on your resume, from which you have derived earned income
(e.g., self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7. Please list each book, article, column, or publication you
have authored, individually or with others.
8. Identify each instance in which you have testified before
Congress in a non-governmental capacity, and specify the subject
matter of each testimony.
9. Please list corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity or financial interest (i.e., any ownership interest of
more than 5%), or whose decisions you had the ability to
influence. Please identify the entity, your relationship to the
entity, and the dates of service and/or affiliation.
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past five years have been, affiliated as an
advisor, attorney, or consultant. It is only necessary to
provide the names of major clients and any client matter in which
you and your firm are involved that might present a potential
conflict of interest with your proposed assignment. Please
include dates of service.
11. With regard to each of the entities identified in the
preceding question, please identify your relationship or duty
with regard to each. Please include dates of service.
12. Other than the entities identified in question 10 above,
please provide the names of any organizations with which your
association might present a potential conflict of interest with
your proposed assignment. For each entity you identify in your
response to this question, please provide your relationship or
duty with regard to each. Please include dates of service.
13. Please describe any contractual or informal arrangement you
may have made with any person or business enterprise in regard to
future employment. Include termination payments or financial
benefits that will be provided for you if you enter government
employment.
14. If you are a member of any licensed profession or occupation
(i.e., lawyer, doctor, accountant, insurance or real estate
broker, etc.) please specify the present status of each license;
and, whether any such license has ever been withdrawn, suspended,
or revoked, including the reason therfor.
15. Do you have a significant interest in any relationship with
the government through contracts, consulting services, grants,
loans, or guarantees? If so, please provide details.
16. Does your spouse or any family member or any business in
which you, your spouse or any family members have a significant
interest, have any relationship with the federal government
through contracts, consulting services, grants, loans, or
guarantees? If so, please provide details.
17. If you have performed any work for, and/or received any
payments from, any foreign government, business, or individual in
the past 10 years, please describe the circumstances. Please
identify the source, as well as the dates of services and/or
payments.
18. Please list any registration as an agent for a foreign
principal, or any exemption from such registration. Please
provide the status of any and all such registrations and/or
exemptions (i.e., whether active and whether personally
registered).
19. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If so, please supply details, including the status of each
registration.
Tax and Financial Information
20. As of the date of this questionnaire, please list all assets
with a fair market value in excess of $1,000 for you and your
spouse. Please provide a good faith estimate of value.
21. As of the date of this questionnaire, please list all
liabilities in excess of $10,000 for you or your spouse. Please
list the name and address of the creditor, the amount owed to the
nearest thousand, a brief description of the nature of the
obligation, the interest rate (if any), the date on which due,
and the present status (i.e., is the obligation current or past
due).
22. Please describe all real estate held in your name or in your
spouse's name during the last six years. Please include real
estate held in combination with others, held in trust, held by a
nominee, or held by or through any other third-person or title-
holding entity. Please include dates held.
23. Have you and your spouse filed all federal, state and local
income tax returns?
24. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
25. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
26. Has a tax lien or other collection procedure ever been
instituted against you or your spouse by federal, state or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Domestic Help Issue
27. Do you presently have or have you in the past had domestic
help? (i.e, a housekeeper, babysitter, nanny, or gardener) If
so, please indicate years of service for each individual and give
a brief description of the services rendered.
Public and Organizational Activities
28. Please list current and past political party affiliations.
29. Have you ever run for public office? If so, does your
campaign have any outstanding campaign debt? If so, are you
personally liable? Please provide complete information as to the
amount of debt and creditors.
30. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent or religious organization, private club or other
membership organization (including any tax-exempt organization)
during the past 10 years. Please include dates of membership and
any positions you may have had with the organization.
31. Have you or your spouse at any time belonged to any
membership organization, including, but not limited to, those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation based on race, sex,
ethnic background, religious or sexual preference?
Legal and Administrative Proceedings and Filings
32. Please list any lawsuits you have brought as a plaintiff, or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
33. Please list and describe any administrative agency
proceeding in which you have been involved as a party.
34. Please list any bankruptcy proceeding in which you or your
spouse have been involved as a debtor.
35. Have you or your spouse ever been investigated by any
federal, state, military or local law enforcement agency? If so,
please identify each instance and supply details, including:
date; place; law enforcement agency; and court.
36. Have you or your spouse ever been arrested, or charged with,
and/or convicted of violating any federal, state or local law,
regulation or ordinance (excluding traffic offenses for which the
fine was less than $100) ? If so, please identify each instance
and supply details, including: date; place;law enforcement
agency; and court.
37. Have you or your spouse ever been accused of or found guilty
of any violations of government or agency procedure (specifically
including securities violations and/or any application, or appeal
process) ?
38. Please list any complaint ever made against you by any
administrative agency, professional association or organization,
or federal, state or local ethics agency, committee, or official.
39. Please list any and all judgements rendered against you,
including the date, amount, the name and subject matter of the
case, and the date of satisfaction. Please include obligations
of child support and alimony, and provide the status of each
judgement and/or obligation.
40. With regard to each obligation of child support and/or
alimony, please state the following: Have any payments been made
late or have there been any lapses in payment? Have any motions
or court actions for modification of child support or alimony
been filed or instituted? Have any actions or motions to compel
payment or initiate collection of late payments and/or past due
amounts been filed or threatened? Have any writs of garnishment
been issued? If your response was "yes" to any of the above
questions, please provide details.
Miscellaneous
41. Have you ever had any association with any person, group or
business venture that could be used, even unfairly, to impugn or
attack your character and qualifications for a government
position?
42. Do you know anyone or any organization that might take
steps, overtly or covertly, fairly or unfairly, to criticize your
appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
43. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest, or be a possible source of embarrassment to you,
your family or the President.
PAGE
2
3RD DOCUMENT of Level 1 printed in FULL format.
UNITED STATES CODE SERVICE
Copyright (c) 1996, Lawyers Cooperative Publishing
*** CURRENT THROUGH 104-141, 5/6/96, ***
*** EXCEPT FOR PLs 127, 132, 134, 140 ***
TITLE 3. THE PRESIDENT
CHAPTER 2. OFFICE AND COMPENSATION OF PRESIDENT
3 USCS @ 105 (1996)
@ 105. Assistance and services for the President
(a) (1) Subject to the provisons [provisions] of paragraph (2) of this
subsection, the President is authorized to appoint and fix the pay of employees
in the White House Office without regard to any other provision of law
regulating the employment or compensation of persons in the Government service.
Employees so appointed shall perform such official duties as the President may
prescribe.
(2) The President may, under paragraph (1) of this subsection, appoint and
fix the pay of not more than--
(A) 25 employees at rates not to exceed the rate of basic pay then currently
paid for level II of the Executive Schedule of section 5313 of title 5; and in
addition
(B) 25 employees at rates not to exceed the rate of basic pay then currently
paid for level III of the Executive Schedule of section 5314 of title 5; and in
addition
(C) (C) 50 employees at rates not to exceed the maximum rate of basic pay
then currently paid for GS-18 of the General Schedule of section 5332 of Title
5; and in addition
(D) (D) such number of other employees as he may determine to be appropriate
at rates not to exceed the minimum rate of basic pay then currently paid for
GS-16 of the General Schedule of section 5332 of title 5.
(b) (1) Subject to the provisions of paragraph (2) of this subsection, the
President is authorized to appoint and fix the pay of employees in the
Executive Residence at the White House without regard to any other provision of
law regulating the employment or compensation of persons in the Government
service. Employees so appointed shall perform such official duties as the
President may prescribe.
(2) The President may, under paragraph (1) of this subsection, appoint and
fix the pay of not more than--
(A) 3 employees at rates not to exceed the maximum rate of basic pay then
currently paid for GS-18 of the General Schedule of Section 5332 of Title 5; and
in addition
(B) such number of other employees as he may determine to be appropriate at
rates not to exceed the minimum rate of basic pay then currently paid for
PAGE
3
3 USCS @ 105 (1996)
GS-16 of the General Schedule of section 5332 of title 5.
(c) The President is authorized to procure for the White House Office and the
Executive Residence at the White House, as provided in appropriation Acts,
temporary or intermittent services of experts and consultants, as described in
and in accordance with the first two sentences of section 3109 (b) of title 5--
(1) in the case of the White House Office, at respective daily rates of pay
for individuals which are not more than the daily equivalent of the rate of
basic pay then currently paid for level II of the Executive Schedule of section
5313 of title 5; and
(2) in the case of the Executive Residence, at respective daily rates of pay
for individuals which are not more than the daily equivalent of the maximum rate
of basic pay then currently paid for GS-18 of the General Schedule of section
5332 of title 5.
Notwithstanding such section 3109 (b), temporary services of any expert or
consultant described in such section 3109 (b) may be procured for a period in
excess of one year if the President determines such procurement is necessary.
(d) There are authorized to be appropriated each fiscal year to the President
such sums as may be necessary for--
(1) the care, maintenance, repair, alteration, refurnishing, improvement,
air-conditioning, heating, and lighting (including electric power and fixtures)
of the Executive Residence at the White House;
(2) the official expenses of the White House Office;
(3) the official entertainment expenses of the President;
(4) the official entertainment expenses for allocation within the Executive
Office of the President; and
(5) the subsistence expenses of persons in the Government service while
traveling on official business in connection with the travel of the President.
Sums appropriated under this subsection for expenses described in paragraphs
(1), (3), and (5) may be expended as the President may determine,
notwithstanding the provisions of any other law. Such sums shall be accounted
for solely on the certificate of the President, except that, with respect to
such expenses, the Comptroller General may inspect all necessary books,
documents, papers, and records relating to any such expenditures solely for the
purpose of verifying that all such expenditures related to expenses in paragraph
(1), (3), or (5). The Comptroller General shall certify to Congress the fact of
such verification, and shall report any such expenses not expended for such
purpose.
(e) Assistance and services authorized pursuant to this section to the
President are authorized to be provided to the spouse of the President in
connection with assistance provided by such spouse to the President in the
discharge of the President's duties and responsibilities. If the President does
not have a spouse, such assistance and services may be provided for such
purposes to a member of the President's family whom the President designates.
PAGE
4
3 USCS @ 105 (1996)
HISTORY: (June 25, 1948, ch 644, @ 1, 62 Stat. 678; Oct. 15, 1949, ch 695, @
2(a), 63 Stat. 880; July 31, 1956, ch 804, Title I, @ 109, 70 Stat. 740; Oct. 4,
1961, P.L. 87-367, Title III, @ 303(h), 75 Stat. 794; Aug. 14, 1964, P.L.
88-426, Title III, @@ 304 (b), 305(i), 78 Stat. 422; Dec. 23, 1967, P.L. 90-222,
Title I, @ (c), 81 Stat. 726; Nov. 2, 1978, P.L. 95-570, @ (a), 92 Stat.
2445.)
HISTORY; ANCILLARY LAWS AND DIRECTIVES
EXPLANATORY NOTES:
The bracketed word "provisions" was inserted in subsec. (a) (1) as the word
probably intended by Congress.
AMENDMENTS:
1949. Act Oct. 15, 1949, increased compensation of secretaries, and
executive, administrative, and staff assistants. Section 9 of such Act provided
that the amendment of this section shall become effective on the first day of
the first pay period after Oct. 15, 1949.
1956. Act July 31, 1956, substituted "eight" for "five", "$ 22,500" for "$
20,000", "$ 21,000" for "$ 18,000", and "$ 20,000" for "$ 15,000", and ", and
three at rates not exceeding $ 17,500 per annum." for "and".
1961. Act Oct. 4, 1961, substituted "$ 18,500" for "$ 17,500". Section 305
of such Act provided that the amendment of this section shall become effective
at the beginning of the first pay period which starts on or after the sixtieth
day following Oct. 4, 1961.
1964. Act Aug. 14, 1964 substituted this section for one which read: "The
President is authorized to fix the compensation of the six administrative
assistants authorized to be appointed under section 106 of this title, of the
Executive Secretary of the National Security Council, and of eight other
secretaries or other immediate staff assistants in the White House Office, as
follows: Two at rates not exceeding $ 22,500 per annum, three at rates not
exceeding $ 21,000 per annum, seven at rates not exceeding $ 20,000 per annum,
and three at rates not exceeding $ 18,500 per annum." Section 501 of such Act
provided that the amendment of this section shall become effective on the first
day of the first pay period which begins on or after July 1, 1964, except to the
extent provided in @ 501 (c) of such Act.
1967. Act Dec. 23, 1967 (effective 12/23/67, as provided by @ 401 of such
Act), inserted "of the Executive Secretary of the Economic Opportunity
Council,".
1978. Act Nov. 2, 1978 substituted this section and catchline for ones which
read:
"@ 105. Compensation of secretaries and executive, administrative, and staff
assistants to President
"The President is authorized to fix the compensation of the six
administrative assistants authorized to be appointed under section 106 of this
title, of the Executive Secretary of the National Security Council, of the
Executive Secretary of the National Aeronautics and Space Council, of the
Executive Secretary of the Economic Opportunity Council, and of eight other
secretaries or immediate staff assistants in the White House Office at rates of
basic compensation not to exceed that of level II of the Federal Executive
Salary Schedule.".
OTHER PROVISIONS:
Application of amendments made by Act Nov. 2, 1978. Act Nov. 2, 1978, P.L.
95-570, @ 6(a), 92 Stat. 2451, provided: "The amendments made by this Act
PAGE
5
3 USCS @ 105 (1996)
[which, among other things, amended this section; for full classification,
consult USCS Tables volumes] shall apply to any fiscal year which begins on or
after Oct. 1, 1978.
NOTES:
CROSS REFERENCES
Former Presidents, office staff, 3 USCS @ 102.
This section is referred to in,5 USCS @@ 8343a, 8420a; 18 USCS @@ 207, 1751;
26 USCS @ 3121; 31 USCS @ 3524; 42 USCS @ 410.
RESEARCH GUIDE
AM JUR:
77 Am Jur 2d, United States @ 42.
INTERPRETIVE NOTES AND DECISIONS
President's Task Force on National Health Care Reform was not advisory group
subject to FACA since First Lady, who was appointed to chair Task Force, was
federal employee; Congress has recognized in 3 USCS @ 105 that President's
spouse is functional equivalent of assistant to President, and President's
implicit authority to enlist his spouse in aid of discharge of his federal
duties undermines claim that treating President's spouse as officer or employee
would violate anti-nepotism provisions of 5 USCS @ 3110. Association of Am.
Physicians & Surgeons, Inc. V Clinton (1993, App DC) 997 F2d 898, 21 Media L R
1705, motion gr (DC Dist Col) 1993 US Dist LEXIS 15969.
PAGE
2
43 F.3d 1488 printed in FULL format.
SEAN T. HADDON, APPELLANT V. GARY J. WALTERS, CHIEF USHER,
APPELLEE
No. 93-5303
UNITED STATES COURT OF APPEALS FOR THE DISTRICT OF COLUMBIA
CIRCUIT
43 F.3d 1488; 1995 U.S. App. LEXIS 291; 310 U.S. App. D.C.
63
December 5, 1994, Argued
January 10, 1995, Decided
PRIOR HISTORY: [**1] Appeal from the United States District Court for the
District of Columbia (93cv01254).
COUNSEL: Rodney R. Sweetland argued the cause and filed the briefs for
appellant.
Mark B. Stern, Attorney, U.S. Department of Justice, with whom Frank W. Hunger,
Assistant Attorney General, and Eric H. Holder, Jr., United States Attorney,
were on the brief, for appellee. Margaret S. Hewing entered an appearance for
appellee.
JUDGES: Before BUCKLEY, GINSBURG, and SENTELLE, Circuit Judges.
OPINION: [*1489] PER CURIAM: Sean Haddon, a former White House chef, filed
an employment discrimination suit against Gary Walters, the White House Chief
Usher. The district court dismissed the complaint for want of subject-matter
jurisdiction. We find that the court erred in so finding; but because we hold
that Mr. Haddon has failed to state a claim on which relief could be granted, we
affirm the judgment.
I. BACKGROUND
A. Factual and Procedural History
Mr. Haddon is a white male who served as an assistant chef at the White House
("White House" or "Executive Residence") from July 1988 to March 25, 1994. He
claims that he was passed over for promotion at least in part because of his
engagement to a black woman. He also alleges [**2] that he confronted Mr.
Walters in an attempt to resolve his grievance but that his employment
discrimination complaint was rejected on the ground that the White House staff
were not subject to Title VII of the Civil Rights Act of 1964.
In June 1993, Mr. Haddon filed suit in the U.S. District Court for the
District of Columbia alleging that the Executive Residence had violated Title
VII, as amended. After briefing and argument, the district court granted Mr.
Walters' motion to dismiss for lack of subject-matter jurisdiction. Haddon V.
Walters, 836 F. Supp. 1, 3 (D.D.C. 1993). Mr. Haddon filed a timely notice of
appeal. While his appeal was pending, Mr. Haddon moved the district court for
relief from its final order on the ground that further research had revealed
additional evidence of prior White House compliance with Title VII. The
PAGE
3
43 F.3d 1488, *; 1995 U.S. App. LEXIS 291, **;
LEXSEE
310 U.S. App. D.C. 63
district court denied the motion.
B. Statutory Framework
In 1972, Congress amended Title VII to extend its prohibition of
discrimination based on race, color, religion, sex, or national origin to
personnel actions affecting most federal employees. 42 U.S.C. @ 2000e-16 (1988 &
Supp. [**3] III 1991) ("section 2000e-16"). In pertinent part, section
2000e-16 applies to "employees ... in executive agencies as defined in section
105 of Title 5." 42 U.S.C. @ 2000e-16(a) Section 105 of Title 5 in turn defines
an executive agency as "an Executive department, a Government corporation, [or]
an independent establishment." 5 U.S.C. @ 105 (1988). In 1991, Congress further
amended Title VII to cover certain Presidential appointees not already covered
by section 2000e-16. 2 U.S.C. @ 1219 (Supp. III 1991) ("1991 Amendments" or
"section 1219").
Sections 2000e-16 and 1219 prescribe different paths for obtaining judicial
review. Section 2000e-16 authorizes a party who has exhausted his administrative
remedies and who is aggrieved "by the final disposition of his complaint, or by
the failure to take final action on his complaint," to file a civil action in
the district court. 42 U.S.C. @@ 2000e-5 (f) (3) & 2000e-16 (c) (1988 & Supp. III
1991). Section 1219, however, provides that a Presidential appointee may file a
complaint with the Equal [**4] Employment Opportunity Commission, "or such
other entity as is designated by the President by Executive Order," and that any
party aggrieved by a final order disposing of such a complaint may petition for
review by the United States Court of Appeals for the Federal Circuit. 2 U.S.C. @
1219 (a) (2) & (3) (A). Thus, whether or not section 1219 applies to Mr. Haddon, it
cannot be the basis for jurisdiction in the district court. The question before
us, then, is whether he is covered by section 2000e-16.
II. DISCUSSION
Mr. Haddon argues that the district court erred when it concluded that he was
not covered by section 2000e-16. That section provides, in pertinent part:
All personnel actions affecting employees or applicants for employment ...
in
executive agencies as defined in section 105 of Title 5 (including employees and
applicants for employment who are paid from nonappropriated funds) ... shall
be
made free from any discrimination based on race, color, religion, sex, or
national origin.
42 U.S.C. @ 2000e-16 (a) (emphasis added). This case turns on whether the
Executive Residence is an "executive [**5] agency" within the meaning of
section 2000e-16. As defined by reference to 5 U.S.C. @ 105, executive agency
"means an Executive department, a [*1490] Government corporation, and an
independent establishment." The Executive Residence is not included in Title 5's
exclusive list of Executive departments. 5 U.S.C. @ 101 (1988). Nor does it fit
within Title 5's definition of a Government corporation. 5 U.S.C. @ 103 (1988).
By process of elimination, section 2000e-16 applies to Mr. Haddon if and only if
the Executive Residence is an "independent establishment."
Title 5 defines "independent establishment" to mean
(1) an establishment in the executive branch (other than the United States
PAGE
4
43 F.3d 1488, *; 1995 U.S. App. LEXIS 291, **;
LEXSEE
310 U.S. App. D.C. 63
Postal Service or the Postal Rate Commission) which is not an Executive
department, military department, Government corporation, or part thereof, or
part of an independent establishment; and
(2) the General Accounting Office.
5 U.S.C. @ 104 (1988). Although this definition of independent establishment
does not clearly foreclose Mr. Haddon's argument, he fails to [**6] explain
how the Executive Residence fits within the compass of that term. We conclude
that it does not for two reasons.
First, we note that elsewhere Congress has used the term "independent
establishment" in distinction to the Executive Residence. Specifically, Congress
has authorized "the head of any department, agency, or independent establishment
of the executive branch of the Government [to] detail, from time to time,
employees of such department, agency, or establishment to the White House
Office, the Executive Residence at the White House, the Office of the Vice
President, the Domestic Policy Staff, and the Office of Administration." 3
U.S.C. @ 112 (1988) (emphasis added). That Congress distinguished the Executive
Residence from the independent establishments, whatever they may be, suggests
that Congress does not regard the Executive Residence to be an independent
establishment, as it uses that term.
Second, while Title 5 relates to government organization and employees and
prescribes pay and working conditions for agency employees, see, e.g., 5 U.S.C.
@ 7103 (a) (1988 & Supp. III 1991), Title [**7] 3 addresses similar concerns
with respect to the President's advisors and the staff of the Executive
Residence. See, e.g., 3 U.S.C. @ 105 (b) (1) (1988) (authorizing the President "to
appoint and fix the pay of employees in the Executive Residence at the White
House without regard to any other provision of law regulating the employment or
compensation of persons in the Government service"). Accordingly, as Mr. Walters
argues, section 2000e-16's incorporation of Title 5's definition of executive
agency further suggests that it does not apply to the staff of the Executive
Residence.
Mr. Haddon contends, finally, that the administrations of prior Presidents
read section 2000e-16 more broadly than we do and that their interpretations of
the statute deserve great deference. In support of this contention, he cites a
conclusory Executive Order issued by President Carter and a "Stipulation of
Compromise" that was entered into by the Nixon Justice Department in a case
involving a discrimination claim. Neither explains why it should be concluded
that the "White House Office" is subject to section 2000e-16; nor are these
documents analogous to an administrative [**8] agency's construction of a
statute it has been entrusted to administer, with respect to which we generally
require a reasoned explanation for a departure from past practice. Therefore, we
hold that the Executive Residence is not an executive agency within the meaning
of section 2000e-16.
While Mr. Haddon's section 2000e-16 claim fails to present a cause of action
on which relief could be granted, we cannot accept the district court's
conclusion that it lacked subject-matter jurisdiction over it even though we are
aware that at least one circuit has reached the same conclusion under similar
circumstances. See Dumas V. Town of Mt. Vernon, 612 F.2d 974, 980 (5th Cir.
PAGE
5
43 F.3d 1488, *; 1995 U.S. App. LEXIS 291, **;
LEXSEE
310 U.S. App. D.C. 63
1980). Mr. Haddon's claim arises under the laws of the United States. That
suffices to establish the district court's jurisdiction "unless the alleged
claim clearly appears to be immaterial and made solely for the purpose of
obtaining jurisdiction, or [is] wholly insubstantial and frivolous." Kleiman V.
Department of Energy, 294 U.S. App. D.C. 49, 956 F.2d 335, 339 (D.C. Cir. 1992)
(internal quotation marks, ellipsis and citation omitted). As the [**9]
Supreme [*1491] Court stated in Bell V. Hood, 327 U.S. 678, 682, 90 L. Ed.
939, 66 S. Ct. 773 (1946)
Jurisdiction
...
is not defeated
...
by the possibility that the averments might
fail to state a cause of action on which petitioners could actually recover
Whether the complaint states a cause of action on which relief could be granted
is a question of law and just as issues of fact it must be decided after and not
before the court has assumed jurisdiction over the controversy. If the court
does later exercise its jurisdiction to determine that the allegations in the
complaint do not state a ground for relief, then dismissal of the case would be
on the merits, not for want of jurisdiction.
See also Associated Dry Goods Corp. V. EEOC, 419 F. Supp. 814, 818 (E.D. Va.
1976) ("Defendant's assertion that the sections of federal law cited by
plaintiff are not applicable to the instant case does not defeat jurisdiction,
but rather contests whether the plaintiff has stated a cause of action. ").
Although Mr. Haddon brought this action under section VII of the Civil Rights
Act "as amended,' and [**10] although he may have alleged facts that would
support a claim for relief under the 1991 Amendments, we do not remand the case
in order to allow him to pursue this alternative theory. Were we to do so, the
district court would quite properly dismiss the claim for want of jurisdiction.
See 2 U.S.C. @ 1219 (a) (2) & (3) (A).
III. CONCLUSION
Because we hold that Mr. Haddon has failed to present a claim on which the
district court could grant relief and because "we may affirm on different
grounds the judgment of a lower court if it is correct as a matter of law,"
Kleiman, 956 F.2d at 339 (internal quotation marks and citation omitted), we
affirm the judgment of the district court. We do so, however, without prejudice
to any right Mr. Haddon may have to pursue a section 1219 claim in the
appropriate forum.
So ordered.
ID:2022262144
JUL 02'96
18:08 No 009 P.02
WILLIAM #. CLINGER. JR., PENNSYLVANIA
CARDISS COLLINS. ILLINOIS
CHAIRMAN
RANKING MINDRITY MEMBER
BENJAMIN A OR MAN NEW YORK
HENRY A. WAXMAN CALIFORNIA
DAN BURTON INDIANA
ONE HUNDRED FOURTH CONGRESS
TOM LANTOS CA FORMA
J. DENNIS MASTERT. ILLINOIS
ROBERT e wer. A. WEST VIRGINIA
CONSTANCE A. MORELLA. MARYLAND
MAJOR R. OWENS. NEW YORK
CHRISTOPHE SHAYS. CONNECTICUT
Congress of the United States
EDOLPHUS TOWNS NEW YORK
STEVEN SCHIPF NEW MEXICO
JOHN M. SPRATT, JR., SOUTH CAROLINA
ILEANA ROS-LEHTINEN. PLORIDA
LOUISE McINTOSH SLAUGHTER NEW YOR
WILLIAM H. ZELIFF. JR., NEW HAMPSHIRE
PAUL 6 KANJORSKI. PENNSYLVANIA
JOHN M MCHUGH, NEW YORK
STEPHEN HORN, CALIFORNIA
house of Representatives
QARY A CONDIT, CALIFORNIA
COLLIN c. PETERSON. MINNESOTA
JOHN L MICA. FLORIDA
KAREN L THURMAN. FLORIDA
PETER BLUTE MASSACHUSETTS
CAROLYN B MALONEY, NEW YORK
THOMAS M. DAVIS. VIRGINIA
COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT
THOMAS M BARRETT WISCONSIN
BARRARA-ROSE COLLING. MICHIGAN
DAVID M. McINTOSH. INDIANA
JON D FOX. PENNSYL
2157 RAYSURN House OFFICE BUILDING
ELEANOR HOLVES NORTON. DC
RANDY TATE. WASHINGTON
JAMES P. MORAN, VIRGINIA
DICK CHRYSLER. MICHIGAN
GENE GREEN, TEXAS
WASHINGTON, DC 20515-6143
CARRIE P MEEK. FLORIDA
Ga. OUTKNECHT. MINNESOTA
CHAKA FATTAM PENNSYLVANIA
MARK E. BOUDER INDIANA
BILL K. BREWSTER. OKLAHOMA
WILLIAM. , MARTINI NEW JERMEY
TM MOLDEN. PENNSYLVANIA
JOE SCARBOROUGH, FLORIDA
JOHN SHADEGO. ARIZONA
MICHAEL PATRICK FLANAGAN, ILLINOIS
CHARLES P. BASE NEW HAMPSHIRE
STEVE c. LATOURETTE OHIO
BERNARD SANDERS. VERMONT
MARSHALL "MARK" SANF ORD. SOUTH CAROLINA
July 2, 1996
INDEPENDENT
ROBERT L. EMALICH, JR., MARYLAND
MAJORITY-(20P) 225-8074
WINDINITY-(20P) 223-6051
Jack Quinn, Esquire
Counsel to the President
The White House
Washington, DC
Dear Mr. Quinn:
During the course of the Committee's investigation into the White House Travel Office
matter, we have learned that the Office of White House Counsel developed and administered a
"Personal Data Statement Questionnaire" to White House employees (see attached).
The opening statement on this questionnaire reads: "As part of the clearance procedures
for your prospective position, please answer all of the following questions." The forty-three
questions which follow pertain to personal data involving one's family, educational, and
professional background. There is an additional section which includes questions relating to
one's political party affiliation. The Government Reform and Oversight Subcommittee on Civil
Service holds jurisdiction over all matters pertaining to federal employment. Thus, we request
further clarification concerning who administered, received, and answered these questionnaires.
Please supply the Committee with the following:
1)
How many different versions of the Personal Data Statement Questionnaire have
been used between January 20, 1993 and this date. Please enclose copies of each
such version and indicate the specific period of time during which it was used.
2)
To which employees or applicants were these questionnaires distributed? Which
employees or applicants were directed to supply the information requested in the
questionnaire? Please specify employees by position, by their employing office in
the White House, and indicate whether each employee was appointed (or to be
appointed) under title 3 or title 5 of the United States Code.
3)
What offices at the White House used this questionnaire for employment
screening purposes? Which components within the Executive Office of the
President used the questionnaire for employment screening purposes.
4)
Which offices and/or employees reviewed the completed questionnaires?
ID:2022262144
JUL 02'96
18:08 No 009 P.03
Thank you for your prompt attention to this matter. Please provide this information to the
Committee by 3:00 P.M. on Friday, July 5, 1996.
Sincerely,
william William F. Clinger F. Q
Chairman
Chairman
Committee on Government Reform & Oversight
Subcommittee on Civil Service
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
BERNIE NUSSBAUM
COUNSEL TO THE PRESIDENT
As part of the clearance procedures for your prospective
position, please answer all of the following questions (please do
not respond "not applicable" or "N/A" if your response is "no" or
"none.") In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, which is not
subject to public disclosure, will remain confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date the response.
Because your appointment cannot be finalized until all necessary
reviews have been completed, please supply this information
within 72 hours to Angelina Walker in my office. (Room 128,
OEOB).
If you have any questions or need assistance in responding to
this questionnaire, please do not hesitate to contact this office
at 202-456-7900. Thank you for your cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and telephone number; date and place of
birth; citizenship; and social security number.
2. Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3. Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4.
Please list each high school, college, and graduate school
you attended; the dates of your attendance; and degrees awarded.
5.
Please furnish a copy of your resume.
6.
Please list chronologically activities, other than those
listed on your resume, from which you have derived earned income
(e.g., self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7. Please list each book, article, or other publication you
have authored, individually or with others.
8.
Identify each instance in which you have testified before
Congress in a non-governmental capacity and specify the subject
matter of each testimony.
9.
Please list all corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity or financial interest (i.e., any ownership interest of
more than 5%), or whose decisions you had the ability to
influence.
2
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past five years have been, affiliated as an
advisor, attorney or consultant. It is only necessary to provide
the names of major clients and any client matter in which you and
your firm are involved that might present a potential conflict of
interest with your proposed assignment. Please identify the
clients by name unless it would breach a confidential
relationship or duty respecting a privileged matter. In
addition, please provide the names of any other organizations
with which you were associated which might present a potential
conflict or the appearance of conflict of interest with your
prospective appointment.
11. Please describe any contractual or informal arrangement you
may have made with any person or any business enterprise in
regard to future employment or termination payments or financial
benefits that will be provided you if you enter government
employment.
12. If you are a member of any licensed profession or occupation
(such as lawyer, doctor, accountant, insurance or real estate
broker, etc.), please specify: the present status of each
license; and whether any such license has ever been withdrawn,
suspended, or revoked, and the reason therefor.
13. Does your spouse or any family member or business in which
you, your spouse or any family members have a significant
interest have any relationship with the federal government
through contracts, consulting services, grants, loans or
guarantees? If yes, please provide details.
3
14. If you have performed any work for and/or received any
payments from any foreign government, business, or individual in
the past 10 years, please describe the circumstances, and
identify the source and amount.
15. Please list any registration as an agent for a foreign
principal, or any exemption from such registration.
16. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If yes, please supply details.
Tax and Financial Information
17. Please list all assets with a fair market value in excess of
$5,000 for you and for your spouse.
18. Please describe all real estate held in your name or in your
spouse's name during the last six years, including any real
estate held in combination with others or on your or your
spouse's behalf in trust, by a nominee, or through any other
title-holding entity.
19. Have you and your spouse filed all federal, state and local
income tax returns?
20. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
4
21. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
22. Has a tax lien or other collection procedure ever been
instituted against your or your spouse by federal, state or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Public and Organizational Activities
23. Please list current and past political party affiliations.
24. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent or religious organization, private club, or other
membership organization (including any tax-exempt organization)
during the past 10 years.
25. Have you or your spouse at any time belonged to any
membership organization, including but not limited to those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation (as a matter of
either policy or practice) based on race, sex, ethnic background,
religious or sexual preference?
5
Legal and Administrative Proceedings and Filings
26. Please list any lawsuits you have brought as a plaintiff or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
27. Please list and describe any administrative agency
proceeding in which you have been involved as a party.
28. Please list any bankruptcy proceeding in which you or your
spouse have been involved as a debtor.
29. Have you or your spouse ever been investigated by any
federal, state, military or local law enforcement agency, or
arrested for, charged with, or convicted of violating any
federal, state or local law, regulation or ordinance (excluding
traffic offenses for which the fine was less than $100)? If so,
please identify each such instance and supply details, including:
date; place; law enforcement agency; and court.
30. Please list any complaint ever made against you or by any
administrative agency, professional association or organization,
or federal, state or local ethics agency, committee, or official.
Miscellaneous
31. Have you ever had any association with any person, group or
business venture that could be used, even unfairly, to impugn or
attack your character and qualifications for a government
position?
6
32. Do you know anyone or any organization that might take any
steps, overtly or covertly, fairly or unfairly, to criticize your
appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
33. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest or be a possible source of embarrassment to you, your
family or the President.
7
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
OFFICE OF THE COUNSEL TO THE PRESIDENT
As part of the clearance procedures for your prospective
position, please answer all of the following questions (Please do
not respond "Not Applicable" or "N/A" if your answer is "No" or
"None"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, as it is not
subject to public disclosure, are confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date the attachment.
Because your appointment cannot be finalized until all necessary
reviews have been completed, and because our review begins with
the receipt of your paperwork, please supply this information
within 30 days to Craig Livingstone, Director White House
Security, at OEOB 84, Washington DC, 20500.
If you have any questions or need assistance in responding to
this questionnaire, please contact Cliff Mauton, White House
Counsel's Office at (202)456-6229. Thank you for your
cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and phone number; date and place of birth;
citizenship; and social security number.
2. Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3. Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4. Please list each high school, college, and graduate school
you attended; the dates of your attendance; and degrees awarded.
5.
Please furnish a copy of your resume and a brief
biographical statement.
6.
Please chronologically list activities, other than those
listed on your resume, from which you have derived earned income
(e.g., self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7.
Please list each book, article, column, or publication you
have authored, individually or with others.
8.
Identify each instance in which you have testified before
Congress in a non-governmental capacity, and specify the subject
matter of each testimony.
9. Please list corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity or financial interest (i.e., any ownership interest of
more than 5%), or whose decisions you had the ability to
influence. Please identify the entity, your relationship to the
entity, and the dates of service and/or affiliation.
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past five years have been, affiliated as an
advisor, attorney, or consultant. It is only necessary to
provide the names of major clients and any client matter in which
you and your firm are involved that might present a potential
conflict of interest with your proposed assignment. Please
include dates of service.
11. With regard to each of the entities identified in the
preceding question, please identify your relationship or duty
with regard to each. Please include dates of service.
12. Other than the entities identified in question 10 above,
please provide the names of any organizations with which your
association might present a potential conflict of interest with
your proposed assignment. For each entity you identify in your
response to this question, please provide your relationship or
duty with regard to each. Please include dates of service.
13. Please describe any contractual or informal arrangement you
may have made with any person or business enterprise in regard to
future employment. Include termination payments or financial
benefits that will be provided for you if you enter government
employment.
14. If you are a member of any licensed profession or occupation
(i.e., lawyer, doctor, accountant, insurance or real estate
broker, etc.) please specify the present status of each license;
and, whether any such license has ever been withdrawn, suspended,
or revoked, including the reason therfor.
15. Do you have a significant interest in any relationship with
the government through contracts, consulting services, grants,
loans, or guarantees? If so, please provide details.
16. Does your spouse or any family member or any business in
which you, your spouse or any family members have a significant
interest, have any relationship with the federal government
through contracts, consulting services, grants, loans, or
guarantees? If so, please provide details.
17. If you have performed any work for, and/or received any
payments from, any foreign government, business, or individual in
the past 10 years, please describe the circumstances. Please
identify the source, as well as the dates of services and/or
payments.
18. Please list any registration as an agent for a foreign
principal, or any exemption from such registration. Please
provide the status of any and all such registrations and/or
exemptions (i.e., whether active and whether personally
registered).
19. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If so, please supply details, including the status of each
registration.
Tax and Financial Information
20. As of the date of this questionnaire, please list all assets
with a fair market value in excess of $1,000 for you and your
spouse. Please provide a good faith estimate of value.
21. As of the date of this questionnaire, please list all
liabilities in excess of $10,000 for you or your spouse. Please
list the name and address of the creditor, the amount owed to the
nearest thousand, a brief description of the nature of the
obligation, the interest rate (if any), the date on which due,
and the present status (i.e., is the obligation current or past
due).
22. Please describe all real estate held in your name or in your
spouse's name during the last six years. Please include real
estate held in combination with others, held in trust, held by a
nominee, or held by or through any other third-person or title-
holding entity. Please include dates held.
23. Have you and your spouse filed all federal, state and local
income tax returns?
24. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
25. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
26. Has a tax lien or other collection procedure ever been
instituted against you or your spouse by federal, state or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Domestic Help Issue
27. Do you presently have or have you in the past had domestic
help? (i.e, a housekeeper, babysitter, nanny, or gardener) If
so, please indicate years of service for each individual and give
a brief description of the services rendered.
Public and Organizational Activities
28. Please list current and past political party affiliations.
29. Have you ever run for public office? If so, does your
campaign have any outstanding campaign debt? If so, are you
personally liable? Please provide complete information as to the
amount of debt and creditors.
30. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent or religious organization, private club or other
membership organization (including any tax-exempt organization)
during the past 10 years. Please include dates of membership and
any positions you may have had with the organization.
31. Have you or your spouse at any time belonged to any
membership organization, including, but not limited to, those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation based on race, sex,
ethnic background, religious or sexual preference?
Legal and Administrative Proceedings and Filings
32. Please list any lawsuits you have brought as a plaintiff, or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
33. Please list and describe any administrative agency
proceeding in which you have been involved as a party.
34. Please list any bankruptcy proceeding in which you or your
spouse have been involved as a debtor.
35. Have you or your spouse ever been investigated by any
federal, state, military or local law enforcement agency? If so,
please identify each instance and supply details, including:
date; place; law enforcement agency; and court.
36. Have you or your spouse ever been arrested, or charged with,
and/or convicted of violating any federal, state or local :law,
regulation or ordinance (excluding traffic offenses for which the
fine was less than $100) ? If so, please identify each instance
and supply details, including: date; place; law enforcement
agency; and court.
37. Have you or your spouse ever been accused of or found guilty
of any violations of government or agency procedure (specifically
including securities violations and/or any application, or appeal
process) ?
38. Please list any complaint ever made against you by any
administrative agency, professional association or organization,
or federal, state or local ethics agency, committee, or official.
39. Please list any and all judgements rendered against you,
including the date, amount, the name and subject matter of the
case, and the date of satisfaction. Please include obligations
of child support and alimony, and provide the status of each
judgement and/or obligation.
40. With regard to each obligation of child support and/or
alimony, please state the following: Have any payments been made
late or have there been any lapses in payment? Have any motions
or court actions for modification of child support or alimony
been filed or instituted? Have any actions or motions to compel
payment or initiate collection of late payments and/or past due
amounts been filed or threatened? Have any writs of garnishment
been issued? If your response was "yes" to any of the above
questions, please provide details.
Miscellaneous
41. Have you ever had any association with any person, group or
business venture that could be used, even unfairly, to impugn or
attack your character and qualifications for a government
position?
42. Do you know anyone or any organization that might take
steps, overtly or covertly, fairly or unfairly, to criticize your
appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
43. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest, or be a possible source of embarrassment to you,
your family or the President.
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
OFFICE OF THE COUNSEL TO THE PRESIDENT
As part of the clearance procedures for your prospective
position, please answer all of the following questions (Please do
not respond "Not Applicable" or "N/A" if your answer is "No" or
"None"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, as it is not
subject to public disclosure, are confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date the attachment.
Because your appointment cannot be finalized until all necessary
reviews have been completed, and because our review begins with
the receipt of your paperwork, please supply this information
within 30 days to Craig Livingstone, Director White House
Security, at OEOB 84, Washington DC, 20500.
If you have any questions or need assistance in responding to
this questionnaire, please contact Cliff Mauton, White House
Counsel's Office at (202) 456-6229. Thank you for your
cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and phone number; date and place of birth;
citizenship; and social security number.
2.
Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3.
Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4. Please list each high school, college, and graduate school
you attended; the dates of your attendance; and degrees awarded.
5.
Please furnish a copy of your resume and a brief
biographical statement.
6.
Please chronologically list activities, other than those
listed on your resume, from which you have derived earned income
(e.g., self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7.
Please list each book, article, column, or publication you
have authored, individually or with others.
8.
Identify each instance in which you have testified before
Congress in a non-governmental capacity, and specify the subject
matter of each testimony.
9. Please list corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity or financial interest (i.e., any ownership interest of
more than 5%), or whose decisions you had the ability to
influence. Please identify the entity, your relationship to the
entity, and the dates of service and/or affiliation.
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past five years have been, affiliated as an
advisor, attorney, or consultant. It is only necessary to
provide the names of major clients and any client matter in which
you and your firm are involved that might present a potential
conflict of interest with your proposed assignment. Please
include dates of service.
11. With regard to each of the entities identified in the
preceding question, please identify your relationship or duty
with regard to each. Please include dates of service.
12. Other than the entities identified in question 10 above,
please provide the names of any organizations with which your
association might present a potential conflict of interest with
your proposed assignment. For each entity you identify in your
response to this question, please provide your relationship or
duty with regard to each. Please include dates of service.
13. Please describe any contractual or informal arrangement you
may have made with any person or business enterprise in regard to
future employment. Include termination payments or financial
benefits that will be provided for you if you enter government
employment.
14. If you are a member of any licensed profession or occupation
(i.e., lawyer, doctor, accountant, insurance or real estate
broker, etc.) please specify the present status of each license;
and, whether any such license has ever been withdrawn, suspended,
or revoked, including the reason therfor.
15. Do you have a significant interest in any relationship with
the government through contracts, consulting services, grants,
loans, or guarantees? If so, please provide details.
16. Does your spouse or any family member or any business in
which you, your spouse or any family members have a significant
interest, have any relationship with the federal government
through contracts, consulting services, grants, loans, or
guarantees? If so, please provide details.
17. If you have performed any work for, and/or received any
payments from, any foreign government, business, or individual in
the past 10 years, please describe the circumstances. Please
identify the source, as well as the dates of services and/or
payments.
18. Please list any registration as an agent for a foreign
principal, or any exemption from such registration. Please
provide the status of any and all such registrations and/or
exemptions (i.e., whether active and whether personally
registered).
19. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If so, please supply details, including the status of each
registration.
Tax and Financial Information
20. As of the date of this questionnaire, please list all assets
with a fair market value in excess of $1,000 for you and your
spouse. Please provide a good faith estimate of value.
21. As of the date of this questionnaire, please list all
liabilities in excess of $10,000 for you or your spouse. Please
list the name and address of the creditor, the amount owed to the
nearest thousand, a brief description of the nature of the
obligation, the interest rate (if any), the date on which due,
and the present status (i.e., is the obligation current or past
due).
22. Please describe all real estate held in your name or in your
spouse's name during the last six years. Please include real
estate held in combination with others, held in trust, held by a
nominee, or held by or through any other third-person or title-
holding entity. Please include dates held.
23. Have you and your spouse filed all federal, state and local
income tax returns?
24. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
25. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
26. Has a tax lien or other collection procedure ever been
instituted against you or your spouse by federal, state or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Domestic Help Issue
27. Do you presently have or have you in the past had domestic
help? (i.e, a housekeeper, babysitter, nanny, or gardener) If
so, please indicate years of service for each individual and give
a brief description of the services rendered.
Public and Organizational Activities
28. Please list current and past political party affiliations.
29. Have you ever run for public office? If so, does your
campaign have any outstanding campaign debt? If so, are you
personally liable? Please provide complete information as to the
amount of debt and creditors.
30. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent or religious organization, private club or other
membership organization (including any tax-exempt organization)
during the past 10 years. Please include dates of membership and
any positions you may have had with the organization.
31. Have you or your spouse at any time belonged to any
membership organization, including, but not limited to, those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation based on race, sex,
ethnic background, religious or sexual preference?
Legal and Administrative Proceedings and Filings
32. Please list any lawsuits you have brought as a plaintiff, or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
33. Please list and describe any administrative agency
proceeding in which you have been involved as a party.
34. Please list any bankruptcy proceeding in which you or your
spouse have been involved as a debtor.
35. Have you or your spouse ever been investigated by any
federal, state, military or local law enforcement agency? If so,
please identify each instance and supply details, including:
date; place; law enforcement agency; and court.
36. Have you or your spouse ever been arrested, or charged with,
and/or convicted of violating any federal, state or local -law,
regulation or ordinance (excluding traffic offenses for which the
fine was less than $100) If so, please identify each instance
and supply details, including: date; place; law enforcement
agency; and court.
37. Have you or your spouse ever been accused of or found guilty
of any violations of government or agency procedure (specifically
including securities violations and/or any application, or appeal
process) ?
38. Please list any complaint ever made against you by any
administrative agency, professional association or organization,
or federal, state or local ethics agency, committee, or official.
39. Please list any and all judgements rendered against you,
including the date, amount, the name and subject matter of the
case, and the date of satisfaction. Please include obligations
of child support and alimony, and provide the status of each
judgement and/or obligation.
40. With regard to each obligation of child support and/or
alimony, please state the following: Have any payments been made
late or have there been any lapses in payment? Have any motions
or court actions for modification of child support or alimony
been filed or instituted? Have any actions or motions to compel
payment or initiate collection of late payments and/or past due
amounts been filed or threatened? Have any writs of garnishment
been issued? If your response was "yes" to any of the above
questions, please provide details.
Miscellaneous
41. Have you ever had any association with any person, group or
business venture that could be used, even unfairly, to impugn or
attack your character and qualifications for a government
position?
42. Do you know anyone or any organization that might take
steps, overtly or covertly, fairly or unfairly, to criticize your
appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
43. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest, or be a possible source of embarrassment to you,
your family or the President.
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
JACK QUINN
COUNSEL TO THE PRESIDENT
As part of the clearance procedure for your prospective position,
please answer all of the following questions (please do not
respond "not applicable" or "N/A" if your answer is "no" or
"none"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, which is not
subject to public disclosure, are confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date any attachments.
Because your appointment cannot be finalized until all necessary
reviews have been completed, please supply this information
within 24 hours to Craig Livingstone, Director White House
Security. (Old Executive Office Building, Room #84, Washington,
D.C. 20500; fax number: (202) 456-7029).
If you have any questions or need assistance in responding to
this questionnaire, please do not hesitate to contact this office
at (202) 456-2345. Thank you for your cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and telephone number; date and place of
birth; citizenship; and social security number.
2
2.
Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3. Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4. Please list each high school, college, and graduate school
you attended; the dates of you attended; the dates of your
attendance; and degrees awarded.
5. Please furnish a copy of your resume and a brief
biographical statement.
6. Please chronologically list activities, other than those
listed on your resume, from which you have derived earned income
(e.g. self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7. Please list each book, article, or publication you have
authored, individually or with others.
8. Identify each instance in which you have testified before
Congress in a non-governmental capacity and specify the subject
matter of each testimony.
3
9. Please list all corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity of financial interest (i.e. any ownership interest of more
than 5%), or whose decisions you had the ability to influence.
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past have years have been, affiliated as an
advisor, attorney, or consultant. It is only necessary to
provide the names of major clients and any client matter in which
you and your firm are involved that might present a potential
conflict of interest with your proposed assignment. Please
identify the clients by name unless it would breach a
confidential relationship or duty respecting a privileged matter.
In addition, please provide the names of any organizations with
which you were associated which might present a potential
conflict or the appearance of conflict of interest with your
prospective appointment.
11. Please describe any contractual or informal arrangement you
may have made with any person or any business enterprise in
regard to future employment or termination payments or financial
benefits that will be provided to you if you enter government
employment.
12. If you are a member of any licensed profession or occupation
(such as lawyer, doctor, k accountant, insurance, or real estate
broker, etc.), please specify: the present status of each
license; and whether any such license has ever been withdrawn,
suspended, or revoked, and the reason therefor.
4
13. Does your spouse or any family member or business in which
you, your spouse or any family members have a significant
interest have any relationship with the federal government
through contracts, consulting services, grants, loans, or
guarantees? If yes, please provide details.
14. If you have performed any work for and/or received any
payments from any foreign government, business, or individual in
the past 10 years, please describe the circumstances, and
identify the source and amount.
15. Please list any registration as an agent for a foreign
principal, or any exemption from such registration.
16. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If yes, please supply details.
Tax and Financial Information
17. As of the date of this questionnaire, please list all assets
and liabilities with a fair market value in excess of $5,000 for
you and your spouse and provide a good faith estimate of value.
As to liabilities, please list the name and address of the
creditor, the amount owed to the nearest thousand dollar, a brief
description of the nature of the obligation, the interest rate
(if any) and the date on which due.
5
18. Please describe all real estate held in your name or in your
spouse's name during the last six years, including any real
estate held in combination with other or on your or your spouse's
behalf in trust, by a nominee, or through any other title-holding
entity.
19. Have you and your spouse filed all federal, state, and local
income tax returns?
20. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
21. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
22. Has a tax lien or other collection procedure ever been
instituted against you or your spouse by federal, state, or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Public and Organizational Activities
23. Please list current and past political party affiliations.
6
24. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent, or religious organization, private club, or other
membership organization (including any tax-exempt organization)
during the past 10 years.
25. Have you or your spouse at any time belonged to any
membership organization, including but not limited to those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation (as a matter of
either policy or practice) based on race, sex, ethnic background,
religious or sexual preference?
Legal and Administrative Proceedings and Filings
26. Please list any lawsuits you have brought as a plaintiff or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
27. Please list and describe any administrative agency
proceeding in you have been involved as a party.
28. Please list and describe any bankruptcy proceeding in which
you or your spouse have been involved as a debtor.
7
29. Have you or your spouse ever been investigated by any
federal, state, military, or local law enforcement agency, or
arrested for, charged with, or convicted of violating any
federal, state, or local law, regulation, or ordinance (excluding
traffic offenses for which the fine was less than $100) ? If so,
please identify each such instance and supply details, including:
date; place; law enforcement agency; and court.
30. Please list any complaint ever made against you or by any
administrative agency, professional association or organization,
or federal, state, or local ethics agency, committee, or
official.
Miscellaneous
31. Have you ever had any association with any person, group, or
business venture that could be used, even unfairly, to impugn or
attack you character and qualifications for a government
position?
32. Do you know of any person or organization that might take
any steps, overtly or covertly, fairly or unfairly, to criticize
your appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
33. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest or be a possible source of embarrassment to you, you
family, or the President.
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
JACK QUINN
COUNSEL TO THE PRESIDENT
As part of the clearance procedure for your prospective position,
please answer all of the following questions (please do not
respond "not applicable" or "N/A" if your answer is "no" or
"none"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to
be relevant. Your responses to this questionnaire, which is not
subject to public disclosure, are confidential.
You can type your responses in memorandum form on a separate
sheet of paper with each answer corresponding to the number of
the question. You do not need to retype the questions, but
please sign and date any attachments.
Because your appointment cannot be finalized until all necessary
reviews have been completed, please supply this information
within 24 hours to Craig Livingstone, Director White House
Security. (Old Executive Office Building, Room #84, Washington,
D.C. 20500; fax number: (202) 456-7029).
If you have any questions or need assistance in responding to
this questionnaire, please do not hesitate to contact this office
at (202) 456-2345. - Thank you for your cooperation.
Personal and Family Background
1. Please list your full name; home address and telephone
number; office address and telephone number; date and place of
birth; citizenship; and social security number.
2
2.
Please identify your current marital status; spouse's name,
citizenship, occupation, and current employer; and the names and
ages of your children.
3. Do you have any medical conditions that could interfere with
your ability to fulfill your duties? Please explain.
Professional and Educational Background
4. Please list each high school, college, and graduate school
you attended; the dates of you attended; the dates of your
attendance; and degrees awarded.
5. Please furnish a copy of your resume and a brief
biographical statement.
6. Please chronologically list activities, other than those
listed on your resume, from which you have derived earned income
(e.g. self-employment, consulting activities, writing, speaking,
royalties, and honoraria) since age 21.
7. Please list each book, article, or publication you have
authored, individually or with others.
8. Identify each instance in which you have testified before
Congress in a non-governmental capacity and specify the subject
matter of each testimony.
3
9. Please list all corporations, partnerships, trusts, or other
business entities with which you have ever been affiliated as an
officer, director, trustee, partner, or holder of a significant
equity of financial interest (i.e. any ownership interest of more
than 5%), or whose decisions you had the ability to influence.
10. Please provide the names of all corporations, firms,
partnerships, trusts, or other business enterprises, and all non-
profit organizations and other institutions with which you are
now, or during the past have years have been, affiliated as an
advisor, attorney, or consultant. It is only necessary to
provide the names of major clients and any client matter in which
you and your firm are involved that might present a potential
conflict of interest with your proposed assignment. Please
identify the clients by name unless it would breach a
confidential relationship or duty respecting a privileged matter.
In addition, please provide the names of any organizations with
which you were associated which might present a potential
conflict or the appearance of conflict of interest with your
prospective appointment.
11. Please describe any contractual or informal arrangement you
may have made with any person or any business enterprise in
regard to future employment or termination payments or financial
benefits that will be provided to you if you enter government
employment.
12. If you are a member of any licensed profession or occupation
(such as lawyer, doctor, k accountant, insurance, or real estate
broker, etc.), please specify: the present status of each
license; and whether any such license has ever been withdrawn,
suspended, or revoked, and the reason therefor.
4
13. Does your spouse or any family member or business in which
you, your spouse or any family members have a significant
interest have any relationship with the federal government
through contracts, consulting services, grants, loans, or
guarantees? If yes, please provide details.
14. If you have performed any work for and/or received any
payments from any foreign government, business, or individual in
the past 10 years, please describe the circumstances, and
identify the source and amount.
15. Please list any registration as an agent for a foreign
principal, or any exemption from such registration.
16. Have you ever registered as a lobbyist or other legislative
agent to influence federal or state legislation or administrative
acts? If yes, please supply details.
Tax and Financial Information
17. As of the date of this questionnaire, please list all assets
and liabilities with a fair market value in excess of $5,000 for
you and your spouse and provide a good faith estimate of value.
As to liabilities, please list the name and address of the
creditor, the amount owed to the nearest thousand dollar, a brief
description of the nature of the obligation, the interest rate
(if any) and the date on which due.
5
18. Please describe all real estate held in your name or in your
spouse's name during the last six years, including any real
estate held in combination with other or on your or your spouse's
behalf in trust, by a nominee, or through any other title-holding
entity.
19. Have you and your spouse filed all federal, state, and local
income tax returns?
20. Have you or your spouse ever filed a late income tax return
without a valid extension? If so, describe the circumstances and
the resolution of the matter.
21. Have you or your spouse ever paid any tax penalties? If so,
describe the circumstances and the resolution of the matter.
22. Has a tax lien or other collection procedure ever been
instituted against you or your spouse by federal, state, or local
authorities? If so, describe the circumstances and the
resolution of the matter.
Public and Organizational Activities
23. Please list current and past political party affiliations.
6
24. Please list each membership you have had with any civic,
social, charitable, educational, professional, fraternal,
benevolent, or religious organization, private club, or other
membership organization (including any tax-exempt organization)
during the past 10 years.
25. Have you or your spouse at any time belonged to any
membership organization, including but not limited to those
described in the preceding paragraph, that as a matter of policy
or practice denied or restricted affiliation (as a matter of
either policy or practice) based on race, sex, ethnic background,
religious or sexual preference?
Legal and Administrative Proceedings and Filings
26. Please list any lawsuits you have brought as a plaintiff or
which were brought against you as a defendant or third party.
Include in this response any contested divorce proceedings or
other domestic relations matters.
27. Please list and describe any administrative agency
proceeding in you have been involved as a party.
28. Please list and describe any bankruptcy proceeding in which
you or your spouse have been involved as a debtor.
7
29. Have you or your spouse ever been investigated by any
federal, state, military, or local law enforcement agency, or
arrested for, charged with, or convicted of violating any
federal, state, or local law, regulation, or ordinance (excluding
traffic offenses for which the fine was less than $100) ? If so,
please identify each such instance and supply details, including:
date; place; law enforcement agency; and court.
30. Please list any complaint ever made against you or by any
administrative agency, professional association or organization,
or federal, state, or local ethics agency, committee, or
official.
Miscellaneous
31. Have you ever had any association with any person, group, or
business venture that could be used, even unfairly, to impugn or
attack you character and qualifications for a government
position?
32. Do you know of any person or organization that might take
any steps, overtly or covertly, fairly or unfairly, to criticize
your appointment, including any news organization? If so, please
identify and explain the basis for the potential criticism.
33. Please provide any other information, including information
about other members of your family, that could suggest a conflict
of interest or be a possible source of embarrassment to you, you
family, or the President.
PERSONAL DATA STATEMENT QUESTIONNAIRE FOR NON-CAREER SES
APPOINTEES
As part of the clearance procedures for your prospective position, please answer all of
the following questions (please do not respond "not applicable" or "N/A" if your
response is "no" or "none"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to be relevant. Your
responses to this questionnaire, which is not subject to public disclosure, are
confidential.
You can type your responses in memorandum form on a separate sheet of paper with
each answer corresponding to the number of the question. You do not need to retype
the questions, but please sign and date the response.
If you have any questions or need assistance in responding to this questionnaire,
please do not hesitate to contact this office. Thank you for your cooperation.
Personal and Family Background
1.
Please list your full name; home address and telephone number; office address
and telephone number; date and place of birth; citizenship; and social security
number.
2.
Please identify your current marital status; spouse's name, citizenship,
occupation, and current employer; and the names and ages of your children.
3.
Do you have any medical conditions that could interfere with your ability to
fulfill your duties? Please explain.
Professional and Educational Background
4.
Please list each high school, college, and graduate school you attended; the
dates of your attendance; and degrees awarded.
5.
Please furnish a copy of your resume and a brief biographical statement.
6.
Please chronologically list activities, other than those listed on your resume,
from which you have derived earned income (e.g., self-employment, consulting
activities, writing, speaking, royalties, and honoraria) since age 21.
7.
Please list each book, article, or publication you have authored, individually
or with others.
8.
Identify each instance in which you have testified before Congress in a non-
governmental capacity and specify the subject matter of each testimony.
9.
Please list all corporations, partnerships, trusts, or other business entities with
which you have ever been affiliated as an officer, director, trustee, partner, or holder
of a significant equity or financial interest (i.e., any ownership interest of more than
5%), or whose decisions you had the ability to influence. Please identify the entity,
your relationship to the entity, and dates of service and/or affiliation.
2
10.
Please provide the names of all corporations, firms, partnerships, trusts, or
other business enterprises, and all non-profit organizations and other institutions with
which you are now, or during the past five years have been, affiliated as an advisor,
attorney or consultant. It is only necessary to provide the names of major clients and
any client matter in which you and your firm are involved that might present a
potential conflict of interest with your proposed assignment. Please include dates of
service.
11.
With regard to each of the entities identified in the preceding question, please
identify your relationship or duty with regard to each. Please include dates of
service.
12.
Other than the entities identified in question number 10 above, please provide
the names of organizations with which you were associated which might present a
potential conflict of interest with your proposed assignment. For each entity you
identified in your response to this question, please provide your relationship or duty
with regard to each. Please include dates of service.
13.
Please describe any contractual or informal arrangement you may have made
with any person or any business enterprise in regard to future employment or
termination payments or financial benefits that will be provided you if you enter
government employment.
14.
If you are a member of any licensed profession or occupation (such as lawyer,
doctor, accountant, insurance or real estate broker, etc.), please specify: the present
status of each license; and whether any such license has ever been withdrawn,
suspended, or revoked, and the reason therefor.
3
15.
Do you have a significant interest in any relationship with the government
through contracts, consulting services, grants, loans or guarantees? If yes, please
provide details.
16.
Does your spouse or any family member or business in which you, your
spouse or any family members have a significant interest have any relationship with
the federal government through contracts, consulting services, grants, loans or
guarantees? If yes, please provide details.
17.
If you have performed any work for and/or received any payments from any
foreign government, business, or individual in the past 10 years, please describe the
circumstances, and identify the source and dates of services and/or payments.
18.
Please list any registration as an agent for a foreign principal, or any
exemption from such registration. Please provide the status of any and all such
registrations and/or exemptions (i.e., whether active and whether personally
registered).
19.
Have you ever registered as a lobbyist or other legislative agent to influence
federal or state legislation or administrative acts? If yes, please supply details
including the status of each registration.
Tax and Financial Information
20.
As of the date of this questionnaire, please list all assets with a fair market
value in excess of $1,000 for you and your spouse and provide a good faith estimate
of value.
4
21.
As of the date of this questionnaire, please list all liabilities in excess of
$10,000 for you and your spouse. Please list the name and address of the creditor,
the amount owed to the nearest thousand dollar, a brief description of the nature of
the obligation, the interest rate (if any), the date on which due, and the present status
(i.e., is the obligation current or past due).
22.
Please describe all real estate held in your name or in your spouse's name
during the last six years. Please include real estate held in combination with others,
held in trust, held by a nominee, or held by or through any other title-holding entity.
Please also include dates held.
23.
Have you and your spouse filed all federal, state and local income tax returns?
24.
Have you or your spouse ever filed a late income tax return without a valid
extension? If so, describe the circumstances and the resolution of the matter.
25.
Have you or your spouse ever paid any tax penalties? If so, describe the
circumstances and the resolution of the matter.
26.
Has a tax lien or other collection procedure ever been instituted against your
or your spouse by federal, state or local authorities? If so, describe the circumstances
and the resolution of the matter.
5
Domestic Help Issue
27.
Do you presently have or have you in the past had domestic help? (i.e., a
housekeeper, babysitter, nanny, or gardener) If yes, please indicate years of service
for each individual and also give a brief description of the services rendered.
Public and Organizational Activities
28. Please list current and past political party affiliations.
29. Have you ever run for public office? If yes, does your campaign have any
outstanding campaign debt? If so, are you personally liable? Please also provide
complete information as to amount of debt and creditors.
30. Please list each membership you have had with any civic, social, charitable,
educational, professional, fraternal, benevolent or religious organization, private club,
or other membership organization (including any tax-exempt organization) during the
past 10 years. Please include dates of membership and any positions you may have
had with the organization.
31. Have you or your spouse at any time belonged to any membership
organization, including but not limited to those described in the preceding paragraph,
that as a matter of policy or practice denied or restricted affiliation (as a matter of
either policy or practice) based on race, sex, ethnic background, religious or sexual
preference?
6
Legal and Administrative Proceedings and Filings
32.
Please list any lawsuits you have brought as a plaintiff or which were brought
against you as a defendant or third party. Include in this response any contested
divorce proceedings or other domestic relations matters.
33.
Please list and describe any administrative agency proceeding in which you
have been involved as a party.
34.
Please list any bankruptcy proceeding in which you or your spouse have been
involved as a debtor.
35.
Have you or your spouse ever been investigated by any federal, state, military
or local law enforcement agency. If so, please identify each such instance and supply
details, including: date; place; law enforcement agency; and court.
36.
Have you or your spouse ever been arrested for, charged with, or convicted of
violating any federal, state or local law, regulation or ordinance (excluding traffic
offenses for which the fine was less than $100)? If so, please identify each such
instance and supply details, including: date; place; law enforcement agency; and
court.
37.
Have you or your spouse ever been accused of or found guilty of any
violations of government or agency procedure (specifically including security
violations and/or any application, or appeal process)?
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38.
Please list any complaint ever made against you or by any administrative
agency, professional association or organization, or federal, state or local ethics
agency, committee, or official.
39.
Please list any and all judgments rendered against you including the date,
amount, the name of each case and subject matter of the case, and the date of
satisfaction. Please include obligations of child support and alimony and provide the
status of each judgement and/or obligation.
40.
With regard to each obligation of child support and/or alimony, please state
the following: Have any payments been made late or have there been any lapses in
payment? Have any motions or court actions for modification of child support or
alimony been filed or instituted? Have any actions or motions to compel payment or
initiate collections of late payments and/or past due amounts been filed or threatened?
Have any writs of garnishment been issued? If your response was yes to any of the
above questions, please provide details.
Miscellaneous
41.
Have you ever had any association with any person, group or business venture
that could be used, even unfairly, to impugn or attack your character and
qualifications for a government position?
42.
Do you know anyone or any organization that might take any steps, overtly or
covertly, fairly or unfairly, to criticize your appointment, including any news
organization? If so, please identify and explain the basis for the potential criticism.
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43.
Please provide any other information, including information about other
members of your family, that could suggest a conflict of interest or be a possible
source of embarrassment to you, your family or the President.
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