CERTIFICATION REGARDING LOBBYING 

Certification for Contracts, Grants, Loans, and Cooperative Agreements 

The undersigned certifies, to the best of his or her knowledge and belief, that: 

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any 

person for influencing or attempting to influence an officer or employee of an agency, a Member of 

Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with 

the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the 

entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or 

modification of any Federal contract, grant, loan, or cooperative agreement. 

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person 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 this Federal 

contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard 

Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions. 

(3) The undersigned shall require that the language of this certification be included in the award documents 

for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and 

cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification 

is a material representation of fact upon which reliance was placed when this transaction was made or 

entered into. Submission of this certification is a prerequisite for making or entering into this transaction 

imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be 

subject to a civil penalty of not less than $10,00 0 and not more than $100,000 for each such failure. 

Statement for Loan Guarantees and Loan Insurance 

The undersigned states, to the best of his or her knowledge and belief, that: 

If any funds have been paid or will be paid to any person 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 this commitment providing for the United States to insure or 

guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying 

Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or 

entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the 

required statement shall be subjec t to a civil penalty of not less than $10,000 and not more than $100,000 

for each such failure. 

* APPLICANT'S ORGANIZATION 

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE 

Prefix: * First Name: Middle Name: 

* Last Name: Suffix: 

* Title: 

* SIGNATURE: Completed on submission to Grants.gov * DATE: Completed on submission to Grants.gov