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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 osae~ooas See reverse for ublic burden disclosure. 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract ~a. bid/offerlapplication ~ 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: S. If Reporting Entity in No. 4 is a Subawardee, Enter Name ^ prime ^ subawardae and Address of Prime: Tier ___, if known: Con ressional District, if known: Con ressional District, if known: 6. Federal DepartmentlAgency: 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 (if individual, last name, first name, MI): different from No. 10a) (last name, first name, Ml): (attach Continuatlon Shee t(s) SF-LLLA, ifnecessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that appy): ^ 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 Continuadon Sheet(s) SF-LLLA, i/necessary) 15. Continuation Sheets SF-LLIA attached: ^ res ^ Ro 1t1. Inlormetion reguealetl mreugh Mis /omi is aumorizetl by title 3, u.s.c. cation ,352. This Cistlos,xe of bbbyi,p activities Is a materiel rapesantatian of fed Si nature: g upon which retience wee plapetl by the tler above whm mia bemaotlon was made or entareE IMO. Thic tliscioare is reawrea DOreuant b 31 U S C 1352 This print Name: . . . . information witi be repprletl b the Conpresa wmi~anr,ually enE witl be available fa Titl Dwalc maDeplion. Anv Dawn whp rasa to rtle m. repwre0 aaapapre shall Ib e: aabja, ro a evil D•nela/ a not lo.: roar s,o,ooo aaa not mw. man E,ao,ooo for eeph apd, rwwre. Telephone No.: ______ Date: 'W"edera~ tlS.B+Otrty .. , r r'i Authorized for Loral Reproduction Standard Fonn LLL (Rev. 7-97)