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r <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 undersigned, to any <br />person for influencing or attempting to influence an officer or employee of any agenry, a Member of <br />Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with <br />the awarding of any Federal contract, cantinuatian, renewal, amendment, or modification of any Federal <br />contract, grant, loan, or cooperative agreement. <br />2. If any funds other than Federal appropriated funds have been paid or will be paid W any person far <br />influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an <br />officer or employee of Congress, or an employee of a Member of Congress in connection with this <br />Federally funded contract, grant, loan, or cooperative agreement; the undersigned shall complete and <br />submit Standard Form SF-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. <br />3. The undersigned shall require that the language of this certification be included in the awazd document <br />for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and <br />cooperative agreements) who receive federal funds of S 100,000.00 or more and that all subrecipients shall <br />certify and disclose accordmgly. <br />This certification is a material representation of fact upon which reliance was placed when this transaction <br />was made or entered into. Submission of this certification is a prerequisite for making or entering into this <br />transaction imposed by Section 1352, Title 3l, U:S. Code. Any person who fails to file the required <br />certification shall be subject to a civil penalty of not less than S 10,000.00 and not mare than S 100,000.00 <br />far each such failure. <br />Signature <br />Agency/Organization <br />Title <br />Date <br />(Certification signature should be same as Contract signature.) <br />14 <br />