Commission Forms

Required of State officers and employees designated as policy-makers whose intended outside activity requires both their agency Ethics Officer and Commission on Ethics and Lobbying approval. Revised 6/30/2022

State officers and employees, and statewide elected officials, are required to request and receive approval from their Approving Authority before accepting an official activity expense payment or service payment (as those terms are defined in 19 NYCRR Part 931 of the Commission regulations).

Updated 6/30/22

State officers and employees, and statewide elected officials, are required to request and receive approval from their Approving Authority before accepting an honorarium (when allowed by statute and as that term is defined in 19 NYCRR Part 930 of JCOPE regulations).

The Commission on Ethics and Lobbying in Government encourages all filers to submit a FDS through the FDS Online Filing System. However, individuals who submit a paper filing in lieu of an electronic filing may complete this writeable PDF form. 

Effective July 8, 2022.

Revised 6/28/2022

A filer required to file both an annual disclosure report with the New York City Conflict of Interests Board (COIB) and a FDS with the Commission on Ethics and Lobbying in Government may be able to submit the COIB filing to the Commission along with completing and submitting this supplemental form.

Revised July 5, 2022

The Commission encourages all filers to submit a FDS through the FDS Online Filing System. However, individuals who submit a paper filing in lieu of an electronic filing may complete this writeable PDF form.

A filer required to file both an annual disclosure report with the New York City Conflict of Interests Board (COIB) and a FDS with the Commission on Ethics and Lobbying in Government may be able to submit the COIB filing to the Commission along with completing and submitting this supplemental form.

Questions 1 - 3: Name, position, family

Revised July 5, 2022

Question 4(a) (Individual): Positions of Authority (other than those with the State) 

Revised July 5, 2022

Question 4(b) (Spouse and Unemancipated Child): Positions of Authority (other than those with the State) 

Revised July 5, 2022

Question 5(a) (Individual): Other Occupation/Outside Employment

Revised July 5, 2022

Question 5(b) (Spouse and Unemancipated Child): Other Occupation/Outside Employment

Revised July 5, 2022

Question 6: Interests and Contracts with a State or local government

Revised July 5, 2022

Question 7: Political Party Positions and Activities

Revised July 5, 2022

Question 8(a): Licensed Professions

Revised July 5, 2022

Question 8(b): Business Relationships and Client Disclosure

Question 8(b-1)

Revised July 5, 2022

Question 8(b-2)(i)

Revised July 5, 2022

Question 8(b-2)(ii)

Revised July 5, 2022

Question 8(c)

Revised July 5, 2022

Question 8(d): Business Investments

Revised July 5, 2022

Question 9: Gifts

Revised July 5, 2022

Question 10: Reimbursements by non-governmental sources related to Official State Duties

Revised July 5, 2022

Question 11: Retirement, Trusts, Estates

Revised July 5, 2022

Question 12(a): Employment Agreements

Revised July 5, 2022

Question 12(b): Employment Agreements - Prior Employment

Revised July 5, 2022

Question 13: All non-State income

Revised July 5, 2022

Question 14: Deferred Income

Revised July 5, 2022

Question 15: Assignment of income or transfer of assets

Revised July 5, 2022

Question 16: Investments in Securities

Revised July 5, 2022

Question 17: Real Estate

Revised July 5, 2022

Question 18: Money due or Notes and Accounts Receivable

Revised July 5, 2022

Question 19:  Debts and Liabilities

Revised July 5, 2022

Question 20: Signature Line

Revised July 5, 2022

Questions 1 - 3: Name, position, family

Question 4(a) (Individual): Positions of Authority (other than those with the State) 

Question 4(b) (Spouse and Unemancipated Child): Positions of Authority (other than those with the State) 

Question 5(a) (Individual): Other Occupation/Outside Employment

Question 5(b) (Spouse and Unemancipated Child): Other Occupation/Outside Employment

Question 6: Interests and Contracts with a State or local government

Question 7: Political Party Positions and Activities

Question 8(a): Licensed Professions

Question 8(b): Business Relationships and Client Disclosure

Question 8(b-1)

Question 8(b-2)(i)

Question 8(b-2)(ii)

Question 8(c)

Question 8(d): Business Investments

Question 9: Gifts

Question 10: Reimbursements by non-governmental sources related to Official State Duties

Question 11: Retirement, Trusts, Estates

Question 12a: Employment Agreements

Question 12(b): Employment Agreements - Prior Employment

Question 13: All non-State income

Question 14: Deferred Income

Question 15: Assignment of income or transfer of assets

Question 16: Investments in Securities

Question 17: Real Estate

Question 18: Money due or Notes and Accounts Receivable

Question 19:  Debts and Liabilities

Question 20: Signature Line

A filer who is not designated as a policy maker and whose annual salary exceeds the SG-24 filing rate may request an exemption from filing a FDS. Such exemptions may be requested through the FDS Online Filing System or by completing and submitting this writeable PDF form, which must be received or postmarked on or before the filing due date.

Revised July 5, 2022

State agencies and labor unions may request an exemption from filing a FDS on behalf of individuals in the same title or job classification who are not designated as policy makers and whose annual salary exceeds the SG-24 filing rate. Such exemptions may be requested through the FDS Online Filing System or by completing and submitting this writeable PDF form, which must be received or postmarked on or before the filing due date.

Revised July 5, 2022

A filer may request a 45-day extension of time to file the FDS based on justifiable cause or undue hardship. Extensions may be requested through the FDS Online Filing System or by completing and submitting this writeable PDF form, which must be received or postmarked on or before the filing due date.

Revised July 5, 2022

State officers and employees required to file a FDS may also be required to provide information regarding their spouses.  Filers with extenuating circumstances that prevent them from obtaining information regarding a spouse may utilize this form and submit to the Commision on Ethics and Lobbying in Government.  

Revised 7/5/2022

This form is available for State officers and employees who have left State service and would like to request a copy of previously filed FDS.  Please note: this form must be notarized. 

Revised July 5, 2022

A filer may request redaction of specific information from the copy of his or her FDS that is made publicly available. Redactions may be requested through the FDS Online Filing System or by completing and submitting this writeable PDF form. The Commission on Ethics and Lobbying in Government, at its discretion, may grant the request if the information sought to be redacted has no material bearing on the discharge of the filer’s official duties. This form may also be used to request an exemption from disclosing certain information pertaining to a spouse and/or unemancipated children. Again, at its discretion, the Commission may grant the request if (1) the spouse, on his or her own behalf or on behalf of an unemancipated child, objects to the disclosure of such information, and (2) the information has no bearing on the discharge of the filer's official duties. 

Revised July 5, 2022

Writable PDF for Paper Filers.  Use this form to file and submit your Lobbyist/Public Corporation Statement of Registration.

Revised 10/19/2022

Writable PDF for Paper Filers.  Use this form to file and submit your Lobbyist Bi-Monthly Report.

Revised 10/19/2022

Writable PDF for Paper Filers.  Use this form to file and submit your Public Corporation Bi-Monthly Report.

Revised 10/19/2022

Writable PDF for Paper Filers.  Use this form to file and submit your Client Semi-Annual Report. 

Revised 11/18/2022

This form may be used by Beneficial Clients that are Paper (PDF) Filers. All Beneficial Clients are required to complete this PDF form or submit this statement in the online Lobbying Application.  Completed PDF forms must be mailed to the Commission on Ethics and Lobbying.  Beneficial Clients required to disclose information on Sources must complete and mail this form AND e-mail the pre-formatted Excel Spreadsheet to [email protected].

Mail completed forms to:

NYS Commission on Ethics and Lobbying in Government

540 Broadway

Albany, New York 12207

Revised 11/1/2022

Revised 4/4/19

Please use this pre-formatted Excel Spreadsheet to disclose information on Sources for Source of Funding.  PAPER Filers who meet the Expenditure Threshold and are required to disclose Source of Funding information MUST utilize the pre-formatted Excel Spreadsheet.  The completed, original spreadsheet must be emailed to Commission staff at [email protected]; and should include your contact information and the name of the Beneficial Client to avoid filing delays.

ONLINE FILERS who meet the Expenditure Threshold and are required to disclose Source of Funding (“SoF”) information must either: utilize the Commission's online Lobbying Application (“LA”) to data-enter each Source individually; or complete and upload the pre-formatted Excel Spreadsheet provided by the Commission on Ethics and Lobbying. 

Refer to the 'Instructions for Completing the Pre-formatted Excel Spreadsheet to Disclose Source of Funding Information' prior to completing the blank spreadsheet.

Please note - this spreadsheet will not immediately appear on your screen; it will be automatically download and appear in your 'downloads' folder, or at the bottom of your screen. 

Use this form to disclose a Reportable Business Relationship with an Entity. 

Revised 10/19/2022

Use this form to disclose a Reportable Business Relationship with a State Person.

Revised 10/19/2022

Writable PDF for Paper Filers.  Use this form to file and submit your Lobbyist Disbursement of Public Monies Report. 

Revised 10/19/2022

This is for use by Coalitions to determine if any members of the Coalition exceed the $5,000 Compensation and Expenses threshold and would need to be listed as Beneficial Clients.  Only applicable for the 2019-2020 Biennial.

Writable PDF.  Revised 7/24/2019.

Only applicable for the 2019-2020 biennial.  Do NOT use for the 2021-2022 Bi-Monthly reports.  

Writable PDF.  Only applicable for the 2019-2020 Biennial. 

DO NOT use for 2021-2022 Biennial.  

The 2019-2020 Client Semi-Annual PDF form for paper Filers.  Revised 7/6/2020

This form may be submitted with a Statement of Registration in lieu of a copy of a lobbying agreement or contract.

Revised 11/2/2022

This form may be submitted with a Statement of Registration in lieu of a copy of a lobbying agreement or contract.  

Revised 11/1/2022

This form may be used by a Retained Lobbyist who is prepared to register with the Commission, but has not received the signed (executed) Lobbying Agreement back from your Client.

NEW for the 2021-2022 Biennial

Revised 6/28/2022

Use this sample written authorization letter for filing years 2023 through 2019.

Revised 10/20/2022

Use this sample written authorization letter for Employed Lobbyists for filing years 2023 through 2019.

Revised 10/20/2022

This sample letter advises the Commission of a change in the terms of an agreement/authorization for filing years 2023 through 2019.

Revised 10/20/22

This sample letter allows a chief administrative officer of an organization to designate another individual to make and sign statement(s) and/or report(s). A "Designation Letter" is not necessary for filers utilizing the online filing system.

Please Note - The chief administrative officer may designate another to sign and file the reports, but this designation does not relieve the chief administrative officer of liability due to a failure to file, late filing or false filing of any report(s).

Revised 10/31/2022

Use this letter as a sample letter for Registration Terminations related to 2019 and later year filings. 

Revised 11/2/2022

Sample letter to assist Filers in terminating an Individual Lobbyist from an Organization Profile related to 2019 and later year filings.  

For Paper PDF Filers only.  Filers that utilize the online Lobbying Application must terminate Individual Lobbyists online. 

Revised 11/2/2022

Use this letter as a sample letter for Client Terminations related to 2019 and later year filings. 

Revised 11/2/2022

This sample letter can be used if (1) the Lobbying Agreement was not executed by a Client within 15 days of the date on which the Lobbyist agreed to – or was authorized to – begin Lobbying Activity (the start date); or (2) there is a ‘gap in time’ from the expiration (end date) of a Lobbying Agreement already on file with the Commission, and the start date of a ‘new’ extended agreement.

Only valid for Filings for the 2019-2020 Biennial Period. 

Use this writable PDF form for all 2018 and prior year filings. 

Use this writable PDF form for all 2018 and prior year filings. 

Use this writable PDF form for all 2018 and prior year filings. 

Use this writable PDF form for all 2018 and prior year filings. 

Use this form for all 2018 and prior year filings. 

Use this form for all 2018 and prior year filings. 

Use this form for all 2018 and prior year filings. 

Revised 4/4/19

Use this form for all 2018 and prior year filings. 

Use this form for all 2018 and prior year filings.