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Environmental Protection Agency P • 34r APP• i3
<br /> INSTRUCTIONS FOR COMPLETION OF SF•LI4 DISCLOSURE OF LORRVING ACTIVITIES
<br /> This disclosure form 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 lunge to a previous filing, pursuant to title 31 U.S.C.
<br /> section IIS2. The filing of a fam is required for each payment or apvement to rake payment to any lobbying entity for
<br /> infiuendng or atterepting to innuence an officer or empk"t of a agency, a Member of Congress. an officer or
<br /> employee of Cnrtgreas, or an atwlov m of a Member o1 Congress M connection with a covered Federal action. Use the
<br /> SF-LLL, eontMrwtion Sheet far ,additional bnfornst ion If the space on the form k Inadequate. Complete all Items that
<br /> apply far both he Initial filing and material lunge report. Rehr to the implementing guidance published by the Office of
<br /> Management and Rudget for additional Information,
<br /> 11 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 Federal anion.
<br /> 2, identify the status of the covered Federal action,
<br /> 1. Identify the appropriate du lfiration of this report. If tics is a foliowup report caused by a materia) change to the
<br /> information previously reported, enter the year and quarter in which the dhartge occurred. Enter Ike date of the tats
<br /> previously tubmhted report by this reporting entity for this covered Federal action.
<br /> 4. Faster the full name, address, city, state and zip code of the reportinentity. include Congressdanal District,
<br /> If
<br /> known, cheek the appropriate clasalfication of the reporting entity that I signates if it is, or expects to be, a prime
<br /> or subaward revlppi�ert. Identify the tier of the subawardee, e.g., the First subawardee of the prime is the 1st tier,
<br /> Subsevuds inckde but are not limited to subconuacts, subgants and contact awards under grants.
<br /> S. If the organization filing the report In hem 4 checks "Subawerdee", then enter the full name, address, drya state and
<br /> sip 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 ons organizational
<br /> fetal below agency name, " known. For example, Department of Transportation, United States Goad Guard. -
<br /> 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full
<br /> Catalog of Fedeat Domestic Assistance ICFDM number for grsrMt, cooperative agreements, loans, and ban
<br /> tommitments.
<br /> S. Enter the most spproptim Federal identifying number avaliable for the Federal action identified in hem 1- (e.g.,
<br /> grant, orifosr,award number, therapplicaliaruproposltation lot al (control numbberber rnsigned by thatir erent Federal agency),
<br /> contract,
<br /> nclude
<br /> prefixes, e.g., "RFP•DE4"01 ,"
<br /> 9. For it covered Federal action what there has been an award or ban commitment by the Federal agency, enter the
<br /> Federal amount of the swardlioan commitment for the prime entity Identified In item 4 or S.
<br /> 10. (A) Enter the gull none, address, city, stale and tip code of the iobbying entity engaged by the reporting entity
<br /> Identified in hem 4 to influence the covered Federal action.
<br /> (b)Enter the .full names of the Individualist performing services, and kidude full address if different from 10 (a).
<br /> Enter Last None, First Name, and Middle Initial (M%
<br /> 11. Enter the amount of rnmpensadon paid or teasonably expected to be paid. by the reporting entity (lam 4) to the
<br /> lobbying entity (Nem 10). indicate whether the payment has been mode factual) or will be made (planned), Check
<br /> all boxes that apply. If Ods Is a material change report enter the cumulstive amount of payment made or piavied
<br /> to be made.
<br /> 12. Check the appropriate box(es). Check mit boxes that apply. If payment is made through an in•kind contribution,
<br /> specify the rsanoe and value of the in-kind payment.
<br /> 11. Check the approptiate bogies). Check all boxes that APPiy. If other. gmdty nature.
<br /> 141 hovide a specific and detailed dascgption at the services that the lobbyist has performed or will be expected to
<br /> perform, and the date(d of any services tendered. Include all preparatory and related activity, rot lust time spent in
<br /> actual contact with Federal officials. Identity the Fed cal official(a) or empbybe(s) contacted or the ofgcer(s),
<br /> empioyee(t ), or Mamberis) of Congress that were contacted,
<br /> 15. Check whether or not a SF•Lt LLA Continuation Sheets) is ariathed.
<br /> 16. The certifying official stall sign and date doe form, print W%ther name, title, and telephone number.
<br /> Public assorting burden for the coliecuon d kdon"oW t+ is exein red so average 70 wwrem par response, including time for revie.wrrg
<br /> ins r&wbans, "%Khwq emotig ndace sources, pow it .id wwiriWnbeg the sf W needed, and oeeeWeb"! and re+kwvng d e ex>uecaen of
<br /> iMawan
<br /> ud . kvid earenenn neaiding the Morden eaierote or any wirer W+scr of elk tethmon Of int mutien, inciuding "WWXbont
<br /> far kpk" this brwean, to the Office of and tnsdaet h Isenirak Redseoan Proied 90300046h WA+49ton, C.C. 1090.1.
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