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INSTRUCTIONS 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
<br /> the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31
<br /> U.S.C . section 1352 . The filing of a form is required for each payment or agreement to make payment to
<br /> any
<br /> lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of
<br /> Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered
<br /> Federal action. 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
<br /> influence the outcome of a covered Federal action.
<br /> 2 . Identify the status of the covered Federal action.
<br /> 3 . Identify the appropriate classification of this report. If this is a followup 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 the reporting entity for this covered Federal
<br /> 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
<br /> expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first
<br /> subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts,
<br /> subgrants and contract awards under grants.
<br /> 5. If 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
<br /> States Coast Guard.
<br /> 7. Enter the Federal program name or description for the covered Federal action (item 1 ) . If known, enter
<br /> the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements,
<br /> loans, and loan commitments.
<br /> 8 . Enter the most appropriate Federal identifying number available for the Federal action identified in
<br /> item 1 (e.g., Request for Proposal (RFP) number ; Invitation for Bid (IFB) number ; grant announcement
<br /> number; the contract, grant, or loan award number; the application/proposal control number assigned
<br /> by the Federal agency) . Include prefixes, e.g., "RFP-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 reporting
<br /> 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
<br /> from 10 (a) . Enter Last Name, First Name, and Middle Initial (MI) .
<br /> 11 . The certifying official shall sign and date the form, print his/her name, title and telephone number.
<br /> According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information
<br /> unless it
<br /> displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public
<br /> reporting burden for this collection of information is estimated to average 30 minutes per response, including time
<br /> for reviewing
<br /> instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
<br /> information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions
<br /> for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503.
<br /> Form DEP 55-221 (01 /01 ) Page 2 of 2
<br /> DEP 55 -215 (01 /02)
<br /> DEP Agreement No . GO 143 , Attaclunent F , Page 2 of 2
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