## LOBBYING AND LITIGATION CERTIFICATION FO R G RANTS AND C OOPE RATIVE AGREEMENTS*

INSTRUCTIONS: *At project co mp letion, co mple te this for m pursuant to the 20 01 De part me nt of Veterans Affairs and Housing and Urb an Develo pm ent, and Indepe nd ent Approp r iat i ons Act, Public Law 1 0 6-377 , Section 42 4 and 20 00 Depart me nt of Veterans Aff ai rs a nd Hous in g a nd Ur ba n D evel opm ent, and In de pendent Ap pr opriations Ac t, Public Law 106-7 4 , Section 4 2 6 an d
an y other su b sequent Appropriation Act require me nts. Please mail this form to your EPA Grant Specialist within 90 days of project co mp letion. DO NO T s end thi s infor m at i on to the Office of Management & Budget. Assistance Agreement Number(s):

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I hereby certify that none of these funds have been used to engage in the lobbying of the Federal Government or in litigation against the United S tate s un le ss a uthor ize d under e xis ti ng la w.

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__ __ Signature of the Chief Executive Officer Date

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__ Print Na me
Burden Statement - The annual public reporting and record keeping burden for this collect ion of in for m ation is est im a ted to average 5 minutes per respondent. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide in form ation to or for a Federal ag en cy. This includes th e ti me ne eded to re vie w inst ruction s; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to
a co ll ect ion of in for m ation; search data sources; complete and review the colle cti on o f in forma tio n; and tr an sm itor othe rwise disclos e the information. An agency may not conduct or sponsor, and a person is not required to respond to , a collection of information unle ss it displa ys a currently valid OMB control number. The OMB control numbers for EPA’s regulations are listed in 40 CFR Part 9 and 48 CFR Chapter 15. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automa te d co llecti on tec hniques to the Director, Regulatory Information Division, U.S. Environmental Protection Agency, Ariel Rios Building, 1200 Pennsylvania Avenue, N.W., Mail Code 3213A, Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Man agement and Budget, 725 17 th Street, N.W., Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number and OMB control number in any correspondence.

EPA Form 5700-53 (Rev. 04/2 01 2 ) United States 

### ENVIRONMENTAL PROTECTION AGENCY Washington, DC 20460 OMB Control No. 2030-0020 Approval expires 04/30/2012