Payment to Agency Report
Instructions
FPPC Form 801 (Jan/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
California
Form
801
A Public Document
This form is used to report certain payments received by state and local
government agencies. It includes:
• apaymentforanocial’stravelexpensesforthepurposeof
facilitangthepublic’sbusinessinlieuofapaymentusingagency
funds; and
• apaymentthatwouldotherwisebeconsideredagiorincome
tothebenengocial,butisinsteadacceptedonbehalfofthe
agency.
FPPCRegulaons18944and18950.1provideaprocedurethatstate
and local agencies may use to disclose payments used for agency
purposesandpaidbyathirdparty.Theregulaons’reporng
proceduresprovideanalternavemeanstodiscloseapayment
thatmayotherwisebeconsideredincomeoragitoabeneng
employeeandsubjecttoreporngonaStatementofEconomic
Interest,Form700.
When and Where to File
AnagencyaccepngapaymentpursuanttoRegulaon18944
and18950.1mustcompleteForm801foreachpaymentreceived
regardless of the amount. The form must be maintained as a public
document.Ifpaymentsaggregate$2,500ormoreinacalendar
quarter,websiteposngisrequired.
Website Posng:
State Agencies
Within30daysaertheendofacalendarquarterifaggregated
reportedpayments,fortravelandnon-travelpurposes,total$2,500or
more:
• the agency must post the reports (or a report summary) on the
agency website; and
• forwardtheinformaontotheFPPCwhichwillalsopostthe
informaon.
Local Agencies
Thewebsiteposngrulesdierfortravelandnon-travelpayments.
Travel
Within30daysaertheendofacalendarquarterifaggregated
reportedpaymentstotal$2,500ormore:
• the agency must post the reports (or a report summary) on the
agency website; and
• forwardtheinformaontotheFPPC.
Payments Not Related to Travel
Theagency’slingocerforStatementofEconomicInterests,Form
700,mustreceivethereport.Within30daysaertheendofa
calendarquarterifaggregatedreportedpaymentstotal$2,500or
more,thelocalagencymustposttheinformaononthelocalagency
website. A report is not sent to the FPPC unless the agency does not
have a website.
Posngsmustbedisplayedinaprominentmannerandeasily
accessible. Reports may be posted earlier.
FPPC:Statementsshouldbeemailedtoform801@fppc.ca.gov.
Statementsmayalsobemailedto1102 Q Street, Suite 3000,
Sacramento, CA 95811orfaxedto(916)322-3711.
Part 1. Agency Idencaon
Listtheagency’snameandaddressandthenameofanagencycontact.
Marktheamendmentboxifchanginganyinformaononapreviously
ledformandincludethedateoftheoriginalling.
Part 2. Donor Informaon
Disclose the name and address of the donor. If the donor is not an
individual,idenfythebusinessacvityornatureandinterestsofthe
enty.
If the donor received funds from other sources that were used in
conneconwiththepayment,disclosethenameandpayment
informaonforeachsource.
Part 3. Payment Informaon
Expensesmayberoundedtowholedollars.
Secon 3.1.a. Itemize travel payments including departure and return
dates.Completeallelds,use“n/a”appropriately.Totaltheexpenses
foritemssuchastaxirides,gratuies,andrentalcarsinthe“other”
eldanddescribeinthecommentssecon.
Secon 3.1.b. Report agency payments that are not travel related.
Secon 3.2. Descripon
Allpaymentsmustincludeaspecicdescriponoftheuseofthe
paymentandtheintendedpurposeforagencybusiness.Forexample,
atravelpaymentmayread:TraveltoaendanEPAco-sponsoredsolar
energy seminar in Washington D.C.
Secon 3.3. Idenfy Ocials
TravelPayments:Thenameoftheposion/tleanddepartmentof
eachocialwhousedthepaymentisrequired.Listtheocial’sname
ifhe/sheisanelectedorappointedocial.Itisnotrequiredtolistthe
namesofotherocials,ratherinsert“n/a.”Donotleaveblank.
Non-TravelPayments:Thename,posion/tleanddepartmentofthe
agencyocialwhousedthepaymentmustbeidened.Allocials’
names are required.
Part 4. Vericaon
Vericaonoftravelpaymentsmustbesignedbyanauthorizedagency
ocial.Suchindividualsarethosewhohavetheauthoritytoapprove
similar travel payments when made with agency funds.
Vericaonofnon-travelpaymentsmustbesignedbytheagencyhead.