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INSTRUCTIONS FOR COAUILETION OF SF -LLL,
<br />DISCLOSURE OF LOBBYING ACTIVITIES
<br />This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the
<br />initiation or receipt of covered Federal action or a material change to previous fling pursuant to title 31 U.S.C, section
<br />1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing
<br />or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of
<br />Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation
<br />sheet for additional information if the space on the fonn is inadequate. Complete all items that apply for both the initial
<br />filing and material change report. Refer to the implementing guidance published by the Office of Management and
<br />Budget for additional information.
<br />1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence,
<br />the outcome of a covered. Federal action.
<br />2. Identify the status of the covered Federal action.
<br />3. Identify the appropriate classification of this report, if this is a follow-up report caused by a material change to
<br />the information previously reported, enter the year and quarter in which the change occurred. Enter the date of
<br />the last, previously submitted report by this reporting entity for this covered Federal action.
<br />4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if
<br />known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime
<br />or subaward recipient. Identify the tier of the subawardee, e.g, the first subawardee of the prime is the first tier.
<br />S ubawards include but are not limited to subconnnets, subgrants and contract awards under grants.
<br />5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state
<br />and zip code of the prime Federal recipient. Include Congressional District, if known.
<br />6. Enter the name of the Federal agency malting the award or loan commitment. Include at least one organization
<br />level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
<br />7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full
<br />Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan
<br />commitments.
<br />8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1
<br />(e.g., Request for Proposal (RFP) number, Invitation for Bid (iFB) number, grant announcement marcher, the
<br />contract grant. or loan award number, the application/proposal control number assigned by the Federal agency).
<br />Include prefixes, e.g., "RFP -DE -90-001."
<br />9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
<br />Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5.
<br />10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
<br />identified in item 4 to influenced the covered Federal action.
<br />(b) Enter the full names of the individual(s) performing services and include fall address if different from 10 (a).
<br />Enter Last Name, First Name and Middle initial (MI).
<br />11. Enter the amotmt of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the
<br />lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned).
<br />Check all boxes that apply. If this is'a material change report, enter the cumulative amount of payment made or
<br />planned to be made.
<br />12. Check the appropriate box. Check all boxes that apply. If payment is made through an in-kind contribution,
<br />specify the nature and value of the in-kind payment.
<br />13, Check the appropriate box. Check all boxes that apply. If cdrer, specify nature.
<br />14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to
<br />perform and the date(s) of any services rendered. Include all preparatory and related activity not just time spent
<br />in actual contact with Federal officials. Identify the Federal officer(s) or employees) contacted or the officer(s)
<br />employees) or Member(s) of Congress that were contacted. _
<br />15. Check whether or not a continuation sheet(s) is attached.
<br />16. The certifying official shall sign and date the form, print his/her name title and telephone number.
<br />Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time
<br />for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this
<br />collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,
<br />Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. 5nLLL-r.=Wom R ,. o5.044 NSN0Ir»
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