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ATTACHMENT G Fvm Anp 401EB NG 931+921 AN{Env. lel o= LOBBYING AND LITIGATION CERTIFICATE* EPA I hereby certify that none of these fimds have been used to engage in the lobbying of the Federal Government or in litigation against the United States unless authorized under existing law. Assistance AgreementNutnber(s j** Chief Executive Officer Date *Complete this form pursuant to the 2001 Department of Veterans Affairs and Housing and Urban Development, and Independent Appropriations Acts, Public Lau 106-277, Section 424 and 2000 Department of Veterans Affairs and Housing and Urban Development, and Independent Appropriations Acts, Public Law 106-74, Section 426 and any other subsegnentAppropriation Act requirements. **If certifying for more than one grant number and more space is needed, please list additional numbers in the space provided below: Plciec mail this foml to your Grant Specialist. DO NOT said this infommtion to the Office ofManagemcnt$Budget. Burden Statement - The annual public reporting and record keeping burden for this collection of information is estimated to average 5 nunrtes per respondent Burden means the total time, effort, or financial resom ccs expended by persons to generate, mtintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acilme, install, and utilize technology and systans for the purposes of collecting, validating, and verifying infomlation, processing and maintaining ird- rrietion, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requuremmts; train persomcl to be able to respond to a colloction of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information hurl ess it displays a CWrenlV valid On1B control nnnber. The O1YIB control numbers for EPA's regulations are listed in 40 CFR Pmt 9 and 48 CFR Chapter 19. Send comments on the Agcncy's need for this infortution, the accuracy of the provided burden estirrules, and any suggested methods for ntinimizing respondent burden, ineltiding through the use of automated collection techniques to the Director, Regulatory bnfoonmion Division U.S. Environmental Pn'otection Agency (2137).401 M. Sc, S.W. Washington, DC' 0460; and to the Office of Infornmtion and Regulatory Affairs, Office of Martagemart mud Budget, 725 17th Strect, N4W, Washington, DC 20503, Attation: Desk Officer for EPA. Include the EPA ICR number and OMB control number in any correspondence. EPA Fonn 5701-53 (Rev. 2-02) DEP Agreement No. G0182, Attachment G, Page 1 of 1