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INSTRUCTION FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
<br /> This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or
<br /> receipt of a covered Federal action,or a material change to a previous filing,pursuant to title 31 U.S.C.section 1352. The filing of a
<br /> form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an
<br /> officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
<br /> Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space
<br /> on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the
<br /> implementing guidance published by the Office of Management and Budget for additional information.
<br /> 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
<br /> outcome of a covered action.
<br /> 2. Identify the status of the covered Federal action.
<br /> 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material
<br /> change to the information previously reported, enter the year and quarter in which the change occurred.
<br /> Enter the date of the last 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
<br /> District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to
<br /> be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the
<br /> prime is the 1st tier. Subawards include but at not limited to subcontracts, subgrants and contract awards under
<br /> grants.
<br /> 5. Of the organization filing the report in item 4 checks "Subawardee", then enter the full name, address,
<br /> city, state, and 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
<br /> organizational level below agency name, if known. For example, Department of Transportation, United States Coast
<br /> Guard.
<br /> 7. Enter the Federal program name or description for the covered Federal action (item 1). If known,enter the full Catalog
<br /> of Federal Domestic Assistance(CFDA)number for grants,cooperative agreements, loans, and loan commitments.
<br /> 8. 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 for Bid (IFB) number; grant announcement number; the contract, grant, or
<br /> loan award number;the application/proposal control number assigned by the Federal agency). Include prefixes,e.g., "RFP-
<br /> DE-90-001."
<br /> 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
<br /> enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
<br /> 10. (a) Enter the full name, address, city, state, and zip code of the lobbying entity engaged by the
<br /> report entity identified in item 4 to influence the covered Federal action.
<br /> (b) Enter the full names of the individual(s) performing services, and include full address if different from
<br /> 10(a). Enter Last Name,First Name, and Middle Initial(MI).
<br /> 1. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4)
<br /> to the lobbying entity(item 10). Indicate whether the payment has been made (actual) or will be made (planned).
<br /> Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or
<br /> planned to be made.
<br /> 2. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-
<br /> kind contribution,specify the nature and value of the in-kind payment.
<br /> 3. Check the appropriate box(es). Check all boxes that apply, If other,specify nature.
<br /> 4. Provide a specific and detailed description of the service that the lobbyist has performed,or will be expected to
<br /> perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just
<br /> time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or
<br /> the officer(s),employee(s),or Member(s)of Congress that were contacted.
<br /> 5. Check whether or not a SF-LLL-A Continuation Sheet(s)is attached.
<br /> 6. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
<br /> Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for
<br /> reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and
<br /> reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection
<br /> of information, including suggestions for reducing this burden,to the Office of Management and Budget, Paperwork
<br /> Reduction Project(0348-0046),Washington D.C.20503.
<br /> Federal Register/Vol.54,No.243/Wednesday,December 20,1989/Notices 52325
<br /> Exhibit J
<br /> HCS-16-42-1601-198
<br /> City of Everett
<br /> Page 3 of 4
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