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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 tiling, pursuant to title 31
<br />U.S.C. section 1352. The tiling of a form is required for each payment or agreement to make payment to 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 Paperwm'k Reduction Act, as amended, no persons are required to respond to a collection of information unless it
<br />displays a valid OMR 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 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)
<br />DEP Agreement No. G0182, Attachment F, Page 2 of 2
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