CONFIDENTIAL STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS
(FOR USE BY SPECIAL GOVERNMENT EMPLOYEES)

PART I - TO BE COMPLETED BY AGENCY (Agency completes Parts III & IV after appointee completes Part II)

NAME (Last, First, Initial)

SHANK, Robert E., M.D.

SOCIAL SECURITY NUMBER (Appointee
will furnish in Part II.)

ORGANIZATION LOCATION (Agency, Bureau, Division)

DHEW/NIH/NIAMD-Gastroenterology and
Nutrition Training Grants Committee

PERIOD OF APPOINTMENT IN THIS AGENCY

FROM: 7/1/68 TO: 6/30/69

ESTIMATED NO. DAYS
SERVICE TO BE
PERFORMED 15

PART II - TO BE COMPLETED BY APPOINTEE

The information to be furnished in this statement is required by Executive Order 11222 and the regulations issued thereunder. The Order does not require the submission of any information relating to an employee's connection with, or interest in, a professional society or a charitable, religious, social, fraternal, recreational, public service, civic, or political organization or any similar organization not conducted as a business enterprise and which is not engaged in the ownership or conduct of a business enterprise. Educational and other institutions doing research and development or related work involving grants from or contracts with the Government are deemed to be "business enterprises" for purposes of this report and should be included.

FEDERAL GOVERNMENT EMPLOYMENT - List all other Federal agencies and other organizational elements of this Department in which you are presently employed. Please specify the organization in as much detail as possible. If none, write "NONE."

DEPARTMENT OR AGENCY	LOCATION (Street, City, and State)	APPOINTMENT PERIOD		EST. NO. OF DAYS
		TO	FROM
PHS-Nutrition Program, Bureau of Preventive Medical Services	Bethesda, Maryland	6/30/68	7/1/67	5
Army (OSG) Nutrition Advisory Committee	Washington, D.C.	6/30/68	7/1/67	5

NON-FEDERAL EMPLOYMENT - List all corporations, companies, firms, State or local Government organizations, research organizations, and educational and other institutions in which you are serving as employee, officer, member, owner, trustee, director, expert, advisor, or consultant, with or without compensation. If none, write "NONE."

NAME AND KIND OF ORGANIZATION (e.g., Manufacturing, research, insurance)	LOCATION (City and State)	TITLE OR KIND OF POSITION
Washington University (Education)	Lindell & Skinker St. Louis, Missouri	Danforth Professor of Preventive Med.
(Research)
National Research Council (professional)	Washington, D.C.	Member, Food and Nutrition Board
American Medical Association	Chicago, Illinois	Member, Council on Foods & Nutrition
State of California (Governmt)	Berkeley, California	Consultant in Nutrition, State Dept. of Public Health

HEW-474
(8-66)

Source: https://www.industrydocuments.ucsf.edu/docs/nnvd0227