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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 13520348-0046 <br /> (See reverse for public burden disclosure.) <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 For Material Change Only: <br /> d. loan year quarter <br /> ❑ e. loan guarante® date of last report <br /> f. loan insurance <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name <br /> Prime Subawardee and Address of Prime: <br /> Tier , if known: <br /> Congressional District, if known: 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 Entity b. Individuals Performing Services (including address if <br /> (if individual, last name, first name, MI): different from No. 10a) <br /> (last name,first name, Ml): <br /> (attach Continuation She.it(s)SF-LLLA,if necessary) <br /> 11. Amount of Payment(check all that apply): 13. Type of Payment (check all that apply): <br /> $ actual planned a.retainer <br /> b.one-time fee <br /> 12. Form of Payment(c®ck all that ap ): ❑ c.commission <br /> a.cash ❑ d.contingent fee <br /> b.in-kind;specify: nature ❑ e.deferred <br /> ❑ value ❑ f.other;specify: <br /> ❑ ❑ <br /> 14. Brief Description of Services Performed or to be Perfoged and Date(s) of Service, including officer(s), <br /> employee(s), or Member(s) contacted,for Payment Indicated in Item 11: <br /> (attach Continuation Sheet(s)SF-LLLA.if necessary) <br /> 15. Continuation Sheet(s) SF-LLLA attached: ❑ Yes fl No <br /> 16Information requested through this form is authorized by title 31 U.S.C. section <br /> .1352. This disclosure of lobbying activities is a material representation of fact Signature: <br /> upon which reliance was placed by the tier above when this transaction was made <br /> or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Print Name: <br /> information will be reported to the Congress semi-annually and will be available for <br /> public inspection. Any person who fails to file the required disclosure shall be Title: <br /> subject to a civil penalty of not less that$10,000 and not more than$100,000 for <br /> each such failure. Telephone No.: Date: <br /> Federal Use Only: Authorized for Local Reproduction <br /> Standard Form LLL(Rev.7-97) <br /> Exhibit F <br /> Housing Hope's Kennedy Court Improvement Project <br /> Page 2 of 4 <br />