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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act) OR MORE IN ORMA ION ABOU HE HA CH AC

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION)

Page 2 of 7

___________________________________________________________________________________________
U.S. OFFICE OF SPECIAL COUNSEL (202) 254-3650 / (800) 854-2824

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (VIOLATION OF THE HATCH ACT) (Please print legibly or type and complete all pertinent items. Enter "N/A" (Not Applicable) or "Unk nown" where appropriate. (If more space is needed, use Continuation Sheet at page 4.) PART 1: COMPLAINANTS INFORMATION 1. Name of person filing complaint: O'Brien Murray 2. Agency name (if referring complaint): 3. Agency Address (if referring complaint): Mr. ( ) Ms. ( ) Mrs. ( ) Miss. ( )

4. Home or mailing address (if filing complaint): 5. Contact information: Telephone number(s):

( 917 (

) ) ) 884-0620

(Home) (Office) Ext.

Fax number: E-mail address

( 212

EOM@OBrienMurray.com ( ( ) OSC brochure ) union ( ( ) OSC poster ) co-worker

6. How did you first become aware that you could file a complaint with OSC? ) OSC Web site ( ) OSC speaker ( ( ) news story ( ) agency personnel office ( )other (please describe): Date (approximate):

PART 2: SUBJECT'S INFORMATION

7. Name of person who violated the Hatch Act (Subject): Ambassador Patrick Gaspard 8. Agency: Department of State 9. Position/Title: US Ambassador 10.Federal, District of Columbia (DC), State/Local or Nonprofit employee (check one): ( ) Federal employee ( ) DC emloyee. ( ) State or Local employee ( ) Nonprofit organization employee 11. Contact information: Telephone number(s):

( (

) +27 (11) 290 3000 ) ) +27 (11) 884 0396

(Home) (Office) Ext.

Fax number: E-mail address:

consularjohannesburg@state.gov

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION)

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__________________________________________________________________________________________

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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act)

12.Subject's Supervisor's Name: Secretary of State John Kerry 13.Subject's Supervisor's Contact Information: Telephone number(s): ( 202 ) 647-4000 ( Fax number: E-mail address: 14.Does Subject have knowledge of the Hatch Act? (check one) : ( ( ) Yes ) No ( ) ) (Home) (Office) Ext.

( ) Not sure 15.If you answered Yes to question 14, plea explain how Subject knows about the Hatch Act (e.g. agency training, agencys distribution of brochures, flyers, e-mails, etc.) :

P a t r i c kG a s p a r di saU n i t e dS t a t e sA m b a s s a d o rt oS o u t hA f r i c a .P r e v i o u s l yM r .G a s p a r dw a sD i r e c t o ro f t h eW h i t eH o u s eO f f i c eo fP o l i t i c a lA f f a i r s .H eh a sa l s oh e l do t h e rp o l i t i c a lj o b sa n da p p o i n t m e n t s t h a tw o u l dh a v ei n v o l v e dh i sk n o w l e d g eo ft h eH a t c hA c t . A m b a s s a d o rG a s p a r di saP o l i t i c a lA p p o i n t e ew i t hS e n a t eC o n f i r m a t i o n .H ew a sn o m i n a t e db yP r e s i d e n t B a r a kO b a m aa n ds w o r ni no nA u g u s t2 6 ,2 0 1 3 . T h e r e f o r e ,y e sIf i r m l yb e l i e v et h a tP a t r i c kG a s p a r dh a dk n o w l e d g eo ft h eH a t c hA c t .

PLEASE COMPLETE THE FOLLOWING ONLY IF THE SUBJECT IS A STATE OR LOCAL OR NONPROFIT ORGANIZATION EMPLOYEE. IF NOT, SKIP TO PART 3: 16.Does Subjects employing agency receive federal funds? (check one) : ( ( ) Yes ) No

( ) Not sure 17.If you answered Yes to question 16, please provide the following: a) Nature and source of federal funds

b) Name of individual (s) at agency responsible for federal funds:

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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act)

c) Contact information for individual (s) responsible for federal funds: Telephone number(s): ) ( ( Fax number: E-mail address: ( ) )

(Home) (Office) Ext.

18.Does the Subject perform duties in connection with federal funds? (check one) : ( ( ) Yes ) No

) Not sure ( 19.If you answered yes to question 18, please provide the type of duties Subject performs in connection with Federal funds:

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION) Page 4 of 7

PART 3: DETAILS OF COMPLAINT 20.What are the actions that you are reporting to OSC? Please attach all supporting documentation to the complaint form. IF YOU ARE ALLEGING CANDIDACY IN A PARTISAN ELECTION, PLEASE PROVIDE THE DATE OF THE ELECTION AND/OR THE DATE NOMINATING PETITIONS ARE DUE. IF YOU ARE ALLEGING POLITICAL ACTIVITY WHILE ON DUTY OR IN A FEDERAL BUILDING FOR FEDERAL EMPLOYEES, PLEASE PROVIDE THE TIME AND/OR PLACE THE ACTIVITY OCCURRED. W h i l eU n i t e dS t a t e sA m b a s s a d o rt oS o u t hA f r i c a ,A m b a s s a d o rP a t r i c kG a s p a r dd i dk n o w i n g l ye n g a g ei n p a r t i s a np o l i t i c a la c t i v i t yw i t hh i si n v o l v e m e n ti nt h eN e wY o r kC i t yM a y o rr a c ea n dh i si n v o l v e m e n t i nt h eN e wY o r kC i t yS p e a k e r ' sr a c e . B o t hr a c e sa r ep a r t i s a na n dt h e r e f o r eav i o l a t i o no ft h eH a t c h A c t . P r i o rt oA m b a s s a d o rG a p a r d ' sa p p o i n t m e n ta n dc o n f i r m a t i o nh eh a dt h ef o l l o w i n gp o l i t i c a le x p e r i e n c e : D i r e c t o ro ft h eW h i t eH o u s eO f f i c eo fP o l i t i c a lA f f a i r sf o rt h eO b a m aa d m i n i s t r a t i o nf r o mJ a n u a r y2 0 0 9 t o2 0 1 1 , A s s o c i a t eP e r s o n n e lD i r e c t o ro fP r e s i d e n t e l e c tO b a m a ' st r a n s i t i o nt e a m ,a n dN a t i o n a l P o l i t i c a lD i r e c t o ro fB a r a c kO b a m a ' s2 0 0 8p r e s i d e n t i a lc a m p a i g n . G a s p a r d ' se a r l yc a r e e rw a ss p e n ti nN e wY o r kC i t y ,i n c l u d i n gw o r k i n go nt h e1 9 8 8J e s s eJ a c k s o n p r e s i d e n t i a lb i da n dD a v i dD i n k i n s ' ss u c c e s s f u l1 9 8 9m a y o r a lc a m p a i g n . H ew e n to nt os e r v ea saS p e c i a l A s s i s t a n ti nt h eO f f i c eo fM a n h a t t a nB o r o u g hP r e s i d e n ta n dS p e c i a lA s s i s t a n ti nt h eO f f i c eo fM a y o r D i n k i n s ,a n dl a t e r ,f r o m1 9 9 8 1 9 9 9 ,C h i e fo fS t a f ft ot h eN e wY o r kC i t yC o u n c i l . [ 5 ]I n2 0 0 3 2 0 0 4 ,h e w o r k e df o rG o v e r n o rH o w a r dD e a n ' s2 0 0 4p r e s i d e n t i a lc a m p a i g na st h eN a t i o n a lD e p u t yF i e l dD i r e c t o r , a n di n2 0 0 4 ,w a st h eN a t i o n a lF i e l dD i r e c t o rf o rA m e r i c aC o m i n gT o g e t h e r .
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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act) G a s p a r ds p e n tn i n ey e a r sa st h ee x e c u t i v ev i c ep r e s i d e n tf o rp o l i t i c sa n dl e g i s l a t i o nf o rt h e1 1 9 9 S E I U U n i t e dH e a l t h c a r eW o r k e r sE a s tl a b o ru n i o n ,t h el a r g e s tl o c a lu n i o ni nA m e r i c a . [ 6 ] [ 7 ]H eh e l p e d c o o r d i n a t ep o l i t i c a la c t i v i t ya n dg o v e r n m e n tr e l a t i o n so nb e h a l fo f3 0 0 , 0 0 0m e m b e r s .I n2 0 0 6 ,h e s e r v e da st h ea c t i n gp o l i t i c a ld i r e c t o rf o rS E I UI n t e r n a t i o n a ld u r i n gt h en a t i o n a lu n i o n ' ss u c c e s s f u l e f f o r tt oh e l pD e m o c r a t sc a p t u r em a j o r i t i e si nt h eH o u s ea n dS e n a t e .

T h ea b o v ei n f o r m a t i o nr e f l e c t sA m b a s s a d o rG a s p a r d ' ss i g n i f i c a n tp o l i t i c a lb a c k g r o u n d ,h i sc o n n e c t i o n s t oN e wY o r kC i t yH a l la n dt h eN e wY o r kC i t yh a l le l e c t i o np r o c e s s . T h ei n f o r m a t i o nb e l o wc o n f i r m s A m b a s s a d o rG a s p a r d ' sc o n n e c t i o nt oM a y o rB i l ld eB l a s i o ,ad e m o c r a tw h ow a se l e c t e do nN o v e m b e r5 , 2 0 1 3i nap a r t i s a ne l e c t i o n . 1 )S e p t e m b e r1 8 ,2 0 1 3-A c c o r d i n gt op u b l i s h e dr e p o r t si nC i t ya n dS t a t eA m b a s s a d o rG a s p a r d c o o r d i n a t e da n de n c o u r a g e dB i l lT h o m p s o nt ol e a v et h eN e wY o r kC i t yM a y o r ' st oa v o i dad e v i c e d e m o c r a t i cr u n o f fa n dp e r m i t t i n gd e m o c r a t i cu n i t ya g a i n s tt h eR e p u b l i c a nn o m i n e eJ o s e p hL h o t a . h t t p : / / w w w . c i t y a n d s t a t e n y . c o m / a m b a s s a d o r b r i d g e d d i v i d e b e t w e e n d e b l a s i o a n d t h o m p s o n / 2 )N o v e m b e r5 ,2 0 1 3-M a y o r e l e c tB i l ld eB l a s i oE l e c t i o nN i g h tS p e e c h : D EB L A S I O :( S P E A K I N GF O R E I G NL A N G U A G E ) T oe v e r y o n ew h ok n o c k e do nd o o r s ,m a d ep h o n ec a l l s ,p e r s u a d e dy o u rf r i e n d s ,h e l dh o u s ep a r t i e so re v e n t w e e t e da b o u tt h i sc a m p a i g n .T h i sv i c t o r yi sy o u r s .T h a n ky o us om u c hf o rw h a ty o ua c h i e v e d . T h e r ea r es om a n yi n s p i r i n gi n d i v i d u a l sa n do r g a n i z a t i o n s ,s om a n yf r i e n d s ,w h om a d et h i sv i c t o r y p o s s i b l e .I fIm e n t i o ne a c hb yn a m ew ew o u l db eh e r ea l ln i g h t .B u ty o uk n o ww h oy o ua r e ,a n dy o uk n o w Iw o u l d n ` tb eh e r ew i t h o u ty o u .Id ow a n tt oa c k n o w l e d g et w oc l o s ef r i e n d sw h og u i d e d a n da d v i s e dm ea te v e r yt u r ne v e nw h e nt h ep o l l sd i d n ` tl o o ks oh o t .P l e a s eg i v ei tu pf o rA m b a s s a d o r P a t r i c kG a s p a r da n dN i c kB a l d i n g .A n dIw a n tt os a yh o wg r a t e f u lIa mt oB i l lH y e r sa n dE m m aW o l fa n d t h eb e s tc a m p a i g nt e a mt h i sc i t yh a se v e rs e e n ! h t t p : / / w w w . n b c n e w s . c o m / i d / 5 3 4 7 7 6 5 9 / # . U s z j v R D u a 8 3 )N o v e m b e r8 ,2 0 1 4-N YT i m e sC i r c l eo fP o w e r T h eN YT i m e ss t a t e d ," W h od o e sM r .d eB l a s i oc a l lf i r s tw h e nd e a l i n gw i t hac r i s i s ,o rg a m i n go u tt h e p o l i t i c s ?M r .G a s p a r dw h oi sn o wt h eU SA m b a s s a d o rt oS o u t hA f r i c a . . . " h t t p : / / w w w . n y t i m e s . c o m / i n t e r a c t i v e / 2 0 1 3 / 1 1 / 0 8 / n y r e g i o n / b i l l d e b l a s i o s c i r c l e o f p o w e r . h t m l ? _ r = 0 4 )D e c e m b e r1 9 ,2 0 1 3-R e p u b l i c a nC i t yC o u n c i lM e m b e re n d o r s e dt h eD e m o c r a ti nt h er a c ef o rt h eN e w Y o r kC i t yS p e a k e r . A c c o r d i n gt oap u b l i s h e dr e p o r tb yP o l i t i c k e r ," M r .U l r i c hs h o c k e dm a n yp o l i t i c a l o b s e r v e r sy e s t e r d a yw h e nh es u d d e n l yb a c k e dM s .M a r k V i v e r i t o ,o n eo ft h el e f t m o s tm e m b e r so ft h e c o u n c i l .M r .U l r i c hh a dp r e v i o u s l yp l e d g e dt ov o t ew i t hh i st w oG O Pc o l l e a g u e s ,b u tb r o k er a n kt oj o i n ad e a lf o r g e db yM a y o r e l e c tB i l ld eB l a s i o ,t h eP r o g r e s s i v eC a u c u sa n dt h eB r o o k l y nD e m o c r a t i cP a r t y t oc r o w nM s .M a r k V i v e r i t o . " h t t p : / / p o l i t i c k e r . c o m / 2 0 1 3 / 1 2 / e r i c u l r i c h s a y s m e l i s s a m a r k v i v e r i t o w o n t b e a d i s a s t e r a f t e r a l l / 5 )D e c e m b e r3 1 ,2 0 1 3-U SA m b a s s a d o rG a s p a r dw a sr e p o r t e db yap o o lr e p o r t e ra c c o r d i n gt oT h o m a s K a p l a no ft h eN YT i m e si nat w e e tt ob ea tt h ep r i v a t eS w e a r i n gi na tt h eh o m eo fM a y o rB i l ld e B l a s i o . S c r e e n s h o to fT w e e tI n c l u d e d 6 )J a n u a r y1 ,2 0 1 4A tt h ei n a u g u r a t i o ni nan e w sr e p o r to nN Y 1b yr e p o r t e rG r a c eR a u hA m b a s s a d o r G a s p a r dw a sq u o t e da ss a y i n gB i l lD eB l a s i ow a saf o u r t hb r o t h e rt oh i ma n dh i sb e s tf r i e n do u t s i d e h i sf a m i l y . h t t p : / / w w w . n y 1 . c o m / c o n t e n t / p o l i t i c s / p o l i t i c a l _ n e w s / 2 0 1 2 3 7 / d e b l a s i o s u p p o r t e r s b a s k i n g l o w o f i n a u g u r a t i o n 7 )J a n u a r y1 ,2 0 1 4-R a n d iW e i n g a r t n e rT w e e t e d ," P a t r i c kG a s p a r d t h es t r a t e g i s tb e h i n dt h e# d e b l a s i o w i n . . . . " S c r e e n s h o to fT w e e tI n c l u d e d 8 )J a n u a r y2 ,2 0 1 4 -AN Y 1r e p o r tb yC o u r t e yG r o s sr e p o r t e d ," S o u r c e st e l lN Y 1t h a tP a t r i c kG a s p a r d , t h ec u r r e n ta m b a s s a d o rt oS o u t hA f r i c aa n dc l o s ef r i e n do ft h em a y o r ,w a sm a k i n gc a l l sp u s h i n gM a r k V i v e r i t o ' sc a n d i d a c yl a s tw e e k . " h t t p : / / w w w . n y 1 . c o m / c o n t e n t / p o l i t i c s / p o l i t i c a l _ n e w s / 2 0 1 2 9 0 / l a t i n o l a w m a k e r s r a l l y f o r m a r k v i v e r i t o s s p e a k e r c a n d i d a c y www.osc.gov/documents/forms/osc13.htm
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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act) P A G EB R E A K -

9 )J a n u a r y3 ,2 0 1 4-A m b a s s a d o rG a s p a r dT w e e t e d ," P r o u dt ob ef r i e n d sw i t hB i l ld e B l a s i of o r2 5y e a r s a n dI ' mt h r i l l e db yh i sw i n .T h a t ' st h ee x t e n to fm yN Y C g a z e .F o c u s e do nm yw o r ki nS A . " S c r e e n s h o to fT w e e tI n c l u d e d 1 0 )J a n u a r y1 0 ,2 0 1 4-P o l i t i c op u b l i s h e das t o r yt h a th a dc o o p e r a t i o nf r o mt h eD e p a r t m e n to fS t a t e w h i c hd i r e c t l yc o n t r a d i c t e dA m b a s s a d o r st w e e tt h a tr e f e r r e dt ot h eA m b a s s a d o r ' si n v o l v e m e n ta sa " g a z e . " T h e r ew a sn os h o r t a g eo fp e o p l ew h ow e r ec o n s t a n t l ya s k i n gh i ma b o u tt h er a c e ,f r o me l e c t e do f f i c i a l s t oi n s t i t u t i o n a lp l a y e r s ,u n i o n s ,a c t i v i s t se tc e t e r a , s a i dap e r s o nc l o s et oG a s p a r d . H en e v e r e v e r ,e v e r ,e v e rh e s i t a t e dt os a yt w ot h i n g st ow h o e v e ra s k e d :O n e , L e t sf i r s tp u to nt h et a b l et h a t Ih a v eb i a sb e c a u s eB i l ld eB l a s i oi sm yc l o s e s tf r i e n di nt h ew o r l d . B u ti r r e s p e c t i v eo ft h a t , I m g o i n gt ot e l ly o ue x a c t l yw h y ,n o to n l yd oIt h i n kh eh a sas t r o n gc h a n c e ,b u tt h a tIt h i n kh e sg o i n g t ob et h en e x tm a y o ro fN e wY o r k . H ew o u l dl a yo u tt h ep a t hf o rd eB l a s i o , t h ep e r s o ns a i d . D e s p i t en o tb e i n gi nt h ec i t yf o ra w h i l e ,h ec o u l dt a l kt h r o u g ht h ed e m o g r a p h i c s ,t h ep o s s i b i l i t i e st h a te x i s t e di nc e r t a i nc o m m u n i t i e s . A n dh eh a p p e n st ob er e a l l yw e l l v e r s e di nt h es t r e n g t h sa n dw e a k n e s s e so fe v e r ys i n g l ep e r s o ni nt h a t f i e l d ,b e c a u s em o s to ft h e m ,h ec a m eu pw i t h . W h e nh e sn o te n t r e n c h e di ne c o n o m i cs t a t e c r a f t ,G a s p a r d ss t i l lo nt h ep h o n ew i t hp e o p l el i k eM a t h i e u E u g e n e ,ac i t yc o u n c i l m a nf r o mK e n s i n g t o na n dD i t m a sP a r ki nB r o o k l y n ,w h o sa m o n gt h o s ew h os a yh e s p e a k sw i t hG a s p a r d v e r yo f t e n . D eB l a s i o sc h i e fo fs t a f f ,L a u r aS a n t u c c i ,w a sG a s p a r d sl o n g t i m ed e p u t y .S h e sn o tt h eo n l yo n ei n C i t yH a l lw h os t i l lt a l k st oh i mr e g u l a r l y .A st h e ys t i l ld oi np u t t i n gt h ea d m i n i s t r a t i o nt o g e t h e r , d eB l a s i o st e a ml e a r n e dt ot r u s tG a s p a r dt ok n o ww h a th ew o u l dt h i n kd u r i n gt h ec a m p a i g n .T h e yr e l i e d o nh i mo c c a s i o n a l l yt op e r s u a d et h ec a n d i d a t et og oa l o n gw i t ht h e i rp l a n s .A n dd eB l a s i os o m e t i m e s a l l o w e dG a s p a r d sa d v i c et os u p e r s e d eh i so w ni n s t i n c t s ,p a r t i c u l a r l yo nt h es u b j e c to fh i sw i f ea n d c h i l d r e n . H e sn o tad a y t o d a yo p e r a t o ri nm a k i n gp o l i t i c a lo rg o v e r n m e n td e c i s i o n sh e sm o r et h eg u a r d i a n o fB i l l se s s e n c ea n dm a k i n gs u r et h a th e sf i r i n go na l lc y l i n d e r s ,t h a th e sb e i n gt r u et oh i m s e l f , t h a th eh a st i m ef o rh i sf a m i l y , s a i dJ o h nD e lC e c a t o ,d eB l a s i o sl e a dc o n s u l t a n t ,w h o mt h e c a n d i d a t eb r i e f e do nG a s p a r d sr o l ea tt h e i rv e r yf i r s tm e e t i n ga b o u tt h ec a m p a i g n . h t t p : / / w w w . p o l i t i c o . c o m / s t o r y / 2 0 1 4 / 0 1 / b a r a c k o b a m a a m b a s s a d o r t o n e w y o r k p a t r i c k g a s p a r d 1 0 1 9 8 9 . h t m l T h e s ee v e n t sa n dp u b l i s h e dr e p o r t ss h o wt h a tA m b a s s a d o rP a t r i c kG a s p a r dh a dr e a d ya c c e s st oM a y o rB i l l d eB l a s i oa n dh a st r i e dt od i s t a n c eh i m s e l ff r o mt h ep u b l i s h e dr e p o r t sa b o u th i si n v o l v e m e n ti n p a r t i s a np o l i t i c s . Ib e l i e v eA m b a s s a d o rG a s p a r dk n o w sh eb r o k et h el a wa c c o r d i n gt h eH a t c ha c ta n di n t h eP o l i t i c os t o r yf r o mJ a n u a r y1 0 ,c i t e da b o v e ,m a yh a v ee v e ng o n ea sf a ra st oc o o r d i n a t ew i t ht h e D e p a r t m e n to fS t a t et oc o v e r u pt h i sc r i m e . T h ec l a i mt h a tt h e r ew a sa ne x i s t i n gr e l a t i o n s h i pw o u l dn o tc o v et h es i g n i f i c a n ta m o u n to ft i m ea n d t h en u m b e ro fp e o p l eA m b a s s a d o rG a s p a r dc o n t a c t e dd u r i n gap a r t i s a ne l e c t i o n .

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION) Page 5 of 7

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PART 4: CONSENT TO CERTAIN DISCLOSURES OF INFORMATION OSC asks everyone who files a complaint alleging a possible prohibited personnel practice or other prohibited activity to select one of three Consent Statements shown below. IF YOU DO NOT SELECT ONE OF THE THREE CONSENT STATEMENTS BELOW, OSC WILL ASSUME YOU H E SELEC E C www.osc.gov/documents/forms/osc13.htm 6/8

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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act)

THAT YOU HAVE SELECTED CONSENT STATEMENT 1. Please: (a) select and sign (or check, if filing electronically) one of the Consent Statements below; and (b) keep a copy of the Consent Statement you select (as well as a copy of all documents that you send to OSC) for your own records. If you initially select a Consent Statement that restricts OSC's use of information, you may later select a less restrictive Consent Statement. If your selection of Consent Statement 2 or 3 prevents OSC from being able to conduct an investigation, an OSC representative will contact you, explain the circumstances, and provide you with an opportunity to select a less restrictive Consent Statement. You should be aware that the Privacy Act allows information in OSC case files to be used or disclosed for certain purposes, regardless of which Consent Statement you sign. See 5 U.S.C. 552a(b). Information about certain circumstances under which OSC can use or disclose information under the Privacy Act appears on the next page. (Please sign one) Consent Statement 1 I consent to OSCs communication with the pertinent individuals involved in my complaint. I agree to allow OSC to disclose my identity as the complainant, and information from or about me, if OSC decides that such disclosure is needed to investigate the allegation(s) in my complaint. I understand that regardless of the Consent Statement I choose, OSC may disclose information from my complaint file when permitted by the Privacy Act (including circumstances summarized in Part 6, below). _________________________________________________________ Complainant's Signature for Consent Statement 1 Consent Statement 2 I consent to OSCs communication with the pertinent individuals involved in my complaint, but I do not agree to allow OSC to disclose my identity as the complainant. I agree to allow OSC to disclose only information from or about me, without disclosing my name or other identifying information, if OSC decides that such disclosure is needed to investigate the allegation(s) in my complaint. I understand that in some circumstances OSC could not maintain my anonymity while communicating with the pertinent individuals. In such cases, I understand that this request for confidentiality might prevent OSC from taking further action on my complaint. I also understand that regardless of the Consent Statement I choose, OSC may disclose information from my complaint file when permitted by the Privacy Act (including circumstances summarized in Part 6, below). _________________________________________________________ Complainant's Signature for Consent Statement 2 Consent Statement 3 I do not consent to OSCs communication with the pertinent individuals involved in my complaint. I understand that if OSC decides that it cannot investigate the allegation(s) in my complaint without communicating with this individuals, my lack of consent will probably prevent OSC from taking further action on the complaint. I understand that regardless of the Consent Statement I choose, OSC may disclose information from my complaint file when permitted by the Privacy Act (including circumstances summarized in Part 6, below). _________________________________________________________ Complainant's Signature for Consent Statement 3 _______________________________ Date Signed _______________________________ Date Signed _______________________________ Date Signed

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION) Page 6 of 7 ___________________________________________________________________________________________

PART 5: CERTIFICATION AND SIGNATURE I certify that all of the statements made in this complaint (including any continuation pages) are true, complete, and correct to the best of my k nowledge and belief. I understand that a false statement or concealment of a material fact is a criminal offense punishable by a fine of up to $250,000, imprisonment for up to five years, or both. 18 U.S.C. 1001. ________________________________________________________ Signature _________________________________ Date Signed

PART 6: PRIVACY ACT / PAPERWORK REDUCTION ACT STATEMENTS Routine Uses . Limited disclosure of information from OSC files is needed to fulfill OSC's investigative, prosecutorial, and related respons bilities. OSC has described 18 routine uses for information in its files in the Federal Register (F.R.), at 66 F.R. 36611 (July 12, 2001), and 66 F.R. 51095 ( , ). y the www.osc.gov/documents/forms/osc13.htm 7/8

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Form OSC-13: Complaint of Possible Probhibited Political Activity (Violation of the Hatch Act) (October 5, 2001). A copy of the routine uses is available from OSC upon request. A summary of the routine uses appears below.

OSC may disclose information from its files in the following circumstances: 1. to disclose that an allegation of prohibited personnel practices or other prohibited activity has been filed; 2. to disclose information to the Office of Personnel Management (OPM) as needed for inquiries involving civil service laws, rules or regulations, or to obtain an advisory opinion; 3. to disclose information about allegations or complaints of discrimination to entities concerned with enforcement of antidiscrimination laws; 4. to the MSPB or the President, when seeking disciplinary action; 5. to the involved agency, MSPB, OPM, or the President when OSC has reason to believe that a prohibited personnel practice has occurred, exists, or is to be taken; 6. to disclose information to Congress in OSC's annual report; 7. to disclose information to third parties (without identifying the complainant unless OSC has the complainant's consent) as needed to conduct an investigation; obtain an agency investigation and report on information disclosed to OSC's whistleblower disclosure channel; or to give notice of the status or outcome of an investigation; 8. to disclose information as needed to obtain information about hiring or retention of an employee; issuance of a security clearance; conduct of a security or suitability investigation; award of a contract; or issuance of a license, grant, or other benefit; 9. to the Office of Management and Budget (OMB) for certain legislative coordination and clearance purposes;

COMPLAINT OF POSSIBLE PROHIBITED POLITICAL ACTIVITY (HATCH ACT VIOLATION) Page 7 of 7

___________________________________________________________________________________________ 10. to provide information from an individual's record to a congressional office acting pursuant to the individual's request; 11. to furnish information to the National Archives and Records Administration for records management purposes; 12. to produce summary statistics and work force or other studies; 13. to provide information to the Department of Justice as needed for certain litigation purposes; 14. to provide information to courts or adjudicative bodies as needed for certain litigation purposes; 15. to disclose information to the MSPB as needed in special studies authorized by law; 16. for coordination with an agency's Office of Inspector General or comparable entity, to facilitate the coordination and conduct of investigations and review of allegations; 17. to news media or the public in certain circumstances (except when the Special Counsel determines that disclosure in a particular case would be an unwarranted invasion of personal privacy); and 18. to the Department of Labor and others as needed to implement the Uniformed Services Employment and Reemployment Rights Act of 1994, and the Veterans' Employment Opportunities Act of 1998. If OSC officials believe that disclosure may be appropriate in a situation not covered by one of OSC's routine uses, or one of the 11 other exceptions to the Privacy Act's general prohibition on disclosure, OSC will seek written authorization from the complainant permitting the disclosure. Purposes, Burdens, and Other Information. An agency may not conduct or sponsor a collection of information, and persons may not be required to respond to a collection of information, unless it: (a) has been approved by OMB; and (b) displays a currently valid OMB control number. The information in this form is collected pursuant to OSC's legal responsibility to investigate: (a) allegations of prohibited political activity (5 U.S.C. 1216). The information will be reviewed by OSC to determine whether the facts establish its jurisdiction over the subject of the complaint, and whether further investigation and disciplinary action is warranted. The reporting burden for this collection of information is estimated to be an average of 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the form. Please send any comments about this burden estimate, and suggestions for reducing the burden, to the Office of Special Counsel, Legal Counsel and Policy Division, 1730 M Street, N.W. (Suite 218), Washington, DC 20036-4505.

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