|
Docusign Envelope ID: 50585F21 -A73"303-BD3F-60841076ED5E
<br /> Identify the type of covered Federal action for which lobbying activity is and/or has eeencsecured toQ�fluence �headtataomoe 30
<br /> of a covered Federal action .
<br /> 1 . Identify the status of the covered Federal action .
<br /> 2 . Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
<br /> information previously reported , enter the year and quarter in which the change occurred. Enter the date of the last
<br /> previously submitted report by this reporting entity for this covered Federal action .
<br /> 3 . Enter the full name, address , city, state and zip code of the reporting entity. Include Congressional District, if known .
<br /> Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-award
<br /> recipient. Identify the tier of the subawardee , e .g . , the first subawardee of the prime is the 1st tier. Subawards include
<br /> but are not limited to subcontracts , subgrants and contract awards under grants .
<br /> 4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name , address , city, state and zip
<br /> code of the prime Federal recipient. Include Congressional District, if known .
<br /> 5 . Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level
<br /> below agency name, if known . For example, Department of Transportation , United States Coast Guard .
<br /> 6 . Enter the Federal program name or description for the covered Federal action ( Item 1 ). If known , enter the full Catalog
<br /> of Federal Domestic Assistance (CFDA) number for grants , cooperative agreements , loans, and loan commitments .
<br /> 7 . Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e . g . , Request
<br /> for Proposal ( RFP) number, Invitation for Bid ( IFB) number, grant announcement number, the contract grant, or loan
<br /> award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g . , " RFP -
<br /> D &90-001 . "
<br /> 8 . For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
<br /> Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5 .
<br /> 9 . (a) Enter the full name , address, city, state and zip code of the lobbying entity engaged by the reporting entity identified
<br /> in Item 4 to influence the covered Federal action .
<br /> (b ) Enter the full names of the individual (s) performing services and include full address if different from 10(a) . Enter
<br /> Last Name , First Name and Middle Initial (MI ).
<br /> 10. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity ( Item 4) to the lobbying
<br /> entity ( Item 10). Indicate whether the payment has been made (actual ) or will be made (planned ). Check all boxes that
<br /> apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.
<br /> 11 . Check the appropriate boxes . Check all boxes that apply. If payment is made through an in -kind contribution , specify
<br /> the nature and value of the in-kind payment.
<br /> 12 . Check the appropriate boxes . Check all boxes that apply. If other, specify nature .
<br /> 13 . Provide a specific and detailed description of the services that the lobbyist has performed , or will be expected to perform,
<br /> and the date(s) of any services rendered . Include all preparatory and related activity, not just time spent in actual contact
<br /> with Federal officials. Identify the Federal official (s ) or employee(s ) contacted or the officer(s) , employee(s) , or
<br /> Member(s) of Congress that were contacted .
<br /> 14. Check whether or not a SF- LLL-A Continuation Sheet(s) is attached .
<br /> 15 . The certifying official shall sign and date the form , print his/her name , title , and telephone number.
<br /> Public reporting burden for this collection of information is estimated to average 30 minutes per response , including time
<br /> for reviewing instructions , searching existing data sources, gathering and maintaining the data needed , and completing
<br /> and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this
<br /> collection of information , including suggestions for reducing this burden , to the Office of Management and Budget,
<br /> Paperwork Reduction Project 0348-0046 , Washington , D . Co 20503
<br />
|