N.Y. Comp. Codes R. & Regs. tit. 19, § 146.4 – Funding disclosure report.

(a) A qualifying 501(c)(3) entity shall file, along with the entity’s funding disclosure report, as required by section 172-e of the Executive Law, a statement of the qualifying 501(c)(3) entity’s mission that is consistent with what was or would be provided to the Internal Revenue Service of the United States Department of the Treasury with a qualifying 501(c)(3) entity’s application for recognition of exemption as a 501(c)(3), all charitable categories identified in such application, any narrative description of the qualifying 501(c)(3) entity’s activities provided with such application, any supporting details to the narrative description provided with such application, and any specific activities that were or would be identified in such application.
(b) If the qualifying 501(c)(3) entity filing a funding disclosure report has reason to believe that public disclosure will cause disclosure-related harm, the qualifying 501(c)(3) entity may submit to the Department of State a statement of relevant facts supporting such assertion. Such statement of relevant facts shall indicate whether disclosure-related harm would stem from public disclosure of all of the in-kind donations to the qualifying 501(c)(3) entity and financial assistance provided by any the qualifying 501(c)(3) entity to one or more the qualifying 501(c)(4) entities, or only to a portion thereof. A statement of relevant facts shall not be subject to publication or public disclosure. The qualifying 501(c)(3) entity providing such statement of relevant fact shall also provide the Department of State with an email address or other manner of receiving electronic notification acceptable to the Department of State that will serve as the means of communicating a notice of intent to publish, as provided in section 146.9 of this Part. It is the responsibility of the filing entity to provide the Department of State with any change to said email address or other approved point of contact.
(c) Certification.
Each funding disclosure report shall be signed by an officer, director or duly authorized person and include the name, address, and capacity in which such person signs such report.
(d) If a funding disclosure report delivered to the Department of State for filing complies as to form with the requirements of law and the filing fee required by law for such report has been paid, the report shall be filed by the Department of State.