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4 . This certification is a material representation of fact upon which reliance was placed <br /> when this transaction was made or entered into . Submission of this certification is a <br /> prerequisite for making or entering into this transaction imposed by Section 1352 , Title <br /> 31 , U . S . Code . Any person who fails to file the required certification shall be subject to a <br /> civil penalty of not less than $ 10 , 000 . 00 and not more than $ 100 , 000 . 00 for each such <br /> failure . <br /> VI . Disclosure Of Lobbying Activities <br /> Instructions <br /> This disclosure form shall be completed by the reporting entity , whether subawardee or <br /> prime Federal recipient , at the initiation or receipt of a covered Federal action , or a material <br /> change to a previous filing, pursuant to title 31 U . S . C . section 1352 . The filing of a form is <br /> required for each payment or agreement to make payment to any lobbying entity for <br /> influencing or attempting to influence an officer or employee of any agency , a Member of <br /> Congress , an officer or employee of Congress , or an employee of a Member of Congress in <br /> connection with a covered Federal action . Use the SF - LLL - A Continuation Sheet for <br /> additional information if the space on the form is inadequate . Complete all items that apply <br /> for both the initial filing and material change report . Refer to the implementing guidance <br /> published by the Office of Management and Budget for additional information . <br /> 1 . Identify the type of covered Federal action for which lobbying activity is and/or has been <br /> secured to influence 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 <br /> by a material change to the information previously reported , enter the year and quarter in <br /> which the change occurred . Enter the date of the last previously submitted report by this <br /> reporting entity for this covered Federal action . <br /> 4 . Enter the full name , address , city , state and zip code of the reporting entity . Include <br /> if known . Check the appropriate classification of the reporting <br /> Congressional District, <br /> entity that designates if it is , or expects to be , a prime or sub - award recipient . Identify <br /> the tier of the subawardee , e . g . , the first subawardee of the prime is the 1st tier . <br /> Subawards include but are not limited to subcontracts , subgrants and contract awards <br /> under grants . <br /> 5 . If the organization filing the report in Item 4 checks " Subawardee " , then enter the full <br /> name , address , city , state and zip code of the prime Federal recipient . Include <br /> Congressional District , if known . <br /> 6 . Enter the name of the Federal agency making the award or loan commitment . Include at <br /> least one organizational level below agency name , if known . For example , Department <br /> of Transportation , United States Coast Guard . <br /> 14 <br />