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