2001-00234 Grant 306 - Laserfiche WebLink

New Search

Approved by OMB 0348 -0046 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer /application a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post -award d. loan For material change only: e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime Subawardee Name and Address of Prime: Tier , if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department /Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individual, last name, first name, MI): different from No. IOa) (last name, first name, MI): • 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying Signature: activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported Title: to the Congress semi - annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than Telephone No.: Date: $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7 -97)