Laserfiche WebLink
<br /> ¡o() :¡ <br /> DISCLOSURE OF LOBBYING ACTIVITIES <br /> Comolete this fonw to disclose lobbying activities pursuant <br /> to 31 U.S.C. 1352 <br /> (See reverse for public burden disclosure) <br /> 1.Type of Federal Action: 2. Status of Federal Action: 3- Report Type: <br /> ~ a.contract 0 a.bid/offer/application 0 a.initial filing <br /> b.material change b. initial award b.material change <br /> c.cooperative agreement c.post-award For Material Change Only: <br /> d_loan year quarter <br /> e.loan guarantee date of last report <br /> f.loan insurance <br /> Name and Address of Reporting Entity 5.lf Reporting Entity in No. ~ is Subawardee, <br /> ] Prime 0 s~wardee Enter Name and address of Prime: <br /> TIer . if known <br /> <br /> Conoressional District i f known: Congressional District, if known: <br /> 6.Federal Department/Agency: 7.Federal Program Name/Descrlptlon: <br /> CFDA No., if appl icable <br /> 8.Federal Action No., i f known: 9.Award Amount, if knoW'1: <br /> $ <br /> 10.a. Name and Address of Lobbying Entity b.Jndividuals Performing Services (including <br /> if individual, last name, first name, MI): address if different from No. <br /> fi rst name, M!): <br /> 11.Amount of Payment(check all that apply): 13.Type of Payment (check all that apply): <br /> $ actual planned a.retainer <br /> b.one-time fee <br /> 12.Form of Payment (check all that apply): c.conmission <br /> a.cash d.contingent fee <br /> b.in-kind:specify: nature e.deferred <br /> value f.other:specify <br /> <br /> 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or <br /> Member(s) contacted, for Payment Indicated in Item 11: <br /> , <br /> I <br /> ! <br /> I <br /> ! <br /> 15.Continuation Sheet(s) SF-LLL-A attached: DYes CJ No <br /> 16.Information requested through this form is authorized by title 31 U.S.C. <br /> Section 1352. This disclosure of lobbying activities is a material Signature: <br /> representation of fact upon which reliance was placed by the tier above when <br /> this transaction was made or entered into. This disclosure is required Print Name: <br /> pursuant to 31 U.S.C. 1352. This information will be reported to the <br /> Congress semi-af'Y"lUally and will be available for public inspection. Any person Ti tle: <br /> who fails to file the required disclosure shall be subject to a civil penalty <br /> of not less than $10,000 and not more than $100,000 for each such fa'lure. Date: <br /> Telephone No.: <br /> - <br /> Federal Use Only: Standard Form-LLL <br />