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Contract Number 00036254, Amendmen Ngm�tr 2tl/ P � 140Y 17
<br />apply for both the initial filing and material change report. Refer to the implementing guidance pu is le y le ice o
<br />Management and Budget for additional information.
<br />I. Identify the type of covered Federal action for which lobbying activity is and /or has been secured to influence the
<br />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 the
<br />information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
<br />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 known.
<br />Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub -
<br />award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the I st tier. Subawards
<br />include but are not limited to subcontracts, subgrants and contract awards under grants.
<br />5. If the organization tiling the report in Item 4 checks "Subawardee ", then enter the full name, address, city, state and
<br />zip code of the prime Federal recipient. Include Congressional District, if known.
<br />6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level
<br />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 I). If known, enter the full
<br />Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
<br />commitments.
<br />S. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item I (e.g.,
<br />Request for Proposal (RFP) number, Invitation for Bid (11713) number, grant announcement number, the contract grant,
<br />or loan award number, the application /proposal control number assigned by the Federal agency). Include prefixes,
<br />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 commitment for the prime entity identified in Item 4 or S.
<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 influence (lie covered Federal action.
<br />(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a).
<br />Enter Last Name, First Name and Middle Initial (MI).
<br />it. Enter the amount 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). Check all
<br />boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be
<br />made.
<br />12. Check the appropriate boxes. Check all boxes that apply. If payment is made through an in -kind contribution, specify
<br />the nature and value of the in -kind payment.
<br />13. Check the appropriate boxes. Check all boxes that apply. If other, specify nature.
<br />Id. Provide a specific and detailed description of (he 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 in
<br />actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s),
<br />employee(s), or Member(s) of Congress that were contacted.
<br />IS. Check whether or not a SF -LLL -A Continuation Sheet(s) is attached.
<br />16. The certifying official shall sign and date the form, print his /her name, title, and teleplione number.
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