Approved by OMB

0348-0046

**Disclosure of Lobbying Activities**

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352

(See reverse for public burden disclosure)

+----------------------+----------+---------+-------------------------+
| 1.  **Type of        | 2.       |         | 3.  **Report Type:**    |
|     Federal          | **Status |         |                         |
|     Action:**        |     of   |         | a\. initial filing      |
|                      |          |         |                         |
| a\. contract         |  Federal |         | \_\_\_\_\_ b. material  |
|                      |     A    |         | change                  |
| \_\_\_\_ b. grant    | ction:** |         |                         |
|                      |          |         | **For material change   |
| c\. cooperative      | a\.      |         | only:**                 |
| agreement            | bid/o    |         |                         |
|                      | ffer/app |         | Year \_\_\_\_\_\_\_     |
| d\. loan             | lication |         | quarter \_\_\_\_\_\_\_  |
|                      |          |         |                         |
| e\. loan guarantee   | \_       |         | Date of last            |
|                      | \_\_\_\_ |         | repor                   |
| f\. loan insurance   | b.       |         | t\_\_\_\_\_\_\_\_\_\_\_ |
|                      | initial  |         |                         |
|                      | award    |         |                         |
|                      |          |         |                         |
|                      | c\.      |         |                         |
|                      | po       |         |                         |
|                      | st-award |         |                         |
+----------------------+----------+---------+-------------------------+
| 4.  **Name and       |          | 5       |                         |
|     Address of       |          | .  **If |                         |
|     Reporting        |          |     Re  |                         |
|     Entity:**        |          | porting |                         |
|                      |          |         |                         |
| \_\_\_\_ Prime       |          |  Entity |                         |
| \_\_\_\_\_           |          |     in  |                         |
| Subawardee           |          |     No. |                         |
|                      |          |     4   |                         |
| > Tier\_\_\_\_\_\_,  |          |     is  |                         |
| > if Known:          |          |         |                         |
|                      |          |  Subawa |                         |
| **Congressional      |          | rdee,** |                         |
| District*, ****if    |          |         |                         |
| known***:**          |          | Enter   |                         |
|                      |          | Name    |                         |
|                      |          | and     |                         |
|                      |          | Address |                         |
|                      |          | of      |                         |
|                      |          | Prime:  |                         |
|                      |          |         |                         |
|                      |          | *       |                         |
|                      |          | *Congre |                         |
|                      |          | ssional |                         |
|                      |          | Dis     |                         |
|                      |          | trict*, |                         |
|                      |          | ****if  |                         |
|                      |          | know    |                         |
|                      |          | n***:** |                         |
+----------------------+----------+---------+-------------------------+
| 6.  **Federal        |          | 7.  **  |                         |
|                      |          | Federal |                         |
| Department/Agency:** |          |         |                         |
|                      |          | Program |                         |
|                      |          |         |                         |
|                      |          |   Name/ |                         |
|                      |          | Descrip |                         |
|                      |          | tion:** |                         |
|                      |          |         |                         |
|                      |          | CFDA    |                         |
|                      |          | Number, |                         |
|                      |          | *if     |                         |
|                      |          | appli   |                         |
|                      |          | cable*: |                         |
|                      |          | \_\     |                         |
|                      |          | _\_\_\_ |                         |
|                      |          | \_\_\_\ |                         |
|                      |          | _\_\_\_ |                         |
+----------------------+----------+---------+-------------------------+
| 8.  **Federal Action |          | 9.      |                         |
|     Number,** *if    |          | **Award |                         |
|     known:*          |          |     Am  |                         |
|                      |          | ount**, |                         |
|                      |          |     *if |                         |
|                      |          |         |                         |
|                      |          | known:* |                         |
|                      |          |         |                         |
|                      |          | >       |                         |
|                      |          |  **\$** |                         |
+----------------------+----------+---------+-------------------------+
| **10. a. Name and    |          | **b.    |                         |
| Address of Lobbying  |          | Indi    |                         |
| Registrant**         |          | viduals |                         |
|                      |          | Per     |                         |
| *(if individual,     |          | forming |                         |
| last name, first     |          | Ser     |                         |
| name, MI):*          |          | vices** |                         |
|                      |          | *(in    |                         |
|                      |          | cluding |                         |
|                      |          | address |                         |
|                      |          | if      |                         |
|                      |          | di      |                         |
|                      |          | fferent |                         |
|                      |          | from    |                         |
|                      |          | No.     |                         |
|                      |          | 10a)*   |                         |
|                      |          |         |                         |
|                      |          | *(last  |                         |
|                      |          | name,   |                         |
|                      |          | first   |                         |
|                      |          | name,   |                         |
|                      |          | MI):*   |                         |
+----------------------+----------+---------+-------------------------+
| **11. Information    |          | **Sig   |                         |
| requested through    |          | nature: |                         |
| this form is         |          | \_\_\_\ |                         |
| authorized by title  |          | _\_\_\_ |                         |
| 31 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    |          |         |                         |
| when this            |          | **Print |                         |
| transaction was made |          | Name:   |                         |
| or entered into.     |          | \_\_\   |                         |
| This disclosure is   |          | _\_\_** |                         |
| required pursuant to |          |         |                         |
| 31 U.S.C. 1352. This |          | *       |                         |
| information will be  |          | *Title: |                         |
| reported to the      |          | \_\_\   |                         |
| Congress             |          | _\_\_** |                         |
| semi-annually and    |          |         |                         |
| will be available    |          | **Te    |                         |
| for public           |          | lephone |                         |
| inspection. Any      |          | No.:    |                         |
| person who fails to  |          | \_\     |                         |
| file the required    |          | _\_\_\_ |                         |
| disclosure shall be  |          | \_\_\_\ |                         |
| subject to a civil   |          | _\_\_\_ |                         |
| penalty of not less  |          | Date:   |                         |
| than \$10,000 and    |          | \_      |                         |
| not more than        |          | \_\_\_\ |                         |
| \$100,000 for each   |          | _\_\_** |                         |
| such failure.**      |          |         |                         |
+----------------------+----------+---------+-------------------------+
| **Federal Use Only** |          | **Aut   |                         |
|                      |          | horized |                         |
|                      |          | for     |                         |
|                      |          | Local   |                         |
|                      |          | Reprodu |                         |
|                      |          | ction** |                         |
|                      |          |         |                         |
|                      |          | **S     |                         |
|                      |          | tandard |                         |
|                      |          | Form -  |                         |
|                      |          | LLL     |                         |
|                      |          | (Rev.   |                         |
|                      |          | 7-97)** |                         |
+----------------------+----------+---------+-------------------------+

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

This disclosure form shall be completed by the reporting entity, whether
subawardee or 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 or 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. 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
followup 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; Invitations for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the
application/proposal control number assigned by the Federal agency).
Included 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 registrant under the Lobbying Disclosure Act of 1995 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\. The certifying official shall sign and date the form, print his/her
name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are
required to respond to a collection of information unless it displays a
valid OMB control Number. The valid OMB control number for this
information collection is OMB No. 0348-0046. Public reporting burden for
this collection of information is estimated to average 10 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, DC 20503