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Surgeon General Invitation Form

Submitted by lgerald on January 11, 2016 | 3:10 pm EST

Thank you for contacting the Office of the Surgeon General (OSG). We appreciate your interest in inviting the Surgeon General to speak at your event. When submitting your request we require the submission of an official letter of invitation in addition to this form. Please also provide a short bio for each distinguished guest in attendance. Limit supplemental material that you feel would be useful to the OSG in rendering a decision to 4 pages. We request that you submit this form along with any supporting materials preferably 4 months prior to the event date.

1a. Who is being requested to speak
1b. If none of the requested speakers can participate, would you accept a surrogate speaker?
(Excluding Q&A)
6. Speaking Date
8. Speaking Start time
:
10. Event Location
(Provide necessary details)
Please indicate the type of event (e.g. meeting, conference, dinner, award ceremony, etc.), then provide a brief summary of the event including goals. Character limit: 1200.
(Provide names, titles, and organization)
15. Type of Address
16. What types of media are invited to the event?
(If yes, what are the fees or what is the fair market value to attend)
20. Event Contact #1
21. Event Contact #2
22. Public Affairs/Media Contact
(Include information that could not be captured by this form)
24. Formal Letter of Invitation
For the invitation, preferably submit on letterhead and as a PDF. You may also send supplemental materials that would be useful to the Office of the Surgeon General when reviewing your request
Files must be less than 2 MB.
Allowed file types: pdf doc docx.

SPEAKING ENGAGEMENTS OR APPEARANCES BY THE SURGEON GENERAL: INFORMATION FOR OUTSIDE ORGANIZATIONS CONCERNING PROHIBITED GIFTS

Organizations that invite the Surgeon General to speak or otherwise participate in their events or activities often ask whether gifts or other tokens of appreciation are permissible. An Executive Order precludes, subject to certain exceptions, the Surgeon General from accepting gifts valued at any amount from registered lobbyists and lobbying organizations. Gifts received from media organizations or 501(c)(3) nonprofit organizations are not subject to the lobbyist gift ban provided that the employee of the organization offering the gift is not him or herself a registered lobbyist. In addition, federal ethics regulations prohibit, subject to certain exceptions, any federal government employee, including the Surgeon General, from personally accepting honoraria, gifts, favors, opportunities, benefits, discounts, or other items of value worth more than $20 that are offered as a result of official position or tendered by those who may have matters before the Department. The following items, however, may be offered and accepted without regard to the $20 limit or the lobbyist gift ban, except where noted in italics.

  • Modest items of food and refreshments, such as soft drinks, coffee and donuts, offered other than as part of a meal.
  • Food, refreshments, and entertainment offered in a group setting with other attendees at an event or conference at which the Surgeon General will deliver official remarks as a speaker or panel participant , if provided by the sponsoring organization on the day of the Surgeon General’s presentation.
  • Food, refreshments, and entertainment at a widely attended gathering for which there is an agency interest in the Surgeon General’s attendance, if the invitation has been tendered directly by the sponsoring organization that is holding the event. An invitation from a third party who has purchased tickets to the event cannot be accepted unless more than 100 persons will attend and the market value of free attendance is $350 or less.Complimentary widely attended gathering invitations from registered lobbyists or lobbying organizations, other than nonprofit or media organizations may not be accepted.
  • Plaques, certificates, and trophies that are intended solely for presentation and that have little intrinsic value are acceptable tokens of appreciation. (Note that art objects, glass works, sculptured trophies and similar items that have residual value or utility, even where diminished by an engraving, logo, or other marking, may not be accepted personally as a token of appreciation. Under certain circumstances, such valuable items may be presented to the Surgeon General, but these gifts must be treated as gifts to the Department for retention or display in accordance with applicable regulations.)
  • Native artwork, crafts, or other items representative of traditional native culture offered by  Indian tribes or Alaska native villages that do not exceed $200 in value. (Note that if the tribe or village has specific matters presently pending for decision by the Surgeon General, then acceptance is permitted only upon a written determination of agency interest.)
  • Food, refreshments, and entertainment, as well as tangible items of appreciation, valued at $350 or less offered by foreign governments, foreign political parties, and international or multinational organizations of which the United States is a member. Tangible items exceeding $350 may be accepted on behalf of the Department for retention or display in accordance with applicable regulations.
  • Food, refreshments, and entertainment at a meeting or event in a foreign country attended by foreign nationals and offered by persons or organizations other than a foreign government, if the value does not exceed the Department of State’s maximum per diem rate for that area. Complimentary hospitality tendered in a foreign country by registered lobbyists or lobbying organizations, other than nonprofit or media organizations may not be accepted.

Other rules apply to honorary degrees and awards for meritorious public service or achievement that include gifts of monetary value or that are signified by presentation items other than plaques, certificates, or trophies. These situations must be reviewed and approved in advance by the Department. Your assistance in ensuring compliance with these requirements will avoid an awkward or embarrassing situation in which items tendered impromptu must be declined or returned. Your cooperation in advising the Surgeon General’s Office of any proposed gifts is appreciated.

For more specific instructions and questions please direct them to [email protected].