EVT Music Intiative 4/25/2022 - Laserfiche WebLink

Pt. 21, App. B 31 CFR Subtitle A (7-1-06 Edition) APPENDIX B TO PART 21—DISCLOSURE FORM TO REPORT LOBBYING DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a.contract a. bid/offer/application a.initial filing b.grant b.initial award b.material change c.cooperative agreement For Material Change Only: d.loan c. post-award B y: e.loan guarantee year quarter f. loan insurance date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee,Enter Name 0 Prime 0 Subawardee and Address of Prime: Tier ,if known: Congressional District,if known: Congressional District,if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable: 8. Federal Action Number,if known: 9. Award Amount,if known: $ 10. a. Name and Address of Lobbying Entity b.Individuals Performing Services(including address if (if individual,last name,first name,Mn: different from No.10a) (last name,first name,M0: (attach Continuation Sheet(s)SF-ILL-A J necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): S 0 actual 0 planned 0 a. retainer 0 b.one-time fee 12. Form of Payment(check all that apply): ❑ c.commission ❑ a.cash 0 d.contingent fee ❑ b.in-kind;specify: nature ❑ ere othdefer;s p ti 0 f. other;specify: value P fY 14. Brief Description of Services Performed or to be Performed and Dates)of Service,including officerls),employee(s), or Members)contacted,for Payment Indicated in Item 11: (attach Continuation 5heet(s)5F-tit-A if necessary) 15. Continuation Sheet(s)SF•LLL•A attached: 0 Yes ❑No 16. adornoti.n..quested through dos ham is wtheun.d by tide 31 u.s.e. seCtion 52.ma&sac.,..d hbbyng ricer:,,m,te,w ne.eent+tinn Signature: d r.c:upon whih Mwe.wa plac.d by the tier,ban when ii 3 Print Name. m,read.a.nr«.d mt..mire a3chwr.i,reqvkea pr.nu+ne m Jr u.se.13s:me uoonn.tinn wa be reported to the Congress semi. annually and will be....table for public inspecthn.Any pm.,who la.t,to Title: Me the required di,chu.e shall be wbiect to a s/el penalty at not less than mow ovdnet.mre than slaa.pee r««ch ruck laity.. Telephone No.: Date: aim Use O. Authorized for local Reproduction Standard Form-131 262