disclosures: 037cc30b3fdd196812217c884382df3487f7afb60f0d100a8b01e8ffc199d09a
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| 037cc30b3fdd196812217c884382df3487f7afb60f0d100a8b01e8ffc199d09a | 2024/McAllister_Jennifer_10.15.24_CMR_6.07_-_2.pdf | 2024 | Jennifer McAllister | Department of Mental Health | DISCLOSURE BY STATE EMPLOYEE OF FINANCIAL INTEREST ED IN A CONTRACT TO PROVIDE SOCIAL SERVICES ETHICS COMMISSION PURSUANT TO 930 CMR 6.07 2024 OCT 15 AM 10: 54 STATE EMPLOYEE INFORMATION Name of state Jennifer McAllister employee: Title/ Position: Psychologist IV: forensic psychologist Agency/Department: Department of Mental Health Agency Address: 11 Staniford St Boston, MA 02114 Office phone: 774-363-9603 Office e-mail Jennifer.mcallister@mass.gov I am a state employee, and I seek to have a financial interest in a contract or agreement made by a state agency listed below, or by a provider or organization funded by a state agency listed below: A state agency within the following Executive Offices: Executive Office of Health and Human Services, including the Human Service Transportation Office; Executive Office of Public Safety and Security, Executive Office of Elder Affairs, Executive Office of Veteran's Services, or A sheriff's office. The purpose of the contract is: - To provide personal services to a person or persons who receive services from, or have services paid for by, these state agencies; or - To provide educational services to people who work for these state agencies or for providers or organizations funded by these state agencies. I seek approval of the arrangement from the agency for which I serve as a state employee and from the state agency above that made the contract. FINANCIAL INTEREST IN A CONTRACT WITH A STATE AGENCY PLEASE CHECK OFF ONE OF THE THREE STATEMENTS BELOW AND PROVIDE THE REQUESTED INFORMATION. 1) Service to a state agency I will provide personal or educational services to a state agency listed above. Please identify the state agency and also the Executive Office it is in, if applicable. Executive Office of Health and Human Services, Department of Mental Health 2) Service to a provider or I will provide personal or educational services to a provider or organization funded by a state agency listed above. organization Please provide the name and address of the provider or organization. Please identify the state agency that funds the provider or organization, and also the Executive Office it is in, if applicable. 3) Service to a person or persons I will provide personal services directly to a person or persons who receive services from, or have services paid for by, a state agency listed above. Please identify the state agency that provides services to, or pays for services for, the person or persons, and also the Executive Office it is in, if applicable. Department of Mental Health Please describe the Please provide information about the type of personal or educational services you will provide. services you will Please do not Include the name of any individual who receives services. provide. I have an existing contract with DMH to conduct IFRAs and will also conduct MIPSB evaluations. What will you be IFRAs: $140/hour paid, or what other MIPSB: $2000 record review/$2500 full assessment financial interest will you have? Employee signature Com P.mD Date: 9/17/24 APPROVAL BY AGENCY YOU SERVE AS A STATE EMPLOYEE Name and title of appointing authority Nancy Connolly Assistant commissioner of forensic mental health services Office phone 617-626-8288 Office e-mail Nancy.connolly@mass.gov Signature by By signing here, I indicate that I have reviewed the facts that the state employee has appointing authority disclosed above and approve the arrangement proposed by the state employee. Nancy Connolly, Psy Date: 9/17/24 APPROVAL BY AGENCY THAT MADE THE CONTRACT (IF DIFFERENT) Name and title of person giving approval at the state Nancy Connolly agency that made Assistant commissioner of forensic mental health services the contract Office phone Office e-mail Signature by person By signing here, I indicate that I have reviewed the facts that the state employee has giving approval disclosed above and approve the arrangement proposed by the state employee. Nancy Connolly, PsyD A Date: 9/17/24 Attach additional pages if necessary. File with: State Ethics Commission One Ashburton Place, Room 619 Boston, MA 02108 Form revised February, 2012 | 2024/McAllister_Jennifer_10.15.24_CMR_6.07_-_2.pdf |