2021-169-E Health-NC DHHS FY22 consolidated agreement

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DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 25 of 27 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name,if known. For example,Department of Transportation,United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action(Item 1). If known, enter the full Catalog of Federal Domestic Assistance(CFDA)number for grants, cooperative agreements,loans, and loan commitments. 8. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g.,Request for Proposal (RFP) number, Invitation for Bid(IFB) number, grant announcement number, the contract grant, or loan award number,the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP- DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5. 10. (a) Enter the full name,address,city,state and zip code of the lobbying entity engaged by the reporting entity identified in Item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s)performing services and include full address if different from 10(a).Enter Last Name,First Name and Middle Initial(MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity(Item 4)to the lobbying entity(Item 10). Indicate whether the payment has been made (actual) or will be made(planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate boxes. Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed,or will be expected to perform, and the date(s)of any services rendered.Include all preparatory and related activity,not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s)of Congress that were contacted. 15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached. 16. The certifying official shall sign and date the form,print his/her name, title, and telephone number.