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DocuSian Envelope ID A8C762C9-928E-48B7-A713-EBD8AD177926 <br /> FORM 4.07 DISCLOSURE OF LOBBYING ACTIVITIES <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 <br /> 1.Type of Federal Action: 2.Status of Federal Action: 3. Report Type: <br /> a.contract a. bid/offer/application a. initial filing <br /> b.grant b.initial award b.material change <br /> c.cooperative agreement c. post-award <br /> d.loan <br /> For Material Change Only: year <br /> e.loan guarantee quarter <br /> f. loan insurance <br /> Date of last report: <br /> 4.Name and Address of Reporting Entity: 5.If Reporting Entity in No.4 is a Subawardee,Enter <br /> Name and Address of Prime: <br /> Prime Subawardee <br /> Tier if known: <br /> Congressional District,if known: <br /> Congressional District,if known: <br /> 6.Federal Department/Agency: 7.Federal Program Name/Description: <br /> CFDA Number,if applicable: <br /> 8.Federal Action Number,if known: 9.Award Amount,if known: <br /> 10.a.Name and Address of Lobbying Registrant b.Individuals Performing Services <br /> (if individual,last name,first name,MI): (including address if different from No. 10A) <br /> (last name,first name, MI): <br /> information requested through this form is authorized by title 31 U.S.C. <br /> section 1352.This disclosure of lobbying activities is a material Signature. <br /> representation of fact upon which reliance was placed by the tier above <br /> when this transaction was made or entered into.This disclosure is <br /> required pursuant to 31 U.S.C.1352.This information will be available for Print Name: <br /> public inspection.Any person who fails to file the required disclosure <br /> must be subject to a civil penalty of not less than$10,000 and not more <br /> than$100,000 for each such failure. <br /> Title: <br /> Federal Use Only: Authorized for Local <br /> Reproduction <br /> Standard Form LLL <br /> (Rev.7-97) <br /> (See next page for instructions.) <br /> 01P FORM 4000/2(REV.4-88) <br />