Fillable Name of Individual or Corporate Entity Name of Employer Today's Date SitesFacilities addressed on this form Lynette Hartle NIOSH OCAS 1262007 Feed Materials Production Center Lake Ontario Ordnance Works - cdc

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Conflict or Bias Disclosure Form Identification Name of Individual or Corporate Entity: Name of Employer: Today's Date: Sites/Facilities addressed on this form: Lynette Hartle NIOSH OCAS 1/26/2007 Feed Materials Production Center Lake Ontario Ordnance Works Questions to Identify a Conflict or Bias 1. Are you1 currently engaged in any capacity (paid or unpaid) by the U.S. Department of Energy (DOE)? Check Yes or...
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