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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract �p�a. bid/offer/application �j a. initial filing b. grant [i•• •- b. initial award NN ��"' �� b. material change c. cooperative agreement c. post -award For Material Change Only: d.loan year quarter e. loan guarantee date of last report I. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name ❑ Prime ❑ 3ubawardes and Address of Prime: Tier ____, if known: NIV N1:� Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: NT ^^ /i— CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: ✓A $ N A 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if (if individual, last name, first name, Ml): different from No. 10a) (last name, first name, MI): n !t N /— (attach Continuation Sheets) SF-LLLA, ifnecessary) 11. Amount Payment (check all that apply): 13. Type of Payment (check all that apply): IA— actual $ 1\ _ ❑ actual ❑ planned ❑ a. retainer ❑ b. one-time fee f}- 12. Form of Payment (check all that apply): ❑ c. commission ❑ a. cash N ❑ d. contingent fee ❑ b. in -kind; specify: nature ❑ e. deferred value ❑ f. other; specify: 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: NA (attach Continuation Sheets) SF-LLLA, if neq6ssVv1 15. Continuation Sheets SF-LLLA attached: ❑ Yes ❑ No 16 intmmedon regues(ed Mmbgh Ma form is a Mmd by We 31 U.S.C. sacdon 1=. TMs disclosure of Wbbying activities is a malarial representation a Na Signature: g C Print Name: udon Wbi h m1b. a Waa plated by ale Eer above Wben elia banssa ion Was made m entered info. This disclosure is rmgWred Nisuars to 31 U.S.C. 1W2. This r _ :. n � .. Title: _.� e C . I )-([ l/L t i�. cft-/ - information AN be repoded W Me Congress semi-annually and AN be availaw tm Nibs, inspection. My person who fails W Me No reguimd dedosure Mal be r Telephone No.:-�-/�—t _—_LVAIZ- Date: subject W a civil pensiy of not ass Mal $10,g and not more Man $IW,000 for eachsadhfeiime. F eilf Tiihlf'IYlI$t: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)