2022-033-E-Social Svc-CNC Access INC All ways caring homecare-In home aides service

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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Disclosure Of Lobbying Activities (Approved by OMB 0344-0046) Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ❑ a. contract ❑ a. Bid/offer/application ❑ a. initial filing ❑ b. grant ❑ b. Initial Award ❑ b. material change ❑ c. cooperative agreement ❑ c. Post-Award ❑ d. loan For Material Change Only: ❑ e. loan guarantee ❑ f. loan insurance Year Quarter Date Of Last Report: 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: ❑ Prime ❑ SubawardeeTier (if known) Congressional District(if known) Congressional District(if known) 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number(if applicable) 8. Federal Action Number(if known) 9. Award Amount(if known)$ 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services(including (if individual, last name,first name, MI): address if differentfrom No. IOa.) (last name, first name, 1111): (attach Continuation Sheet(s)SF-LLL-A, if necessary) (attach Continuation Sheet(s)SF-LLL-A, if necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ actual ❑ a. retainer planned ❑ b. one-time fee ❑ c. commission 12. Form of Payment(check all that apply): ❑ d. contingent fee ❑ e. deferred ❑ a. cash ❑ f. other; specify: ❑ b. In-kind; specify: Nature Value 14. Brief Description of Services Performed or to be Performed and Date(s)of Services, including officer(s), employee(s), or Member(s)contacted,for Payment Indicated in Item 11(attach Continuation Sheet(s) SF-LLL-A, if necessary):