CAREER BEGINNINGS OF ORANGE COUNTY 4-2002

Home Browse Search

\".; ..,.,. 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 Reportlng 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 Address:of Reporting Entity 5. If Reporting Entity In No.4 Is Subawardee, enter Name and Address OPrima D Subawardee Tier _____ . if known: 01 Prime 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, Ml) (last name, first name, MI) (attach continuation sheet{s) if necessary) 13. Type of Payment (check all that apply) o a. retainer o b. one-time fee o c. commission D d. contingent fee D e. deferred D f. other (specify)_______________________ 14. Brief Description of Services Perfonned or to be Perfonned and Date{s) of Service,lncluding officer{s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11 11. Amount of Payment (check all that apply) $ actual planned 12. Form of Payment (check all that apply) Da Db cash in.kind; specify: nature __________________ value ___________________________ (attach continuation sheet(s) if necessary) 15. Continuation sheets attached DYes 0 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- 65. Slat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information wiil be reported to the Congress semiannuaily and wiil be availabie for pUbiic inspection. Any person who faiis to file the required disclosure shail be subject to a civii penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only: Signature Print Name Title Telephone No. Dale (mm/dd/yyyy) Authorized for Local Reproduction Standard Form-LLL (7/97)