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R <br /> 17 <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 agency,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,continuation,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 to any person for <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 award document <br /> for subawards at all tiers(including subcontracts,subgrants,and contracts under grants,loans,and <br /> cooperative agreements)who receive federal funds of$100,000.00 or more and that all subrecipients shall <br /> certify and disclose accordingly. <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 malting 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 510,000.00 and not more than 5100,000.00 <br /> for each such failure. <br /> Signature Title <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br />