DISCLOSURE OF LOBBYING ACTIVITY

+-----------------------+-----------------------+----------------------+
| 1\. Type of Federal   | 2\. Status of Federal | 3\. Report Type:     |
| Action:               | Action:               |                      |
|                       |                       | > a\. initial filing |
| > a\. contract        | a\.                   | >                    |
| >                     | bid/offer/application | > b\. material       |
| > b\. grant           |                       | > change             |
| >                     | b\. Initial award     | >                    |
| > c\. cooperative     |                       | > For Material       |
| > agreement           | c\. post-award        | > Change Only:       |
| >                     |                       | >                    |
| > d\. loan            |                       | > year \_\_\_\_\_\_  |
| >                     |                       | > quarter            |
| > e\. loan guarantee  |                       | > \_\_\_\_\_\_\_     |
| >                     |                       | >                    |
| > f\. loan insurance  |                       | > date of last       |
|                       |                       | > re                 |
|                       |                       | port\_\_\_\_\_\_\_\_ |
+-----------------------+-----------------------+----------------------+

+----------------------------------+-----------------------------------+
| 4\. Name and Address of          | 5\. If Reporting Entity in No. 4  |
| Reporting Entity:                | is Subawardee, Enter Name and     |
|                                  | Address of Prime                  |
| \_\_ Prime \_\_\_ Subawardee     |                                   |
|                                  | Congressional District, if known: |
| Tier\_\_\_\_\_, if known:        |                                   |
|                                  |                                   |
| Congressional District, if       |                                   |
| known:                           |                                   |
+----------------------------------+-----------------------------------+
| 6\. Federal Department/Agency:   | 7\. Federal Program               |
|                                  | Name/Description                  |
|                                  |                                   |
|                                  | CFDA Number, if applicable:       |
|                                  | \_\                               |
|                                  | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+----------------------------------+-----------------------------------+
| 8\. Federal Action Number, if    | 9\. Award Amount, if known:       |
| known:                           |                                   |
|                                  | \$                                |
+----------------------------------+-----------------------------------+
| 10\. a. Name and Address of      | b\. Individual Performing         |
| Lobbying Entity                  | Services (including address if    |
|                                  | different from No. 10a)           |
| (if individual, last name, first |                                   |
| name, MI):                       | (last name, first name, MI)       |
|                                  |                                   |
| (attach Continuation Sheet(s)    | SF-LLL-A, if necessary)           |
+----------------------------------+-----------------------------------+
| 11\. Amount of Payment (check    | 13\. Type of Payment (check all   |
| all that apply):                 | that apply):                      |
|                                  |                                   |
| \$\_\_\_\_\_\_\_\_\_\_ \_\_\_    | \_\_ a. retainer                  |
| actual \_\_\_ planned            |                                   |
|                                  | \_\_ b. one-time fee              |
|                                  |                                   |
|                                  | \_\_ c. commission                |
|                                  |                                   |
|                                  | \_\_ d. contingent fee            |
|                                  |                                   |
|                                  | \_\_ e. deferred                  |
|                                  |                                   |
|                                  | \_\_ f. other; specify:           |
|                                  | \_\_\_\_\_\_\_\_\_\_\_\_\         |
|                                  | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+----------------------------------+-----------------------------------+
| 12\. Form of Payment (check all  |                                   |
| that apply):                     |                                   |
|                                  |                                   |
| \_\_ a. cash                     |                                   |
|                                  |                                   |
| \_\_ b. in-kind; specify:        |                                   |
| nature\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| v                                |                                   |
| alue\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
+----------------------------------+-----------------------------------+

+------------------------------+------+--------------------------------+
| 14\. Brief Description of    |      |                                |
| Services Performed or to be  |      |                                |
| Performed and Date(s) of     |      |                                |
| Service, including           |      |                                |
| officer(s), employee(s), or  |      |                                |
| Member(s) contacted, for     |      |                                |
| payment indicated in Item    |      |                                |
| 11:                          |      |                                |
|                              |      |                                |
| (attach Continuation         |      |                                |
| Sheet(s) SF-LLL-A, if        |      |                                |
| necessary)                   |      |                                |
+------------------------------+------+--------------------------------+
| 15\. Continuation Sheet(s)   | Yes  | No                             |
| SF-LLL-A attached:           |      |                                |
+------------------------------+------+--------------------------------+

+-----------------------------------------+----------------------------+
| > 16\. Information requested through    | Signatur                   |
| > this form is authorized by title 31   | e:\_\_\_\_\_\_\_\_\_\_\_\_ |
| > U.S.C. section 1352. This disclosure  | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > of lobbying activities is a material  | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > representation of fact upon which     |                            |
| > reliance was placed by the tier above | Print                      |
| > when this transaction was made or     | N                          |
| > entered into. This disclosure is      | ame:\_\_\_\_\_\_\_\_\_\_\_ |
| > required pursuant to 31 U.S.C. 1352.  | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > This information will be reported to  | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > the Congress semi-annually and will   |                            |
| > be available for public inspection.   | Title:\_\_\_               |
| > Any person who fails to file the      | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > required disclosure shall be subject  | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > to a civil penalty of not less than   | \_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > \$10,000 and not more than \$100,000  |                            |
| > for each failure.                     | Telephone                  |
|                                         | No.:\_\_\_\_\_\            |
|                                         | _\_\_\_\_\_\_\_\_\_\_\_Dat |
|                                         | e:\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------+----------------------------+

+-----------------------------------------+----------------------------+
| **Federal Use Only**                    | Authorized for Local       |
|                                         | Reproduction               |
|                                         |                            |
|                                         | Standard Form‑-LLL         |
+-----------------------------------------+----------------------------+

**DISCLOSURE OF LOBBYING ACTIVITIES**

**CONTINUATION SHEET**

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  Reporting
  Entity:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  Page \_\_\_\_\_ of \_\_\_\_\_

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Approved by OMB

0348-0046

Authorized for Local Reproduction

Standard Form‑-LLL-A

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether
subawardee of prime Federal recipient, at the initiation or receipt of a
covered Federal action, or a material change to a previous filing,
pursuant to title 31 U.S.C. section 1352. The filing of a form is
required for each payment or agreement to make payment to any lobbying
entity for influencing of attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with a covered
Federal action. Use the SF-LLL-A Continuation Sheet for additional
information if the space on the form is inadequate. Complete all items
that apply for both the initial filing and material change report. Refer
to the implementing guidance published by the Office of Management and
Budget for additional information.

1\. Identify the type of covered Federal action for which lobbying
activity is and/or has been secured to influence the outcome of a
covered Federal action.

2\. Identify the status of the covered Federal action.

3\. Identify the appropriate classification of this report. If this is a
follow-up report caused by a material change to the information
previously reported, enter the year and quarter in which the change
occurred. Enter the date of the last previously submitted report by this
reporting entity for this covered Federal action.

4\. Enter the full name, address, city, state and zip code of the
reporting entity. Include Congressional District, if known. Check the
appropriate classification of the reporting entity that designates if it
is, or expects to be, a prime or subaward recipient. Identify the tier
of the subawardee, e.g., the first subawardee of the prime is the 1st
tier. Subawards include but are not limited to subcontracts, subgrants
and contract awards under grants.

5\. If the organization filing the report in item 4 checks
\"Subawardee,\" then enter the full name, address, city, state and zip
code of the prime Federal recipient. Include Congressional District, if
known.

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 charge
report, enter the cumulative amount of payment made or planned to be
made.

12\. Check the appropriate box(es). 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 box(es). 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.

+-----------------------------------------------------------------------+
| Public reporting burden for this collection of information is         |
| estimated to average 30 minutes per response, including time for      |
| reviewing instructions, searching existing data sources, gathering    |
| and maintaining the data needed, and completing and reviewing the     |
| collection of information. Send comments regarding the burden         |
| estimate or any other aspect of this collection of information,       |
| including suggestions for reducing this burden, to the                |
|                                                                       |
| Office of Management and Budget, Paperwork Reduction Project          |
| (0348-0046), Washington, D.C. 20503.                                  |
+-----------------------------------------------------------------------+