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<br /> <br /> <br /> <br /> DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 <br /> (See reverse for public burden disclosure.) <br /> 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: <br /> ? a. contract ? a. bid/offer/application ? a. initial filing <br /> b. grant b. initial award b. material change <br /> c. cooperative agreement c. post-award For Material Change Only: <br /> d. loan year quarter <br /> e. loan guarantee date of last report <br /> f. loan insurance <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address <br /> ? Prime ? Subawardee of Prime: <br /> Tier , if known: <br /> Congressional District, if known: Congressional District, if known: <br /> 6. Federal Department/Agency: 7. Federal Program Name/Description: <br /> CFDA Number, if applicable: <br /> <br /> 8. Federal Action Number, if known: 9. Award Amount, if known: <br /> <br /> 10. a. Name and Address of Lobbying b. Individuals Performing Services ( including address <br /> Entity if different from No. 10a) <br /> ( if individual, last name, first name, MI): (last name, first name, MI): <br /> <br /> (attach Continuation Sheet(s) SF-LLLA, if necessary) <br /> 11. Amount of Payment ( check all that apply): 13. Type of Payment ( check all that apply): <br /> $ ? actual ? planned ? a. retainer <br /> ? b. one-time fee <br /> ? <br /> 12. Form of Payment ( check all that apply): c, commission <br /> ? a. cash ? d. contingent fee <br /> ? e. deferred <br /> ? b. in-kind; specify: nature ? f. other; specify: <br /> value <br /> 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including <br /> officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: <br /> attach Continuation Sheets SF-LLLA, if necessary) <br /> 15. Continuation Sheet(s) SF-LLLA attached: ? Yes ? No <br /> 16. Signature: <br /> Information requested through this form is authorized by title 31 Print me/ <br /> U.S.C. section1352. This disclosure of lobbying activities is a Title: <br /> material representation of fact upon which reliance was placed Tele n Date: 0 <br /> by the tier above when this transaction was made or entered 714Y- 03Zx --J <br /> into. This disclosure is required pursuant to 31 U.S.C. 1352. This <br /> information will be reported to the Congress semi-annually and <br /> will be available for public inspection. Any person who fails to file r <br /> the required disclosure shall be subject to a civil penalty of not / L <br /> r^ ou klzjl <br /> less that $10,000 and not more than $100,000 for each such A/0 <br /> failure. J <br /> Authorized for Local Reproduction <br /> Federal Use Onl : Standard Form LLL Rev. 7-97 <br /> EXHIBIT B <br />