St. Joseph Ballet 1 - Laserfiche WebLink

Home Browse Search

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 �a. 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: S. 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 (if individual, last name, first name, MI): different from No. 10a) (last name, first name, MI): (attach Continuation She SF-LLLA, ifnecessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ ________ ❑ actual ❑ planned ❑ a. retainer ❑ b. one-time fee ❑ c. commission 12. Form of Payment (check all that apply): ❑ 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 Continuation Sheets) SF-LLLA, if necessary) 15. Continuation Sheets SF-LLLA attached: ❑ Yes ❑ No 16 In ormation requested through this form Is authorized by title 31 U.S.C. shim Signature: 1352, This disclosure of lobbying activities is a material rep smatadon of fad print Name: upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant lo 31 U.$.C. 1352. This Title: information will be reported to me Congress semi-annually and will be available for inspection. public Any person who fails W Me the required disclosure shall be Telephone No.: ___--- Date: subjecl to a civil penalty of not less that $10.000 and not more than $10Q000 for each such failure. Federal Use Only: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)