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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 See reverse for public burden disclosure 1. Type of Federal Action: 2. Status of Federal Action: 3.'Report Type: []a. contract Ma. bid/offer/application ~ a. initial filing b. grant ' 'b. initial award ' ' b. material change c. cooperative agreement c. post-award For Material Change Only: d. loan year quarter ...... e. loan guarantee date of last report f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name [] Prime [] Subawardee and Address of Prime: Tier ...... if known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: $ 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if ( i£ individual, last name, first name, MI): different from No. lOa ) (last name, first name, MI): (attach Continuation Sheet(s) SF-LLLA, if necessary) 1 t. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ [] actual [] planned [] a. retainer [] b. one-time fee 12. Form of Payment (check all that apply): [] c. commission [] a. cash [] d. contingent fee [] b. in-kind; specify: nature [] e. deferred value [] f. other; specify: 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: (attach Con~nuation Sheet(s) SF-LLLA, if necessary) 15. Continuation Sheet(s) SF-LLLA attached: [] Yes [] No each =cch failure. Telephone No.: Date: Federal USe Only: I Authorized for Local Roproduction Standard Form LLL (Rev. 7-97)