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<br /> 6 !,/3ç-
<br /> u.s. Department of Justice
<br /> Office of Community Oriented Policing Services
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<br /> 0 iscI OSU re of Lo b byi n g Activiti es
<br /> Insfructions for Compfetion of S~ Disclosure of Lobbying ACtivities
<br /> This disclosure form sha1~ be completed by the reporting entity, whether subawardee or prime Federal recipi-
<br /> ent, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant
<br /> to title 31 U.S.C section 1352. The filing of a form is required for each payment or agreement to make pay-
<br /> ment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a
<br /> Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in con-
<br /> nection with a covered Federal action. Complete all items that apply for both the initial filing and material
<br /> change report. Refer to the implementing guidance published by the Office of Management and Budget for
<br /> additional information.
<br /> 1. Identify the type of covered Federal action for which lob- ered Federal action (item 1). If knovm, enter the full Catalog
<br /> bying activity is and/ or has been S€CUred. to influence the out- of Federal Domestic Assistance (CFDA) number for grants,
<br /> come of a covered Federal action. cooperative agræments, loans and loan commitments.
<br /> 2. Identify the status of the covered Federal action. 8. Enter the most appropriate Federal identifying number
<br /> 3. Identify the appropriate classification of this report. If this available for the Federal ~ction identified in item 1 (e.g.,
<br /> Request for Proposal (RFP) number; Invitation for Bid (IFB)
<br /> is a follow-up report caused by a material change to the infor- number; grant announcement number; the contract, gyant, or
<br /> mation previously reported, enter the year and quarter in loan award number; the application/proposal control number
<br /> which the change OCCUITed. Enter the date of the last previ- assigned by the Federal agency). Include prefixes, e.g., "RFP-
<br /> ously submitted report by this reporting entity for this cov- DE-90--001."
<br /> ered Federal action.
<br /> 9. For a covered Federal action where there has been an
<br /> 4. Enter the full name, address, city, state and zip ccxie of the award or loan commitment by the Federal agency, enter the
<br /> reporting entity. Include Congressional District number, if Federal amount of the award/loan commitment for the prime
<br /> kno\'\:n. Check the appropriate classification of the reporting entity identified in item 4 or 5.
<br /> entity that designates if it is, or expects to be, a prime or sub-
<br /> award recipient. Identify the tier of the subawardee, e.g., the 10. (a) Enter the full name, address, city, state and zip code of
<br /> first subawardee of the prime is the 1st tier. Subav.:ards the lobbying entity engaged by the reporting registrant identi-
<br /> include but are not limited to subcontracts, subgyants and fied in item 4 to influence the covered Federal action.
<br /> contract awards under gyants.
<br /> (b) Enter the full name(s) of the individual(s) performing ser-
<br /> 5. If the organization filing the report in item 4 checks vices, and include full address if different from 10 (a). Enter
<br /> "Subawardee," then enter the full name, address, city, state Last Name, Erst Name, and Middle Initial (Þ..1I).
<br /> and zip code of the prime Federal recipient. Include 11. The certifying official shall sign and date the form, print
<br /> Congressional District, if known. his/her name, title and telephone number.
<br /> 6. Enter the name of the Federal agency making the award or Public reporting burden for this collection of informatian is estimated to
<br /> loan commitment. Include at least one organizational level alJerage 30 minutes per response, including time for 1?""vieuring instrnctions,
<br /> below agency name, if known. For example, Department of searching existing dnta sources, gathering and maintaining the dnta needed,
<br /> Transportation, United States Coast Guard. and completing and rf!1!ir:wing the collection of information. Send com-
<br /> ments regarding the burden estimate or any other aspect of this collection of
<br /> infonnation, including suggestions for reducing this burden, to the Office of
<br /> 7. Enter the Federal program name or description for the cov- M.ll1llgement and Budget, Papen.JJork Reducoon Project (0348-0046),
<br /> Washington, D.C 20530.
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