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ATTACHMENT F Approved by OMB 0348-0046 DISCLOSURE OF LOBBYING ACTIVITIES 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: F] a. contract ❑ a. bid/offer/application a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award d. loan For Material Change Only : e. loan guarantee f. loan insurance year quarter date of last report 4. Name and Address of Reporting Entity : 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: ❑ Prime ❑ Subawardee Tier if known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agcncy: 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, MI): differentfrom No. l0a) (last name, first name, MI): (attach Continuation Sheets) SF-LLLA, if necessary) 11. Information requested through this form is authorized by title 31 U.S.C. Signature: section 1352. This disclosure of lobbying activities is a material print Name representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress Title: semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not Telephone No. : Date: less than $10,000 and not more than $100,000 for each such failure. Federal Use Only: Authorized for Local Reproduction Standard Form — LLL (Rev 7 — 97) Form DEP 55-221 (01/01 ) Page I of 2 DEP Agreement No. G0061 , Attachment F, Page 1 of 2