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DISCLOSURE OF LOBBYING ACTIVITIES ApvrovedbyoM6 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 oaa6-Does (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract ~a. bidloffer/application ~ a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d. loan year __ quarter e. loan guarantee date of last report f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name ^ Prime ^ subawardee and Address of Prime: Tier___, if known: Con ressional District, if known: Con resslonal District, if known: 6. Federal DepartmenUAgency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: __ ___ 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying Entity b. Individuals Pertorming Services (including address if (if individual, last name, first name, MI): different from No. f0a) (last name, first name, MI ): (attach Continuation Shee t(s) SFLLLA, ifnecessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): ^ actual ^ planned ^ a. retainer ^ b. one-time fee 12. Form of Payment (check all that apply): ^ c. commission ^ a. cash ^ d. contingent tae ^ 6. in-kind; speciry: nature __ ^ e. deferred V81Ue __ ^ f. other; speclry: ________ 14. Brief Description of Services Pertormed or to be Pertormed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: (attach Contnuafion Shee s) SF-LLLA, i/necessary) 15. Continuation Sheets SF-LLLA attached: ^ Ves ^ o 1t/ Inlarrnadon requested mrouph tlee tam le auNaized by title 31 U.S.C. sedbn 1351. TMs dkdosure of bbbyirp actlvitles is a mamdel representetlon or fart Si nature: g upon wtlkh reeaxa was pleceC by the tlar above when this transaction was made or entered inm. Tnie disdosura is requred pareuant b 31 U a C 1352 This ~r--~ Print Name: I.i(, r~+~0e vvU ~'°; . . . . Flormetion win be repprmtl m ms Congreee aemFeamelty and wie be availabb M pudic inepecdoa. nay parson wno me m ae the regarea diwoeae span bs Title: _~ Ke(d(C~ OK't: / spbiea to a eve peaaar a r,a be that sto.ooo ana ad more tnan stoo,aoo ra eappn eva~raepre. Telephone No.: '111 8~g -545 ,c 2Ct __ Date: ,. ~ ." , FedBraf tji~$'t~}~)~i': i Authorized for Local Reproduction Standard Form LLL (Rev. 7-97