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<br />"'" <br /> <br />...., <br /> <br />INSTRUCTIONS FOR COMPLETION OF SF-LLL. DISCLOSURE OF LOBBYING ACTIVITIES <br /> <br />this disclosure form shaH be completed by the reportilg entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal <br />action, or a material change to a previous filing, pursuant to title 31 U.S.C, section 1352. The filing of a form is required for each payment or agreementto make <br />payment to any lobbying entity for influencing or attempting to Influence an officer or employeeof any agency, a Member of Congress, an offICer or employee of <br />Congress, or an employeeof a Memberof Congress in connection with a covered Federal action. Use the SF~LlLA Continuation Sheet for additionallnformstion if <br />the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance <br />published by the Office of Management and Budget for additional Information. <br /> <br />1. Identify the type of covered Federal action for which lobbying activity is anellor has been secured to influence the outcome of a covered Federal action. <br /> <br />2. Identify the status of the covered Federal action. <br /> <br />3. Identify the appropriate classification of this report. If this Is a followup report caused by a malerial change to the information previously reported, enter <br />the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal <br />action. <br /> <br />4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriateclassification <br />of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g" the first subawardee <br />of the prime is the 1 st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. <br /> <br />5. If the organizationfifing the report in item 4 checks MSubawardee," then enter the full name, address, city, State and zip code of the prime Federal <br />recipient. Include Congressional District. if known. <br /> <br />6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationaUevel below agency name, if known. For <br />example, Department of Transportation, United Slates Coast Guard. <br /> <br />7. Enter the Federal program name or description for the covered Federal action (item 1). If known. enter the full Catalog of Federal Domestic Assistance <br />(CFDA) number for grants, cooperative agreements, loans, and loan commitments, <br /> <br />8. Enter the most appropriate Federal identifying number avaitabtefor the Federal action identified In item 1 (e.g., Request for Proposal (RFP) number, <br />Invitation for BkI (IFB) number; grant announcement number; the contract, grant, or loan award number: the application/proposal control number <br />ass~ned by tha Federal agency). Include prefixes, e.g., "RFP.DE.90-OO1.- <br /> <br />9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the awardlloan <br />commitment for the prime entity identified in Item 4 or 5. <br /> <br />10. (a) Enter the full name, address, city, State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered <br />Federal action. <br /> <br />(b) Enter the full names of the lndividual(s) performing services, and include full address If different from 10 (a). Enter Last Name, First Name. and <br />Middle Initial (MI). <br /> <br />11. Enterthe amount of compensation paid or reasonabtyexpectedlo be paid by the reporting enuty(item 4) to the lobbying entity (Item 10). Indicate whether <br />the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this Is a material change report, enter the cumulative <br />amount of payment made or planned to be made. <br /> <br />12. Check the appropriatebox(es). Check all boxes that apply. If paymentis made through an in-kind contribution, specify the nature and value of the in-kind <br />payment. <br /> <br />13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature, <br /> <br />14. Providea specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services <br />rendered. Include all preparatory and related activity, not Just time spent In actual contact with Federal officials. Identify the Federalofficlal(s) or <br />employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted. <br /> <br />15. Check whether or not a SF-LLLA Continuation Sheel(s) Is attached. <br /> <br />16. The certifying official shall sign and date the form. print hlslher name, title, and telephone number. <br /> <br />According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of Information unless It displays a valid OMS Control <br />Number, The valid OMS control number for this Information collection is OMS No. 0348..Q046. Public reporting burden for this collection of Information is <br />estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data <br />needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of <br />Information,lncluding suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington, <br />DC 20503. <br />