Manual Exhibit 5-22.3-F
INDIAN HEALTH SERVICE
ANNUAL GIFT ADMINISTRATION REPORT
FISCAL YEAR _______
AREA:_____________________________________________________________________________________________
DIRECTOR:_________________________________________________________________________________________
OFFER |
SOURCE |
ANALYSIS COMPLETED |
ACCEPTED or NOT ACCEPTED |
VALUE |
DISPOSITION |
|---|---|---|---|---|---|
TOTAL:
NOTE: Attach a copy of all gift acceptance letters.
SUBMISSION: This report must be submitted to the Program Integrity and Ethics Staff no later than November 30 of each year.