Fauci Awards Package (Redacted) — page 87

Request for Approval to Accept Gifts Associated With An Award from an Outside Organization 118 Deresdrnesibd Fedilcoend GumenrServizes Use prescribed by NIH Manual 2400-10 National Institutes of Health Use this form only for awards which confer gifts consisting of cash or cash equivalent, or a tangible item or items valued at greater than $20. When an award consists _ only of gifts of travel, meals, or a plaque, certificate, or trophy of little intrinsic value, use other methods to obtain approval, e.g., sponsored travel and/or the widely attended gathering exception. Provide all information. 1. EMPLOYEE NAME, TITLE, IC AND AGENCY ADDRESS 2. REQUEST DATE 02/02/2021 FAUCI, ANTHONY S DIRECTOR NIAID NIH/NIAID a 3. OFFICE TELEPHONE NUMBER 4. OUTSIDE ORGANIZATION (DONOR) OFFERING THE AWARD (Full Name and City, State |5. DATE OF AWARD EVENT or Country) Dan David Foundation Tel Aviv, Non-U.S. 05/09/2021 6. FULL NAME OF THE AWARD 7. LOCATION OF AWARD EVENT (City, State or Country) Tel Aviv, Non-U.S. Dan David Prize 8. AWARD CITATION The Dan David Prize recognizes and encourages innovative and interdisciplinary research that cuts across traditional boundaries and paradigms. It aims to foster universal values of excellence, creativity; justice, democracy, and progress and to promote th 9. Is the award offered by a private foundation? See note on Tax Consequences on page 3. [-]No [Yes _ If Yes, indicate your grade and annual salary: 10. a. Can your performance or non-performance of your official responsibilities have any effect on the donor? b. If the donor is an organization, does the majority of its rnembers have such interests that could be affected by the performance or non-performance of your official duties? [2] No to both aandb Continue to question 11 Yes to either a or b If the award donor can be substantially affected by your performance or nonperformance of official duties, or is an association a majority of whose miembers may be, the award may not be approved. Continue to question 11. 11. Have you solicited the award? [2] No Continue to question 12. ia Yes If you solicited the award, it cannot be approved nor accepted. 12. Do you agree to not accept the gifts incident to the award in return for being influenced in the performance or nonperformance of your official duties? 7] Yes Continue to question 13. [-] No If performance of your official duties will be influenced by accepting the gifts associated with the award, the award cannot be approved. 13. Does this award involve a tangible gift (other than cash or cash equivalent) valued at more than $200 (e.g., a crystal bowl). [1 No Continue with question 14. [7] Yes The award must be confirmed by the DEC as a bona fide award made as part of an established program of awards, before the employee may accept. Submit the written criteria used to select award recipients, and proof that it is given on a regular basis or funded to ensure continuity. Seek assistance from your IC's Ethics Office. 14. Does this award involve a cash or equivalent gift. [-] No Continue with question 15. Yes It must be reviewed through the NIH Ethics Office and confirmed as a bona fide award made as part of an established program of recognition before the employee may accept it. Contact your IC's Ethics Office as soon as possible. 15. Have you accepted gifts, including awards, from the same or different sources so frequently that a reasonable person would be led to believe that you are using your official position for private gain? [-] No Continue with question 16. Yes If you have accepted gifts such that accepting this one would cause any appearance of impropriety, the award may not be approved. NIH-2854 (Rev 08/09)