2000-187 - Laserfiche WebLink

Home Browse Search

6• 40 40 40 Disclosure of Lobbying AcMies Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for instructions and public burden disclosure) Approved by Ohili (13484)046 (as amended) 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 c. past -award d. loan For Material Change Only: e. loan guarantee Year: I. loan insurance Quarter: Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in. No. 4 is Subawardee, Enter C) Prime 11 Subawardee Name and Address of Prime - Tier if known: Congressional District (number), if known: C Congressional District (number), if known: 6. Federal Department/Agency. N 7. Federal Program NamejDescription: CFDANumber, if applicable: S. Federal Action Number, if known: 9. Award Amount, if known: 10, a. Name and Address of Lobbying Registrant 10. b. Individuals Performing Services (if individual, last name, first name, MI). (including address if different from No.IOa) (last name, first name, ml): 11. Information requested through this form is authorized by Signature: Title 31 US.C. Section 1352. This disclosure of lobbying activities is a material representation of fact upon which Print Name: reliance was placed by the tier above when this transartion was made at entered into. This disclosure Is required pur- suant tG 31 U.S.C.1352. 'Phis information will be reported to 'f itle; the Congress se mi•annually and will be available for public inspection. Any person who falls to file the required disdo euro shall be subject to a civil penalty of not less than $10,000 Telephone No : Date: and not more than $1WADO for each such failure. Federal Use Only: Authorirrd for Local Reproduction, Standard Pon, • LLL