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27 <br /> DEPARTMENT OF HEALTH AND HUMAN SERVICES <br /> DIVISION OF PUBLIC HEALTH <br /> CERTIFICATION REGARDING LOBBYING <br /> The undersigned certifies,to the best of his or her knowledge and belief,that: <br /> 1. No Federal appropriated funds have been paid or will be paid by or on behalf of the <br /> undersigned, to any person for influencing or attempting to influence an officer or <br /> employee of any agency, a Member of Congress, an officer or employee of Congress, or <br /> an employee of a Member of Congress in connection with the awarding of any Federal <br /> contract, continuation, renewal, amendment, or modification of any Federal contract; <br /> grant, loan,or cooperative agreement. <br /> 2. If any funds other than Federal appropriated funds have been paid or will be paid to any <br /> person for influencing or attempting to influence an officer or employee of any agency,a <br /> Member of Congress, an officer or employee of Congress, or an employee of a Member <br /> of Congress in connection with this Federally funded contract, grant, loan, or cooperative <br /> agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure <br /> Form to Report Lobbying,"in accordance with its instructions. <br /> 3. The undersigned shall require that the language of this certification be included in the <br /> award document for subawards at all tiers (including subcontracts, subgrants, and <br /> contracts under grants, loans, and cooperative agreements) who receive federal funds of <br /> $100,000 or more and that all subrecipients shall certify and disclose accordingly. • <br /> This certification is a material representation of fact upon which reliance was placed when this <br /> transaction was made or entered into. Submission of this certification is a prerequisite for <br /> making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any <br /> person who fails to file the required certification shall be subject to a civil penalty of not less <br /> than$10,000 and not more than$100,000 for each such failure. <br /> Authorized Agency Official Signature Title <br /> Official Agency Name Date <br /> (Signature should be same as Contract signature) <br /> Lobby 5/00 <br />