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Disclosure Of Lobbying Activities <br />(Approved by OMB 0344-0046) <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 <br />1.Type of Federal Action: <br />a.contract <br />b.grant <br />c.cooperative agreement <br />d.loan <br />e.loan guarantee <br />f.loan insurance <br />2.Status of Federal Action: <br />a.Bid/offer/application <br />b.Initial Award <br />c.Post-Award <br />3.Report Type: <br />a.initial filing <br />b.material change <br />For Material Change Only: <br />Year___________ <br />Quarter____________ <br />Date Of Last <br />Report:_________________ <br />4.Name and Address of Reporting Entity: <br />Prime <br />Subawardee Tier (if known) <br />________________________ <br />Congressional District (if known) <br />_________________________ <br />5.If Reporting Entity in No. 4 is Subawardee, Enter <br />Name and Address of Prime: <br />Congressional District (if known) <br />________________________ <br />6.Federal Department/Agency:7.Federal Program Name/Description: <br />CFDA Number (if applicable) <br />________________________ <br />8.Federal Action Number (if known)9.Award Amount (if known) $ <br />10.a. Name and Address of Lobbying Entity <br />(if individual, last name, first name, MI): <br />(attach Continuation Sheet(s) SF-LLL-A, if necessary) <br />b.Individuals Performing Services (including <br />address if different from No. 10a.) (last name, <br />first name, MI): <br />(attach Continuation Sheet(s) SF-LLL-A, if necessary) <br />11.Amount of Payment (check all that apply): <br />$ € actual <br />€ planned <br />13.Type of Payment (check all that apply): <br />a. retainer <br />b.one-time fee <br />c.commission <br />d.contingent fee <br />e. deferred <br />f.other; specify: <br />_____________________________ <br />12.Form of Payment (check all that apply): <br />a. cash <br />b.In-kind; specify: Nature <br />Value <br />14.Brief Description of Services Performed or to be Performed and Date(s) of Services, including officer(s), <br />employee(s), or Member(s) contacted, for Payment Indicated in Item 11(attach Continuation Sheet(s) SF-LLL-A, if <br />necessary): <br />Docusign Envelope ID: F81AB18E-3792-4847-ABC2-5F4F513E266A