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<br />IP /;/!;¡r' <br />Disclosure of Lobbying Activities 6'= by OMB <br /> <br />(as amended) <br />Complete this form to disclose 10bbying activities pursuant to 31 USe. 1352 <br />(See reverse for instructions and public burden disclosure) <br /> <br />I ¡ <br />1. Type of Federal Action: N / A ¡ 2. Status of Federal Action: N / A 3. Report Type: -1iL A . <br />a. contract i a. bid/offer/application a. initial filing ! <br />b. grant I b. Initial award b. material change ! <br />c. cooperative agreement I. c. post-award <br />d: loan I For Material Change Only: ! <br />I e. loan guarantee Year: [ - <br />f. loan insurance II Quarter:: Î <br />. Date of last report ' <br />I !! <br /> <br />4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee, Enter: . <br />0 Prime 0 Subawardee Name and Address of Prime: <br />TIer -----/ if known: <br /> <br />N/A N/A <br /> <br /> <br /> <br />; Congressional District (number), if known: - I Congressional District (number), if known:- <br /> <br />I <br />I 6. Federal Department/Agency: 7. Federal Program NamelDe~cription: <br /> <br />I <br />N / A CFDA Number, if applicable: N / A i <br /> <br />8. Federal Action Number, if known: 9. Award Amount, if known: <br /> <br />N/A $ N/A <br />I . <br />I 10. a. Name and Address of Lobbying Registrant 10. b. Individuals Performing Services . <br />I (if individual, last no.me, first name, MI): (including address if different from No.IOa) ! <br />I 1 (last name, first name, MI): ' <br />N/A N/A <br /> <br /> <br />¡ <br />I <br /> <br />I 11. Information requested through this form is authorized by Signature: I <br />title 31 U.S.C section 1352. This disclosure of lobbying activi- ! <br />ties is a material representation of fact upon which reliance P . t N <br />I d b th ti b h this cti d nn ame: í <br />was pace y e er a ove w en transa on was ma e : <br />or entered into. This disclosure is required pursuant to 31 I <br />I U.S.C 1352. This information will be reported to the TItle: . <br />I Congress semi-annually and will be available for public : <br />inspection. AI1.y person who fails to file the required disclo- : <br />sure shall be subject to a civil penalty of not less than $10,000 Telephone No.: Date:! <br />I and not more than $100,000 for each such failure. I <br /> <br />. I <br />i Federal Use Only: I Authorized for Local Reproduction, Standard Form - LLL <br />