Apr-ZIMDOB D2i1SaBi Fronj- T-8BD P D02/ODS F-0Z7

BEQUEST FOR APPROVAL OF OUTSIDE ACTIVITY" KWIBI R e v e r t

ReviSea RBIUCK

{Ref HHS Siapaart? of Conduct Regulauons) Runtswal

J fwM5 B.8ST, Firs. iatus9 2 ORGANIZATION UOCATION lOpewngOtwmn. Burwo.. Otvispiy

Browne, Douglas R. NCIP/0VROA/RZB

3 TlTtE OF POSITION « GRADE w D SALARV tFva$iW)

Deputy Branch Chief GS14 $32,838

-5 NAME. ADDRESS AfiO PvSlNESS OF PERSON Oft ORGANIZATION FOR WnOrt S M3CATION WrlERE SERVICES vUju. BE PERFORMEP

(b)(6) (b)(6)

7 rfATuftfi O F ACTIVITY fwoiesm IX^P tfatwifc c c . wan»»a w w w i a w e e « A « a s , «n<f g w tw? u«twpi»f» orsptaiK w*wis wvewvsxw to (•» poifamoa Smaif
(fiwh/jowiow, tno rcuwwwqopysof I««I» ami«>«B>a»'c<aj , p»p«eq«ei!«iy v »'l" , Bps(ft«inBa>

(b)(6)

H ESTIMATED TIME MVOt-VEP

PEWOPCOvgREO B ESTIMATED TOTW-TIME DEVOTED TO ACTtvlTr (iron a eflntorwnp8a5« p/r»
BttmatKPtms paryoai)

FROM Q7/P1/2Q(H TO 06730/2005 (b)(6)

m > mnthi- a e n g B c n p m i n e«iT IPBI v fti <r<S,ng i tSi mt m a m w f i urn iBCT
(b)(6)

{ B pa YOUR QFFcCiAt. cuTiEs REPUTE m m* WAT TO THE PROPOSED ncrivmrT

(b)(6)
*10 F PROVIDING CONSULTATIVE OR PROFESSIONAl. SERVICES APS TOU R tA>0uUH?£ ASSOCIATES RECEIVING OR WILU T « E t SEES. A GRANT OR
CONTRACT PROW AFEOEPAUASgNCrr
(b)(6)

>-« liETMnnnpnagiermrrmpcuigATinM 12 WILL COMPENSATION BEpERtVEP FROM A HHS GRANT OR

COrfrRACT?
(b)(6)
(b)(6)

13 THIS BEQUEST IS M*BE WITH FUU. tfHOW-EPtSg OF DEPARTMENT AND OPERATING PI VISION POUCT AN)5 PROCEDURES ON OUTBlOH ACTIVITIES
Tflg STATEMENTS 1 HAVE M A P E ARETOME.COMPLETE AND CDRRECTTO THE BEST OFfclTnNOW.EPt3B AND BEUEF
(WIU. USE CDvERiUMENT-f INANCEDTlME. S O P P t ) ^ , FACULTIES OR EQUIPMENT ASSIGNED PR WANED TO ME FOR C O M P U S T I O N OF MT OFFICIAL
DUTIES ONLV AS pERMfTTeO Br THE INFORMATION RESOURCES MANAGEMENT MANUAL G U I P E . CDC-8. JUKE S3, "EMPLOYEE uSE 0)= COC
INFORMATION TECHNOLOGY RESOURCES "
14 SIGNATURE OF EMPL0TEE tS OATE is ADDrrior«i.ir«Foptt«.TtOrtATTACfiep
r / l w
.ffi 3 l k ^ - 05/19/2004
f j TES {7J Hawstney jj*

JTACTIOIV RECOMMENDED 0T REVIEWING OFFICIAL

iTURE c TtTtE a PATE
E J JAAPPPP R
J OVAV. - . _ _ _ — —
Cy PwTlne l „ ftvcrj

—I.-.—~--» 1 1 - ^ i i / r . i p ^ . m n in—*B r /'-■'•-'

C0C0SS3HE) COCAODPCACTOOMSOB
/4cTfl«i deputy Bhics Counselor
RE6lflJffGW KCERFIS PROVIDES
Aer-ZO-ZBOS 113:1 Brat From- T-B8D P.004/CB5 F-OET

Computer Statement

The following "computer statement" should be attached to or writtfin and signed on the
Reverse of the H#S-52G, Bequest gj r Apptoval of Outside Activity.

"1 wi|} use OavenraeW-fuianced tita^. supplier jgcUitjies, or equipment assigtted or

Joaned to n» for cotDptetioaaf aiy official dunes only as permitted by The Infonuarion
Resources Management Manual Guide, CDC-8, June89, and Empbyee Use of CDC
Information Teclwmlogy Resource
 T-BBO P 005/flllfi F-OZT

EXCERPTS FROM THE STANDAjSDS OF ETHICAL CONDUCT FOR

BMPLOYEESOFT8E EXECPmm BRANCH AND THE DEPARTMENT O"
HEALTH AND HUMAN SERVICES SUPPLEMENTAL AGENCY ETHICS
REGULATIONS:

TTrifi 5 CQDE OF F S 3 E R A L R S 3 U U T 1 Q M 3
9
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Ajpw«Ji«aOR»Biw«»tl wUfcsltfc decnnifw! ma

t^«rBqt#i»«<sMi» BrtteififflasvtmWa wO*atWllM-M OsrtJias sn^a^mBtVf W0lll«'BtlWJB sctvi^fcje*(a;

tfflUistteT! ar H«n5ThH5«»Btoa erapprovaj for so oi

8635303, Hwquti f w * » mo wM&xpfo tttwjusIlIcajJan
««Mty way uafbf WPN)I&HJ t»o»rM* «n#>n, B may
mshtly iJow najr?HBV» tats wnphtyoi) «j(ftwa»ilt
w rtijifr ty *}J app!Ic*W« fewv H=^«TWiB BtopJoy
eonsat* nor IJPW apptwtf eettmutnv a wuieaon
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B?ftt){ili«3}vtVfUt dwtrfitHl on thosoimtwilcn >
nut BJIJMW Bktty » vfcfa» w y «Jmtat siawps >
BWa nil**. aijployiesartTBrolndooiJtrtaitflni
Vosf "*"■• o rttWan*iwyfca eaflUimplatal. (hat.
OtrimjHlta*, pait otfilMif potirairTjs.

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asfcjrfta ta# pwfajoro* ofWi tfflfc?iJ ens** on »&«*;»«> cajiigfaqa wmm4iu, {B&Blafc&tittyhreD In ton
pnpv&wxBty&t hB&rfto Mf 9» fbasr/ ia^nt
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Eautmlj % Ai wRpfcywr trf*r Ote«p*Jfamif W(iBr«Bd' ftf *i«tn fiffcrifesftwaoOrfo * l ° w*n"><V«'V too
fiUtnRxntai/Hlxniwfifl tvncQSH#.&!afyst*vt*nu eatfoawenniSpffi, 1S»wnf*!jwiifi]iV'nc"aul';>'=i:'
itaiuy, pti tikis* of ftftaata." ftw ffto*StfI U)»
^((ptlMft 6 Otoifca*»t«Iij4 ?B t t R U EPS »*St.Jri>

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nafii* neangfctSfipteflMlp »Sft»? ft* ms«n»>n*oW?SW,s»£

friUAow i ^ w t M ^ HmrttirwW trootstint(trow

appw/aifeatfwtoftirfniBffiitiaJB* faftfloM^topsIn w
teafltwuftrttiron

HHS P9rm"S2o RnswIaUon &cqtpfcs (Janunry i s s a j

Apr~Z0-Z0fl6 A311 Ban From- T-SBD p.DOI/DOS F-DE7
PuDi* Heaitn Service
DEPARTMENT OF HCAtTH & H U M A N SERVICES Centers far Disease Control
__ n ana Prevention (CPC)

Memorandum
Date June 25,2004

Acting Deputy Ethics Counselor

From
Centers for Disease Control and Prevention, and
Agency for Toxic Substances and. Disease Registry
Sypjeci
Outside Activity
T
° Douglas Browne
Deputy Branch Chief; DVRD, NC3D
Through: Deputy Director, NCiD

Your request, to serve on the Advisory Board of the National Save a Life Foundation, has been
approved. fSyou wish TO condaue this activity beyond the period eovcret), yaw muse MtfrmU
a revised or renewed request. Otherwise, your activity will be considered inactive after
June 30,2005.

You may perform this outside activity under the following conditions:

1. it must not pre^te a real or apparent conflict of interest,

2. You roust not participate in any action taken by the organization to endorse, encourage, or
oppose the adoption of aformalpolicy or position of CDC, HHS, or the Federal
Government.

3. Government-financed time, supplies, facilities, or equipment assigned or loaned to you

for completion of your official duties may be used for this outside activity only as
permitted by the Information Resources Management IVfanual Guide, CDC-8, June 99,
"Employee Use of CDC Information Technology Resources."

4. You shall not use or permit the use of your Government position or title or any authority
associated with your public office in a manner feat could reasonably be construed to
imply that CDC or the Government sanctions or endorses your outside activity.

5. You must not represent the organization before any Federal agency where the Federal
Government has a substantial interest in the matter.

6. You are prohibited from taking any action as a CDC employee that could be perceived as
directly and predictably affecting the financial interests of this organization.
Apf-flHBflS 03si Bam Frmr T-B8D P 00Z/CB3 f-M

Page 2. Douglas Browne

7. You may not provide, for compensation, services on. behalf of this organization to
prepare, or assist m the preparation of any grant applications, contract proposals, program
reports, or other documents intended for submission to HfiS.

8. You must not participate in lobbying activities.

9. You may only participate in rundraising activities consistent with the Office of
Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You may
attend fundralsmg functions, and you may participate in discussions and planning of
fundraising activities this outside organization is considering. However, you may not
personally solicit funds or other support from a subordinate or a prohibited source, within
the meaning of the OGE Standards at §2635J203(d).

for moire specific information concerning tnis outside activity, refer to Subpart H - Outside
Aciivxtias. of the Office of Government Ethics Standards of Ethical Conduct for Employees of
the Executive Branch, and Section 5501.106 of the HfiS Supplemental Standards of Ethical
Conduct Please note that if this acrrviry is performed during normal working hours, you must be
on approved leave.

If you have questions Qrntsed additional information, please call Fran Collier, Ethics Program
Activity, Office of the Chief Operating Officer, (404) 498-2857.

Carrion Duncan

Attachment
HHS-520
 m^m
O InMat Request
REQUEST FOR APPROVAL OF OUTSIDE ACTIVITY*
[ T j Revised Requcsl
f/l Renewal
(Ref^ HHS Standards of Conduct Regulations)
2 ORGANIZATION LOCATION (Operating DMnfort, Bureau. Division)
1 NAME (Last, First. Wat)

Browne, Douglas R. NCID/DBMD

3 TITLE OF POSITION 4 GRADE AND S A U R Y (Federal)

Deputy Director QS15 $112,263

•6 NAME, ADDRESS AND BUSINESS OF PERSON OR ORGANIZATION FOR WHOM 6 LOCATION WHERE SERVICES WILL BE PERFORMED
OUTSIDE SERVICES WILL BE PERFORMED
(b)(6)
(b)(6)

7 NATURE OF ACTIVITY (fttdfcale typ» ofaMy, e.g., ieachtog, consultative sendees, anil ghio fall description of specm suites orsarvioes K> B » penormm kpedly,
when possible, tits schedulBt) days of v/eek am) hours ot day proposed activity will fee peiformed.)

8 PERIOD COVERED b ESTIMATED TOTAL TIME DEVOTED TO ACTIVITY (It on a continuing basis,
estimated lime peryear)

FROM 07/01/2005 TO 06/30/2I (b)(6)

c WILL WORK BE PERFORMED ENTIRELY OUTSIDE USUAL WORKING HOURS?
(b)(6)
o m v m II? n m r . m i . DUTIES RELATE IN ANY WAY TO THE PROPOSED ACTIVITY?
(b)(6)

'10 IF PROVIDING CONSULTATIVE OR PROFESSIONAL SERVICES. ARE YOUR WOULD-BE ASSOCIATES RECEIVING OR WILL THEY SEEK. A GRANT OR
CONTRACT FROM A FEDERAL A6ENCY7

r (b)(6)

if METHOD OR BASIS OF COMPENSATION 12 WILL COMPENSATION BE DERIVED FROM A HHS GRANT OR

(b)(6) (b)(6)

13 THIS REQUEST IS MADE WITH FULL KNOWLEDGE OF DEPARTMENT ANlflOPERATING DIVISION POLICY AND PROCEDURES ON OUTSIDS ACTIVITIES
' THE STATEMENTS I HAVE MADE ARE TRUE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF
I WILL USE GOVERNMENT-FINANCED TIME, SUPPUES, FACILITIES. OR EQUIPMENT ASSIGNED OR LOANED TO ME FOR COMPLETION OF MY OFFICIAL
DUTIES ONLY AS PERMITTED BYTHE INFORMATION RESOURCES MANAGEMENT MANUAL GUIDE. CDC-Q. JUNE 99. "EMPLOYEE USE OF CDC
INFORMATION TECHNOLOEY RESOURCES" ■
15. DATE 16 ADDITIONAL INFORMATION ATTACHED

QYES 0NO (Describe) j j

CTtON RECOMMENDED BY REVIEW1NS OFFICIAL

C TITLE
Sharon Richardson
Acting Director, NCiD/OAS

c. TITLE d DATE
Carlton Duncan
Acting Deputy Ethics Counselor
•sue reverse of form
CDC 0 520 (£). CDC Adobo Actobal 5.0 Electronic Version. B/2002
 INSTRUCTIONS

Item 5 - Self-Employment If applicable, indicate self-employment, the type of service (as medical, legal, etc.), whether alone Dr with
partners, giving their names, and, if providing professional services to a large number of clients or patients, estimate the total number
rather than listing them separately.

*lfem 10 - Federal Grants or Contracts Involved: Describe the Federal grants or contracts (type, granting or contracting department,
etc) Full details must be provided on any aspect of professional and consultative services which involves, directly or Indirectly, the
preparation of grant applications, contract proposals, program reports, and other material which are designed to become the subject of
dealings between Institutions and government units and the Federal Government

*Item 16 - Attachments: Be sure to sign copies of all attachments submitted.

'ITEM 17 . CflMMFMTB HP REVIEWING OFFICIAL

•ITEM 18 - REASON FOR DISAPPROVAL ' "U S BPO: 1Bwm4W»1226

CDC 0 520 (E). CDC Adobe Acrobat 6 0 Electronic Vorelon. 8(2002

 Public Health Service
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control
and Prevention (CDC)

mt 21 2«5
Acting Deputy Ethics Counselor
Centers for Disease Control and Prevention, and
Agency for Toxic Substances and Disease Registry

Outside Activity

Douglas Browne
Deputy Director, DBMD, NCTD
Through; Director, NCLD (E51)

Your request, to serve on the advisory board of the National Save a Life, has been
approved. Pursuant to the latest version of the HHS Supplemental Standards of
Ethical Conduct, which were effective February 3,2005, approval of an outside
activity is effective for one year only. Employees must renew their request for
approval annually if they desire to continue any long term outside activity. In
addition, employees must submit a revised request for approval if they change
positions within the agency or if a significant change occurs in the nature of the
outside activity or in the scope of the employees' duties. Please note that the
approval of this outside activity will be considered inactive after June 30,2006.

You may perform this outside activity under the following conditions:

1. It must not create a real or apparent conflict of interest.

2. You must not participate in any action taken by the organization to endorse,
encourage, or oppose the adoption of a formal policy or position of CDC, HHS,
or the Federal Government

3. Government-financed time, supplies, facilities, or equipment assigned or loaned

to you for completion of your official duties may be used for this outside activity
only as permitted by the Information Resources Management Manual Guide,
CDC-8, June 99, "Employee Use of CDC Information Technology Resources."

4. You shall not use or permit the use of your Government position or title or any
authority associated with your public office in a manner that could reasonably be
construed to imply that CDC or the Government sanctions or endorses your
outside activity.

5. You must not represent the organization before any Federal agency where the
Federal Government has a substantial interest in the matter.

forace
Gig«
m
SURNAME DATE OFFICE SURNAME PATg " 1

M. ■V
r??357
Page 2. Douglas R. Browne

You are prohibited from taking any action as a CDC employee that could be
perceived as directly and predictably affecting the financial interests of this
organization.
*•£»"

7- You may not provide, for compensation, services on behalf of this organization to
prepare, or assist in the preparation of any grant applications, contract proposals,
program reports, or other documents intended for submission to HHS.

8. You must not participate in lobbying activities.

9. You may only participate in fund-raising activities consistent with the Office of
Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You
may attend fund-raising functions, and you may participate in discussions and
planning of fund-raising activities this outside organization is considering.
However, you may not personally solicit funds or other support from a
subordinate or a prohibited source, within the meaning of the OGE Standards at
§2635.203(d).

For more specific information concerning this outside activity, refer to Subpart H -
Outside Activities, of the Office of Government Ethics Standards of Ethical Conduct for
Employees of the Executive Branch, and Section 5501.106 of the HHS Supplemental
Standards of Ethical Conduct Please note that if this activity is performed during normal
working hours, you must be on approved leave.

If you have questions or need additional information, please call Fran Collier, Ethics
Program Activity, Office of the Chief Operating Officer, OD, (404) 498-2857.

Cailton Duncan

Attachment
HHS-520
Outside Activity Notice & Regulatory Excerpts
 DEPARTMENT OF HEAtTH AND HUMAN SERVICES
J* «»"«»„

V
***<nt
t REQUEST FOR APPROVAL OF OUTSIDE ACTIVITY
Standards of Ethical Conduct Regulation
HHS Supplemental Ethics Regulation
(6 Cm S635.803, 5 CFR 5501.108(d))
DATE FILED
JO Initial Request O Revised Request {7J Renewal

1 - EMPLOYEE'S NAME (Last. First, Ml)

Browne, Douglas R.
2 AGENCY (Operating/SMI Division) (Subcomponent)

HHS/CDC/CCID NCZVED
3. TITLE OF POSITION 4. GRADE/STEP 5. FEDERAL SAURY

Management O f f i c i a l 15/5 $119,367.00

6. APPOINTMENT TYPE 7. FINANCIAL DISCLOSURE FILING STATUS

Q PAS/PA PJ Non-Career SES Q Career SES Q Schedule C f j Commissioned Corps □ Public (SF Z7B)
f/lGS ri Title 42 P I Other 0 Confidential (OGE 450) Q None
8 OFFICE ADDRESS
STREET

1600 C l i f t o n Rd., NE D-76

CITY STATE ZIP
Atlanta GA 30333
9 OFFICE CONTACT INFORMATION
TELEPHONE FAX
( 404 )639-0274 ( 404 )639-2780
caL EMAIL
drb7@odc.gov
10. NAME OF IMMEDIATE SUPERVISOR 11. TITLE OF SUPERVISOR
R e g i n a l d R. Mebane Chief Management Official
12. SUPERVISOR CONTACT INFORMATION
TELEPHONE FAX

( 404 )639-2100 ( 404 ) 6 3 9 - 2 1 7 0

CELL EMAIL

( 404 )547-5743 rmebane@cdc.gov

AGENCY USE ONLY

M mn i'h 2BB8

HHS-520 (1/06) (Previous Editions Obsolete) PAGE 1 OF 16 I'JCHnlUAnHJMl-UMUW) lip

 Nature of Official Duties
Describe the principal dulies and responsibilities ol your current position. You may attach a copy ol your position description In tieu ot providing the
description unless you currently have significant duties or assignments that are not reflected In that document

Q Position Description Attached

Management Official at the National Center fox Zoonotic, Vector-bourne and

Enteric diseases (NCZVED), responsible for the administrative management of the
Center, including personnel, budget, program and laboratory activities.

2, Relationship of Official Dultes to Outside Activity

Describe any ottiolal duties Ihat relate in any way to the proposed activity II none, explain why.

Advice and assistance on matters of management are similar to those of: my

official duties at CDC.

Effect of Official Duties on Outside Employer

In performing your official duties, explain how your actions or the matters upon which you may be called upon to work could allecl the Interests ot the
pBrson for whom or the organization tor which ths proposed activity will be porformed. If the exercise ol your official duties would not have such an
effect, explain why.

They would have no effect as this is a not-for-profit entity with a dissimilar

mission.

Assignments Involving Outside Employer

Describe any olficia! dulv assignments or other Interactions you have had Ihat Involve the parson forwhom or the organizaiion for which the proposed
activity will be performed and Indicate when such assignments or Inlsraclions occurred. II none, explain
I have attended scheduled advisory meetings in the past. I have met with the
Foundation's staff and engaged in strategic planning.

5. CERTIFICATION
Tha undersigned employee certifies Ihat the notices in Part VIII havo bean read and understood and that the statements made and information provided on
this torm are true, complete, and correct to the best ot the Individual's knowledge

EMPLOYEE SIGNATURE ^ ^ DATE

HHB-520 (1/OS) (Previous Editions Obsolete) PAGE 6 OP 16

1. Summary of Applicable Law
An employee cannot undertake an outside acHvliy lhat conflicts with the employee's official duties. An activity conflicts with official duties; (a) if It is
prohibited by statute or regulation; or flj) It, under the standards in 5 CFR 2635.408 and 8635.502, it would require the employee's reousal from
matters so centra) or critical lo the performance of his or her official duties that the employee's ability to perform the duties of his or her position would
be materially Impaired- Such a reousal would Hkely arise where the outside activity involves a person or entity that Is regulated by, does business with,
receives grants or other benefits from, or Is otherwise substantially Impacted by the programs, policies, and operations ol the employee's agency, and
the employee riormally would be Involved personalty and substantially In such matters on a frequent basis or as a principal duty. In addition, an activity
may be improper If the circumstances suggest lhat the employee received an outside business opportunity based on his or her official position or would
create the appearance of using pubDc office tor the private gain of an outside entity. An employee also must endeavor to avoid any actions that create
the appearance of a violation of law or the ethical standards. Special rules apply to activities involving fundrafeing, expert witness testimony, teaching.
spaaklng, writing, or adding, and aclrvilles with foreign entities Certain categories ot employees, euch as those in FDA, NIH, and OSC. are subject to
component specific rules on outside activities Refer to the Standards of Ethical Conduct, 5 CFR part 2635, subpart H, and thB HHS Supplemental
Ethics Regulation, 5 CFR part 5501,

2. Supervisor's Statement
Describe the extent lo which the employee's official dulles are related to the proposed outside activity.

The employee's official duties do not directly relate to this proposed

outside activity. Employee has been informed that no official support or
endorsement by CDC is intended by his involvement and that no CDC
equipment will be used in the performance of this activity.

Recommendation
The undersigned supervisor, identified In Part I, Hem 10, has reviewed the employee's responses, obtained additional Information where appropriate,
and recommends the lollcwlng acUon:
n Recommend Approval
If this box is checked, the supervisor understands thai if the outside activity Is approved, the employee may be disqualified from performing ofliclat
duties that involve or atfecl any outside entity with which the employee has an outside employment, consulting, or similar relationship. If the
activity constitutes employment or sarvice as an oflicer, direolor, or trustee, or In another fiduciary role, the recusal obligation may extend not only
to government matters that specifically Involve or aflect the outside entity, but to those matters thatalfect generally the Industry or economic
sector In which the outside entity operates The supervisor concludes that any work assignments Involving specific or general matters from which
the employee will be recused can be reassigned to another Individual and are not so central or critical to the performance of the employee's
official duties that the employee's ablflty to perform the duties of his or her position would be materially Impaired.

Q Recommend Disapproval
If this box Is checked, explain the reason(s) In Ihe additional space provided on the last page of (his form.

SUPERVISOR SIGNATURE DATE

6
^CQCCJAA>>^_. 8<UrP$
HHS-520 (OT6) (Previous Editions Obsolete) PAGE 7 OF 16
 ■MANAGEMErMCD
1. Name of Reviewer 2, Title of Reviewer

Frederick Pestorius Management O f f i c i a l , ftCKDCID

3. Reviewer Contact Information
TELEPHONE FAX

( 404 )639-3788 ( )
CELL EMAIL

( )
4. Organization

Coordinating Center for Infectious Diseases

5- Committee
II Ihe reviewer acts on behal! ol a oommitlee, Identify the body and record any dissenting views In the "Comments" below

6. Review " . - ' ■ ' ■ ' ' ■ '

Review the employee's answers and Indicate whether you conour In the supervisor's recommendation Explain your reason(s) In the epace below. Sign
and date the form In the space provided

HHS-S20 (V06) (Previous Editions Obsolete) PAGE BOP 16

1. Name of Agency Ethics Official 2, Title of Agency Ethics Official

T e r e s a Walker-Mason Stlal ce Program Manager

3. Agency Ethics Official Contact Information
TELEPHONE FAX

( 404 ) 6 3 9 - 5 0 0 3 ( 404 ) 6 3 9 - 0 6 2 1
CELL EMAIL
bsg6@cdc.gov
( . >
4. Organisation
Centers for Disease Control and Prevention, OD/OCOO, Atlanta, GA
5. Ethics Review
Review Iha employee's answers and tho supervisor's recomttiendation. Consider iha assessment of any management official, committee, or other
Intermediate reviewer. Based on Iha information provided and applying Ihe standard for approval prescribed In S CFR S501.106(d)(5), Indicate whether
the activity can ba approved or permission must be denied. Explain your reason(s) in the space below and describe any actions deemed necessary to
ensure compliance with applicable ethics laws. Sign and date the lorm In the space provided,
0 Bequest as described may be approved
| Q Bequest may be approved subject to conditions noted In Comments Section
f~] Request as described must be denied
l~] Other disposition noted in Comments Section

AGENCY ETHICS OFFICIAL SIGNATURE

6. Comments
AJTUJ/1

HHS-520 (t/OS) (Previous Editions Obsolete)

PAGE 9 OF 16
 (;^tff^OESjG#^
1 . Name of Agency Deslgnae 2.' Title of Agency Deslgtiee

3. Agency Destgnee Contact Information

TELEPHONE FAX

( ) ( )
CELL EMAIL

( )
<t. Organization

B. Decision
Based on the foregoing statements and any supporting documanlallon, the recommendations ol the supervisor and, If applicable, any management
otllolal, committee, or other Intermediate reviewer, and the review by the agency ethics official, the disposition Indicated below constitutes my writtsn
determination, pursuant to 5 CFR 2635.803 and 5 CFR 8501,106(d), that the request to engage hi the Identified outside activity Is;

Q Approved
V) Approved subject to conditions
Q Dented

AGENCY DESIGNEE (APPROVING OFFICIAL) SIGNATURE DATE

6. Specified Conditions (it any)

7. Comments

HHS-520 (1/06) (Previous Editions Obsolete) PAGE 10 OF 18

APPROVAL OF AN OUTSIDE ACTIVITY DOES NOT RELEASE YOU FROM A CONTINUING LEGAL OBLIGATION TO
DISQUALIFY YOURSELF FROM OFFICIAL ASSIGNMENTS AFFECTING YOUR OUTSIDE EMPLOYER OR THE
ENTITY TO WHICH YOU ARE PROVIDING PERSONAL SERVICES. WHILE PERFORMING AN APPROVED OUTSIDE
ACTIVITY, ANY ACTIONS TAKEN IN CONFLICT WITH APPLICABLE ETHICS LAWS MAY SUBJECT YOU TO
CRIMINAL PROSECUTION OR DISCIPLINARY PROCEEDINGS.
Caution. When you consult, leach, spaak, write, serve on a board,
or work for a company, organization, or other entity outside your
government Job, your relationship with that outside entity has
certain legal and ethical consequences.ThB approval of an outside
activity does not mean that you are free of conflicts of Interest. You
must still follow all substantive ethics requirements after approval is
granted. Consult the ethics regulations at 5 CFR 2635.802 and
5501.106(d)(5) which are reprinted below.
Conlllcts Resolution. An approved HHS Form 520 does not
signify that you need not be concerned about conflicts of Interest.
Under the law, conflicts of Interest arising out of outside
employment or service in a fiduciary position can be resolved In
advance in only three ways: (1) you can inform your supervisor and
disqualify yourself from participating in a conflicting government
matter (often called a recusal); (2) you can seek, If certain legal
requirements are satisfied, a separate legal document from your
appointing official or designee that specifically permits you to work
on the government matter (known as a waiver), or (3) you can
resign from either your government or outside Job. Outside
relationships that fall short of actual employment or a fiduciary role
pose similar appearance concerns that must be addressed under
procedures In 5 CFR 2635.502.
Effect of Prior Approval. The outside activities prior approval
process has very limited purposes. When a reviewer approves an
HHS Form 520 for your outside activity, two fundamental
assessments are being made, which are discussed below. You
reasonably may rely on these specific determinations only if you
provided all relevant Information on the iorm and the circumstances
under review do not thereafter change. You remain responsible for
the legal and ethical consequences of any change in personal or
business affairs or a change in your government duties.
First, based on the information which you provide, the reviewer
determines whether your proposed activity Is plainly prohibited by
applicable statutes or regulations, including the provisions of the
ethical standards governing appearances of Impropriety. For
example, il you want to lobby Federal agencies on behalf of a
non-profit organization that employs you, prior approval will be
denied because a criminal statute prohibits such representational
activities.
Second, assuming your proposed activity Is not specifically
prohibited, the reviewer determines whether, under the circum­
stances, approval should be denied for other reasons specified
under the law. For example, (he reviewer may deny approval if the
facts show that you used your government position to obtain ah
outside compensated business opportunity or II the activity would
create the appearance that you are violating the law or the ethical
standards. Another common reason for denying approval is that the
outside activity may prevent you Irom handling work that Is
expected of you Because the outside activity may cause you to
have to disqualify yourself from a broad range of job assignments,
or even a few crucial projects, that will affect your outside employer
or the entity to which you provide personal services, It may be
Impossible for you to discharge fully your government duties
HH8-520 (1/0$) (Previous Editions Obsolete) PAGE 11 OF 1G
If, however, your outside activity Is approved, the reviewer has
determined that the matters In which you will not be allowed to
participate are not "so central or critical to the performance of Jyour]
official duties" that your ability lo perform the duties of your position
would be materially impaired. In other words, you cannot work on
a government matter affecting your outside employer, but the
reviewer expects that you will be able to stay away from these
assignments and still do your Job.
Recusal Obligations. When performing your Federal duties, you
must not participate In any government matter that will affect your
own self-interest In continuing your outside Job or activity. For
example, you would have to disqualify yourself from participating in
any official matter that might put your outside employer out of
business or seriously affect Its finances, either positively or
negatively, so that the odds of your remaining employed are also
affected. In addition, when you work for an outside employer or
serve in a fiduciary role with an organization, the financial interests
of that company or organization are considered to be your own As
a result, li the company or organization has a financial interest in
how a government matter will be resolved, you cannot work on that
matter, This means that you cannot work on a government matter
that involves or affects your outside employer as a specific party,
such as a contract, grant, audit, Investigation, or litigation, The law
also requires you to stay away from government matters that are
larger in scope, such as deliberations and decisions on developing,
Implementing, or enforcing statutes, regulations, policies, studies,
or proposals, that will have an elfect on a large class of employers
like the one for which you work on the outside For example, If you
were permitted to have an outside position as an employee ol a
hospital, a drug company, or a nonprofit organization, you could not
participate personally In any significant way in a policy decision that
affects the financial interests of the Industry or organizational sector
in which these employers operate. Under certain limited circum­
stances, a waiver tor such "particular matters of general
applicability" can be considered, if you notify your appointing official
In advance and receive a written determination. Outside relation­
ships that fall short of actual employment or a fiduciary role pose
similar appearance concerns, but the recusal obligation is limited lo
specific party matters.
Scope of Recusal. Although many employees understand the
need to disqualily themselves from participating in an official matter
that affects their outside employer, they often believe erroneously
that they can pick and choose among the various aspects of a
particular matter and stay away only from the important decisions
Such incomplete recusals will not protect you from a criminal
conflict oi Interest violation- Unless a waiver, approved In advance,
Identifies specific permitted activities, you must refrain entirely and
absolutely from participating personally and substantially in a
government matter that affects your own financial interest or that of
an outside employer When you are involved significantly In
proposing, planning, advising, deciding, or implementing some
official action, and you do so individually or by actively directing
subordinates, your participation is personal and substantial.
EXCERPTS FROM THE STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH AND
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES SUPPLEMENTAL AGENCY ETHICS REGULATIONS:
TITLE S CODE OF FE
§ 2635,802 Conflicting outside employment and activities.
An employee shall not engage In outside employment or any other
outside activity that conflicts with his official duties. An activity
confllcls with an employee's official duties:
(a) II it Is prohibited by statute or by an agency supplemental
regulation; or
(b) If, under the standards set forth in §§ 2635.402 and 2636 502, it
would require the employee's disqualification from matters so
central or critical to the performance of his official duties that the
employee's ability to perform the duties of his position would be
materially impaired
Employees are cautioned that even though an ouiside activity may
not be prohibited under this section, It may violate other principles
or standards set forth in this part or require the employee to
disqualify himself from participation In certain particular matters
undBr ellher subpart D or subpart E of this part
Example 1: An emptoyee of the Environmental Protection Agency
has just been promoted. His principal duty in his new position Is to
write regulations relating to the disposal of hazardous waste. The
employee may not continue to serve as president of a nonprofit
environmental organization thai rouilnely submits comments on
suoh regulations. His service as an officer would require his
disqualification from duties criilcal to the performance of his official
duties on a basis so frequent as to materially impair his ability to
perform the duties of his position
Example 2s An employee of the Occupational Safety and Health
Administration who was and is expected again to be instrumental In
formulating new OSHA safety standards applicable to manu-
facturers that use chemical solvents has been offered a consulling
contract to provide advice to ah affeoted company in restructuring
its manufacturing operations to comply with the OSHA standards.
The employee should not enter Into the consulting arrangement
even though he Is not currently working on OSHA standards
affecting this industry and his consulting contract can be expeoted
to be completed before he again works on such standards. Even
though the consulting arrangement would not be a conflicting
activity within the meaning of § 2635 802, It would create an
appearance that the employee had used his official position to
obtain the compensated outside business opportunity and it would
create the further appearance of using his public office for the
private gain of the manufacturer
HHS-520 (1/06) (Previous Editions Obsolete) PAGE 12 OF 18
=RAL REGULATIONS
§ 5S01-106(d)(0) Standard for approval.
Approval shall be granted only upon a determination that the
ouiside employment or oiher outside activity is not expected to
involve conduct prohibited by statute or Federal regulation,
including 5 CFR part 2635 and this part.
Note* The granting of approval for an outside activity does not
relieve the employee of the obllgaUon to abide by all
applicable laws governing employee conduct nor does
approval constitute a sanction of any violation. Approval
Involves an assessment that the general activity as described
on the submission does not appear likely to violate any
criminal statutes or other ethics rules. Employees are
reminded that during the course of an otherwise approvable
activity, situations may arise, or actions may be contemplated,
that, nevertheless, pose ethical concerns.
Example 1: A clerical employee with a degree in library science
volunteers to work on the acquisitions committee at a local public
library, Serving on a panel that renders advice'to a non-Federal
entity is subject to prior approval. Because recommending books
for the library collection normally would not pose a conflict wRh the
typing duties assigned the emptoyee, the request would be
approved.
Example 2: While serving on the library acquisitions committee,
the clerical employee in the preceding example is asked to help the
library business office locale a missing book order. Shipment of
the order Is delayed because the publisher has declared
bankruptcy and its assets, including inventory in the warehouse,
have been frozen to satisfy the claims of the Infernal Revenue
Service and other creditors- The employee may not contact the
Federal bankruptcy trustee to seek, on behalf ol the public library,
the release ol the books. Even though the employee's service on
the acquisitions committee had been approved, a criminal statute,
18 US,C. 205, would preclude any representation by a Federal
employee of an outside entity before a Federal court or agency with
respect to a matter In which the United States Is a party or has a
direct and substantial interest.
 The Ethics in Government Act, 5 U.S.C. App. § 101, et seg, Executive Order 12674, as amended by Executive Order 12731,
Sections 301 and 7301 oi Tltie 5 of the II .S Code, and Sections 2635.803 and 5501.106(d) of Title 5 of the Code of Federal
Regulations authorize the collection of this Information Disclosure ol this Information is mandatory for employees seeking prior
autnorteatlon from an agency deslgnee to pursue outside employment or activities pursuant to Sections 2635 803 and
5501.106(d) of Tille 6 of the Code of Federal Regulations Failure to provide all or part of the requested information may result
In denial of the request for approval of the oulslde employment or activity. Falsification of information or failure to file or report
Information required to be reported may subject the employee to disciplinary action. Knowing and. willful falsification of
information required to be reported may subject the employee io criminal prosecution The primary use of this information is to
allow HHS supervisors, management officials, and agency ethics officials to make necessary determinations concerning
employee requests for prior approval of oulslde employment or acllvifles in order to prevent a conflict of Interest or other
violations of the statutes, regulations, and executive orders governing employee conduct, ThB information Is also requested,
pursuant to 5 C.F.R. §§ 2638 203(b)(9),(10), and (11), for the purpose of evaluating ethics program administration, as well as
the Department's supplemental ethics regulations, to determine their continued adequacy and effectiveness In relation to
ourreni agency responsibilities and to ensure that prompt and effeclive action is taken to remedy violations or potential
violations, or appearances thereof, ol conflict of Interest and related ethics provisions. Additionally, this information may be
disclosed to: (1) the Offioe of Personnel Management, Office of Government Ethics, Merit Systems Protection Board, Office oi
the Special Counsel, Equal Employment Opportunity Commission, Federal Labor Relalione Authority, Federal Service
Impasses Panel, Federal Mediation and Conciliation Service, and an arbitrator, In carrying out their functions; (2) a Federal,
State, or locaf agency charged with Investigating or prosecuting violations of, or Implemeniing, the law, in the event there is an
Indication of a violation or potential violation of civil, criminal or regulatory law; (3) a Federal, State, or local agency maintaining
enforcement records or other pertinent records, such as current licenses, if necessary to obtain a record relevant to an agency
decision concerning 1he hiring or retention of an employee, the Issuance of a security clearance, the Istting of a contract, or the
Issuance of a license, grant or other benefit; (4) the National Archives and Records Administration or the General Services
Administration in records management Inspections; (5) the Oflice oi Management and Budget during legislative coordination
on privacy relief legislation; (6) Federal agencies with power to subpoena other Federal agencies' records; (7) a court or party
In a court or Federal administrative proceeding If the Government Is a party or In order Io comply wllh a judge-Issued
subpoena; (8) private firms with which the Department may contract for the purpose of collating, analyzing, aggregating or
otherwise refining records; (9) a Member ol Congress or a Congressional office, pursuant to an inquiry made at the request of
the individual who Is a subject of the record; (10) the Department ol Justice in defense of litigation; and (11) conlractors and
other non-Government employees working for the Federal Government to accomplish a function related to an Office of
Government Ethics Government-wide system ol records- This confidential report will not be disclosed to any requesting person
unless authorized by law. See the OGEA30VT-2 Government-wide executive branch system of records.

HHS-520 (1/06) (Previous Editions Obsolete) PAGE 13 OF 16

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HHS-620 (1/06) (Previous Editions Obsolele) PAGE 14 OF IS

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HHS-52D (1/OB) (Previous Editions Obsolete) PAGE 15 OF 16

 ^TX Pubtlc Health Service
I i / / ^ DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for DEsease Control
and Prevention (CDC)
"".u,i

Date JAN «3 m
Deputy Ethics Counselor
Centers for Disease Control and Prevention, and
From
Agency for Toxic Substances and Disease Registry

Subject Outside Activity

Douglas R. Browne
To Management Official, NCZVED, NCTX>
Through: Director, NCED (A-45)

Your renewal request, to serve on the advisory board of the National Save a Life, has
been approved- Pursuant to the latest version of the HHS Supplemental Standards of
Ethical Conduct, approval of an outside activity is effective for one year only,
Employees must renew their request for approval annually if they desire to continue any
long term outside activity. In addition, employees must submit a revised request for
approval if they change positions within the agency or if a significant change occurs in
the nature of the outside activity or in the scope of the employees' duties. Please note that
the approval of this outside activity will be considered inactive after December 31,2007.

You may perform this outside activity under the following conditions:

1. It must not create a real or apparent conflict of interest.

2. You must not participate in any action taken by the organization to endorse,
encourage, or oppose the adoption of a formal policy or position of CDC, HHS,
or the Federal Government.

Government-financed time, supplies, facilities, or equipment assigned or loaned

to you for completion of your official duties may be used for this outside activity
only as permitted by the Information Resources Management Manual Guide,
CDC-8, June 99, "Employee Use of CDC Information Technology Resources."

You shall not use or permit the use of your Government position or title or any
authority associated with your public office in a manner that could reasonably be
construed to imply that CDC or the Government sanctions or endorses your
outside activity.

5. You must not represent the organization before any Federal agency where the
Federal Government has a substantial interest in the matter.
Page 2. Douglas R. Browne

6. You are prohibited from taking any action as a CDC employee that could be
perceived as directly and predictably affecting the financial interests of this
organization.

7. You may not provide, for compensation, services on behalf of this organization to
prepare, or assist in the preparation of any grant applications, contract proposals,
program reports, or other documents intended for submission to HHS.

8. You must not participate in lobbying activities.

9. You may only participate in fund-raising activities consistent with the Office of
Government Ethics (OGE) Standards of Conduct at § 2635.808(b) and (c). You
may attend fund-raising functions, and you may participate in discussions and
planning of fund-raising activities this outside organization is considering,.
However, you may not personally solicit funds or other support from a
subordinate or a prohibited source, within the meaning of the OGE Standards at
§2635,203(dV

For more specific information concerning this outside activity, refer to Subpart H —
Outside Activities, of the Office of Government Ethics Standards of Ethical Conduct for
Employees of the Executive Branch, and Section 5501.106 of the HHS Supplemental
Standards of Ethical Conduct. Please note that if this activity is perfoimed during normal
working hours, you must be on approved leave.

If you have questions or need additional information, please call•Fran-eoHier, Ethics

Program Activity, Office of the Chief Operating Officer, OD, (404) 639-5113.