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<br /> Office of the Secretary of the Treasury Pt. 21, App. B
<br /> INSTRUCTIONS FOR COMPLETION OF SF•LLL,DISCLOSURE OF LOBBYING ACTIVITIES
<br /> This disclosure form shall be completed by the reporting entity,whether subamarden or prime Federal recipient.st the
<br /> Initiation car receipt of a covered federal action,or a material change to a previous filing,psusuenl to tall.31 U.S.C.
<br /> section 13S7,The tiling of a.form it required for each payment or agreement to make payment to any lobbying entity lot
<br /> Influencing or attempting to Influence an officer or employee of any age(ley,a Member of Congress, an officer nr
<br /> employee of Congress,or an employee of a Member of Congress In connection with a covered federal action.Ute the
<br /> Sfi11.1•+1 Continuation Sheet far additional Information If the space on live form Is Inadequate.Complete all Items that
<br /> apply los both the Initial filing and material lunge report.Refer to the Implementing guidance published by the Office of
<br /> Management and Rudgel for additional Information.
<br /> 1, Identify the type of covered Federal action for which lobbying activity Is andor has been secured to Influence the
<br /> outcome of a covered federal action.
<br /> 2. Identify the status of the covered Federal action.
<br /> I. Identify the appropriate clessificellon of this report, II thin is a lollowup report caused by■material change to the
<br /> Information previously reported,enter the year and quarter In which the change occurred.Inlu the date of the last
<br /> previously submitted report by Oils repotting entity for this covered Federal action.
<br /> i. Inter the full name, address,city,state and rip code of the reporting entity.Include Congressional District,it
<br /> known.Check the appropriate classification of she reporting entity that designate%lilt Is,or expects to be,a prime
<br /> or subaward recipient.Identify the tier of the subawardee,e.g,the first subawardet of the prime Is the 1st tier,
<br /> Subawarda include but are not limited 10 subcontracts,aubgrarus and contract awards under grants,
<br /> S. II the organisation filing the report In Item 4 checks'Subawardee',then enter the lull name,address,city,Val.-soil
<br /> alp code of the prime Federal recipient.include Congressional District,II known.
<br /> as Inter the name of the Federal agency mating the award or loan commitment Include at least one organisational
<br /> level brim*agency name,II known. For example,Department of Transportation,United States Coast Guard.
<br /> 7. Enter the Federal program name or description los the covered Federal action(item 11. II known.enter the lull
<br /> Catalog of Federal Domestic Assistance (CF(M1 number for grants, cooperative agreemenla, loans, and loan
<br /> commltmenls.
<br /> 0. Enter the rnost appropriate Federal Identllying number available for the Federal action Identified In item 1(e.g..
<br /> Request far Proposal(RFP/number,Invitation for Old(IF01 number,gran)announcement number.the contract,
<br /> grant,or loan award number,the applicatioruproposal control number assigned by the Federal agencyl. Include
<br /> prefixes,e.g.,•RFRDE-90-00 I,'
<br /> 9, For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the
<br /> Federal amount of the award/loan commitment for the prime entity Identified in Item 4 or 5.
<br /> 10, 1+1Enler the lull name,address,city,stale and hip code of the lobbying entity engaged by the reporting entity
<br /> Identified In Item a to influence the covered Federal action.
<br /> ib)Enter the lull names nl the Indivldualls)performing services,and Include hall address II different from 10(a).
<br /> Enter Lail Name,first Name,and Middle Initial(Mr,.
<br /> 11. Enter the amount of compensstion paid or reasonably expected to be paid by the reporting entity(item 41 to the
<br /> lobbying entity Mom 101, Indicate whether the payment has been made(actual)or will be made(planned), Check
<br /> all bore,that apply. II this is a material change report,enter the cumulative amount of payment made or planned
<br /> to be made.
<br /> 1). Check the appropriate basin).Check all boxes that apply.II payment la made through an In•klnd contribution,
<br /> specify the nature and value of the In Idnd payment
<br /> 11. Check the appropriate bos(es). Check all boxes that apply, Slather,specify nature.
<br /> if. Provide a specific and detailed description of the services that the lobbyist hat performed,or will be expected to
<br /> perform,and the date(s)of any services rendered.Include all preparatory arid refitted activity,not furl time spent In
<br /> actual contact with Federal officials.identify the Federal offfiidd employee(s)contacted or the olficer(s),
<br /> • emptoyee(s).or Members)of Congress That were contacted.
<br /> 15, Check whether or not a SF•LEL A Continuation Sheet(%)Is attached.
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<br /> lb. The certllying official shall algn and dale the form,print hlUher name,Illle,and telephone number.
<br /> hkrkc reporting burden Ice this edteetion of Int nrudon It ettinuted to avenge SO nintraee per m.iwane,Irduding time for reviewing
<br /> Inonuctionc marching tatting data wizen,{adhering and maintaining the data needed,cod completing end revieNng the collection of
<br /> intern alo n Send raor.anb regarding the burden admate or any other aspect of this collection of Inicrnudon.Irduding auggenrions
<br /> Ice reducing this bode..to the Omer d Muugement tied budget,Paperwork Reduction►reitel(0116 0046),Washington,O.C.00S0).
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