CHRITMAS IN APRIL 1-2001 - Laserfiche WebLink

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"""" ...." DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMS 0346-0046 'See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: o a. contract Oa. bid/offer/application o 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 DPrime o Subawardee and Address of Prime: Tier ___. if known: Conaressional District, if known: Canaressianal District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Descriptian: CFDA Number. if applicable: 8. Federal Actian Number, if known: 9. Award Amaunt, 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, M/): (attach Continuation Shea "s) SF.LLLA, If necessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ D actual D planned D a. retainer D b. one-Umelee 12. Form of Payment (check all that apply): D .. commlulon D a. .ash D d. .onUngenlle. D b.ln-klnd; speclfy: nature D .. delerred value D f. other; speclfy: 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: (BUBch Con~nuB~on Sheetls) SF-LLLA. If necessarY) 15. Continuation Sheetlsl SF.LLLA attached: Dv.. DNo 16 InformaCion requested through this form II lIUthorlzecl by title 31 U.S.C. MCIion Signature: . 1352. Thia Olsclosure of lobbV\ng acllvitias Is 8 material representation of fact upon which relillnce WIll placed by the tier lbovewhen this 1nlnuction wu mIlde Print Name: Of en-.d Into. This dltdoalre i. t8Clul~ plnU8nt 10 31 U.S.C. 1352. This InformaUm will be reported to the Cons1MI Nml-annully end will be 1"'11111;118 for . Trtle: pubic:: lnapectiG'l. Any 1*10" who h11b1 10 ftIe the rMjuNd dildOlUIa .,.1 be subject 10. civil penalty of not I... that $10,ooo."d not more than $100,000 for Telephone No.: Dale: eac:hsud1faillre. Federal Use Only: I Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)