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Office of the Secretary of the Treasury Pt.21, App.B
<br /> INSTRUCTIONS FOR COMPLETION OF 5F-LLL,DISCLOSURE OF LOSRYING ACTIVITIES
<br /> This disclosure fors shall be completed by the reporting entity.whether subawardee or prime Federal recipient,at the
<br /> initiation or receipt of a covered Federal action,or a material change to a previous filing,pursuant to title 31 U.S.C.
<br /> section 1352,.The filing of a form is required for each payment or agreement to make payment to any lobbying entity for
<br /> influencing or attempting to influence an officer or employee of any agency, a Member of Congress.an officer or
<br /> employee of Congress,or an employee of a Member of Congress in connection with a covered Federal action.Use the
<br /> SF'LL•A Continuation Sheet for additional information if the space on the form is inadequate.Complete PI items that
<br /> apply foe both the initial filing and material change report.Refer to the implementing guidance published by the Office of
<br /> Management and Budget for additional information.
<br /> 1. Identify the type of covered Federal action fnr which lobbying activity is anchor has been secured to influence the
<br /> outcome of a covered Federal action,
<br /> 2. Identify the status of the covered Federal action,
<br /> 3. Identify the appropriate classification of this report. II this is a followup report caused by a material change to the
<br /> information previously reported,enter the year and quarter in which the change occurred..Enter the date of the last
<br /> previously submitted report by this reporting entity for this covered Federal action.
<br /> 4. Enter the full name,address,city,state and zip code of the reporting entity. Include Congressional District, if
<br /> known.Check the appropriate classification of the reporting entity that designates if it is,or expects to be,a prime
<br /> or srbaward recipient.Identify the tier of the subawardee,e.g.,the first subawardee of the prime is the 1st tier.
<br /> Subawards include but are not limited to subcontracts,subgrants and contract awards under grants.
<br /> 5. II the organization filing the report in item 4 checks"Subawardee",then enter the full name,address,city,stare.nut
<br /> zip code of the prime Federal recipient.Include Congressional District,if known.
<br /> 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
<br /> level below agency name,if known. For example.Department of Transportation,United States Coast Guard.
<br /> 7. Enter the federal program name or description lot the covered Federal action(item 1). if known,enter the toil
<br /> Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements,loans, and loan
<br /> commitments.
<br /> g.: Enter the most appropriate Federal identifying number available for the Federal action identified in item 1(e.g.,
<br /> Request for Proposal(RFP)number;Invitation tot Bid(IFS)number;grant announcement number,the contract.
<br /> grant,or loan award number,the application,proposal control number assigned by the Federal agency). Include
<br /> prefixes,e.g.,"RFP-DE-90-001,"
<br /> 9. For 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. (at Enter the full name,address,city,state and zip code of the lobbying entity engaged by the reporting entity
<br /> identified in kern 4 to influence the covered Federal anion.
<br /> (b)Enter the full names of the individuals)performing services,and include full address if different from 10(a).
<br /> Enter Last Name,First Name,and Middle Initial(Mt),
<br /> 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity(item 4)to the
<br /> lobbying entity(hem 10). Indicate whether the payment has been made(actual)or will be made(planned). Check
<br /> all boxes that apply. If thin is a material change report,enter the cumulative amount of payment made or planned
<br /> to be made,
<br /> 12, Check the appropriate box(es).Check all boxes that apply.If payment is made through an in-kind contribution,
<br /> specify the nature and value of the in-kind payment.
<br /> 13, Check the appropriate boa(es). Check all boxes that apply. II other,specify nature.
<br /> 14. Provide a specific and detailed description of the services that the lobbyist has performed,or will be expected to
<br /> perform,and the chalets)of any services rendered include all preparatory and related activity,not just time spent in
<br /> actual contact with Federal officials. Identify the Federal officials)or employee(si contacted or the officer(s),
<br /> employee(s),or Member(s)of Congress that were contacted.
<br /> 15. Check whether or not a SF-LLL•A Continuation Sheet(s)is attached.
<br /> 16, The certifying official shall sign and date the form,print his/her name,ride,and telephone number.
<br /> Pr hie reporting harden for lids collet-bon ol inipnution h etdrnand to average 30 ninnies per response,ectudry time for reviewing.
<br /> instructions,searching misery data sources,gadsa0ng mad mainralNry the data needed.and completing and reviewing the maection of
<br /> hilornatron.Send comments regarding the buder,estimate or wry other aspect of this collection d Infnmsatlens,including suggetwom
<br /> for red drag this leaden,to the Office of management and budget.Paperwork Reduceon Project(0343e1:146),Washington,Q.C.10503.
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