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F <br /> Approved by OMB <br /> 0348-0046 <br /> ATTACHMENT B <br /> DISCLOSURE OF LOBBYING ACTIVITIES <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S . C. 1352 <br /> (See reverse for public burden disclosure.) <br /> 1 . Type of Federal Action: 2. Status of Federal Action : 3 . Report Type: <br /> a. contract <br /> a. bid/offer/application � a. initial filing <br /> b. grant b. initial award b. material change <br /> c. cooperative agreement c. post-award <br /> d. loan For Material Change Only: <br /> e. loan guarantee <br /> f. loan insurance year quarter <br /> date of last report <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name <br /> and Address of Prime: <br /> 11 Prime ElSubawardee <br /> Tier , ifknown: <br /> Congressional District, ifknown: Congressional District, if known: <br /> 6. Federal Department/Agency: 7. Federal Program Name/Description : <br /> CFDA Number, if applicable: <br /> 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: <br /> 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if <br /> (if individual, last name, first name. MI): differentfrom No. IOa) <br /> (last name, first name, MI): <br /> (attach Continuation Sheet(s) SF-LLLA, if necessary) <br /> ll. Information requested through this form is authorized by title 31 U.S.C. Signature: <br /> section 1352. This disclosure of lobbying activities is a material print Name: <br /> representation of fact upon which reliance was placed by the tier above <br /> when this transaction was made or entered into. This disclosure is <br /> required pursuant to 31 U S.C. 1352. This information will be reported to Title: <br /> Congress semi-annually and will be available for public inspection. Any <br /> person who fails to file the required disclosure shall be subject to a civil Telephone No.: Date: <br /> penalty of not less than $10,000 and not more than $100,000 for each such <br /> failure. <br /> Federal Use Only: Authorized for Local Reproduction <br /> Standard Form — LLL (Rev 7 — 97) <br /> Form DEP 55-221 (01/01) <br /> DEP Agreement No. LW475, Attachment B, Page 1 of 2 <br />