CAMBODIAN FAMILY, THE 8 - 2002 - Laserfiche WebLink

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'-:.q;,~ \,.I ",,' Disclosure of Lobbying Activities Approved by OMB 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse side for Instructions and Public Reporting burden statement) 1. Type of Federal Action 2. Status of Federal Action 3. Report Type o a. contract D a. bid/offer/application D a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only d. loan year (yyyy) ____ quarter e. loan guarantee f. loan insurance date of last report (mm/dd/yyyy)_____ 4. Name and Addres,{ of Reporting Entity 5. If Reporting Entity In No. 41s Subawardee, enter Name and Address OPrime D Subawardee Tier ___ . jf known: oiPrime 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 $ 10a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if different from No. 10a.) (if individual, last name, first name, MI) (last name, first name. MI) (attach continuation sheet(s) if necessary) 12. Form of Payment (check all that apply) 13. Type of Payment (check all that apply) o 8. retainer o b_ one-time fee o c. commission o d. contingent fee o e. deferred D f. other (specify) 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including offlcer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11 $ actual planned 11. Amount of Payment (check all that apply) Da Db cash in-kind; specify: nature value (attach C(lntinuation sheet's) if necessary) 15. Continuation sheets attached DYes D No 16. Information requested through this form is authorized by Sec.319, Pub. L. 101-121, 103 Stat. 750, as amended by sec. 10; Pub. l. 104- Signature 65, Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name by the above when this transaction was made or entered into, This disclosure is required pursuant to 31 U.S.C. 1352. This informatlon Title will be reported to the Congress semiannualiy and will be availabie tor public inspection, Any person who tails to file the required Telephone No. disclosure shall be subject to a civii penalty of not less than $10,000 and not more than $100,000 for each such failure. Date (mm/dd/yyyy) Federal Use Only: Authorized for Local Reproduction Standard Form.LLL (7/97)