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DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />DIVISION OF PUBLIC HEALTH <br />CERTIFICATION REGARDING LOBBYING <br />The undersigned cxrtifies, to the best of his or her knowledge and belief, drat <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 />entptoyee of any agency, a Member of Cortgr~s, an officer or employce of Congress, or <br />an employce 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 agrcement. <br />2. If any funds other than Federal appropriated funds have been paid or wilt 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 oiBtxr or employee of Congress, or an employce of a Member <br />of Congress in connection with this Federally funded vontrad, grant, loan, or cooperative <br />agreement, the undersigned shall complete and submit 3tandand 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 />S 100,000 or more and that all subrecipients shall -cxrtify and disclose accordingly. <br />This certification is a material representation of fad upon which reliance was placed when this <br />transaction was made or entered into. Submission of this cetific~tion is a pra+oquisite for <br />making or entering into this transaction imposed by Section 1352, Tide 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 S 10,000 and not more than S 100,000 for each such failure. <br />~~ ' "~~ - <br />f#uthurized ency Official Signature <br />Co tln'~.r ~P.4. t.1 r'- ~if e~ <br />Tide ~ <br />Official ency Nsme <br />(Signature should be some as Contract si~atur~e) <br />~I (~_ <br />Date <br />t,obbv sroo <br />