Comment:
FPPC Form 806 (6/13)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
2. Appointments
3. Verification
I have read and understand FPPC Regulation 18705.5. I have verified that the appointment and information identified above is true to the best of my information and belief.
Signature of Agency Head or Designee Print Name Title (Month, Day, Year) Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend (Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1. Agency Name
Designated Agency Contact (Name,Title)
E-mail
Division, Department, or Region (If Applicable)
806
For Official Use Only
Area Code/Phone Number
(Month, Day, Year)
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
Date Posted:
Background
This form is used to report additional compensation that officials receive when appointing themselves to positions on committees, boards, or commissions of another public agency or to a committee or position of the agency of which the public official is a member.
This form is required pursuant to FPPC Regulation 18705.5.
Each agency must post on its website a single Form 806 which lists all the paid appointed positions to which an official will vote to appoint themselves. When there is a change in compensation or a new appointment, the Form 806 is updated to reflect the change. The form must be updated promptly as changes occur.
Instructions
This form must be posted prior to a vote (or consent item) to appoint a governing board member if the appointee will participate in the decision and the appointment results in additional income of $250 or more in a 12-month period. If an appointment does not result in additional income of at least $250 in a 12-month period, this form is not required.
FPPC Regulation 18705.5 provides that as long as the public is informed prior to a vote, an official may vote to hold another position even if the voting official will receive $250 or more in a 12-month period for the appointment.
Part 1. Agency Identification
Identify the agency name and information on who should be contacted for information.
Part 2. Appointments
Identify the name of the other agency, board or commission. List the name of the official, and an alternate, if any.
List the appointment date and the length of term the agency official will serve. Disclose the stipend provided per meeting and the estimated annual payment. The annual salary is an estimate as it will likely vary depending upon the number of meetings. It is not necessary to revise the estimate at the end of the calendar year.
Part 3. Verification
The agency head or his/her designee must sign the verification.
Frequently Asked Questions (FAQs)
1. When does an agency need to complete the Form 806?
A Form 806 is required when an agency’s board members vote to appoint a board member to serve on another
governmental agency or position of the agency of which the official is a member and at least $250 in any 12-month period will be provided to a voting member.
2. The city council votes to serve as the city’s housing authority, a separate entity. Will the Form 806 be required?
If the council members receive additional compensation ($250 or more in a 12-month period) for serving on the
housing authority, the Form 806 is required.
3. Are appointments made by a governing board to appoint one of its members to serve as an officer of that board for additional pay (e.g., mayor) required to be disclosed on Form 806?
Yes. FPPC Regulation 18705.5 permits voting on a member’s own appointment to the position of mayor, as well as other boards and commissions, so long as proper disclosure on the Form 806 is made. This applies to agencies with governing boards that are elected or appointed.
4. In determining the income, must the agency include mileage reimbursements, travel payments, health benefits, and other compensation?
No. FPPC Regulation18705.5 requires only the amount of the stipend or salary to be reported.
5. Which agency must post the Form 806?
The agency that is voting to appoint a public official must post the Form 806 on its website. The agency that the official will serve as a member is not required to post the Form 806. The form is not sent to the FPPC.
6. When must the Form 806 be updated?
The Form 806 should be amended promptly upon any of
the following circumstances: (1) the number of scheduled meetings is changed, (2) there is a change in the
compensation paid to the members, (3) there is a change in membership on the board or commission, or (4) there is a new appointment to a new agency.
7. If officials choose to recuse themselves from the decision and leave the room when a vote is taken to make an
appointment, must the Form 806 be completed?
No. The Form 806 is only required to identify those officials that will vote on an appointment in which the official will also receive additional income of $250 or more in a 12-month period.
Privacy Information Notice
Information requested by the FPPC is used to administer and enforce the Political Reform Act. Failure to provide information may be a violation subject to penalties. All reports are public records available for inspection and reproduction. Direct questions to FPPC’s General Counsel, Fair Political Practices Commission, 428 J Street, Ste. 620, Sacramento, CA 95814.
FPPC Form 806 (6/13)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
California
Form 806
A Public Document
Agency Report of:
Public Official Appointments
FPPC Form 806 (6/13)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
Continuation Sheet
2. Appointments
Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend (Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1. Agency Name
806
(Month, Day, Year)
Date Posted:
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
Name
Name
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
Other
Other
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____