10-75A50126R00001_RFP Att 10 SF LLL Disclosure of Lobbying Activities Form.pdf
PDF 89 KB Posted
- Solicitation number
- 75A50126R00001_RFP_NPIVS_27
About this file
Standard Form LLL – Disclosure of Lobbying Activities
This is a federal form (Standard Form LLL, OMB Number 4040-0013, expiration date 06/30/2028) used to disclose lobbying activities pursuant to 31 U.S.C. Section 1352. The form applies to various types of federal actions including contracts, grants, cooperative agreements, loans, loan guarantees, and loan insurance. It requires disclosure at different stages: bid/offer/application, initial award, or post-award status, with reporting options for initial filing or material changes to prior disclosures.
The form requires the reporting entity (identified as prime or subawardee) to provide complete name and address information, congressional district, and federal department/agency details. Key data elements include the federal program name/description, assistance listing number if applicable, federal action number, and award amount if known. The form mandates identification of the lobbying registrant and any individual performing lobbying services, along with their complete contact information. A signatory authorized to represent the reporting entity must execute the form, providing name, title, telephone number, and date. The disclosure constitutes a material representation of fact and will be reported to Congress semi-annually and made available for public inspection. Failure to file required disclosures subjects entities to civil penalties ranging from $10,000 to $100,000 per violation.
View the file
Other files
Show all 26
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
10. a. Name and Address of Lobbying Registrant:
9. Award Amount, if known:
* Street 1
* City State Zip
Street 2
* Last Name
Prefix * First Name Middle Name
Suffix
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 OMB Number: 4040-0013
Expiration Date: 06/30/2028
1. * Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
2. * Status of Federal Action:
a. bid/offer/application
b. initial award
c. post-award
3. * Report Type:
a. initial filing
b. material change
4. Name and Address of Reporting Entity:
Prime SubAwardee
* Name
* Street 1 Street 2
* City State Zip
Congressional District, if known:
5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
6. * Federal Department/Agency: 7. * Federal Program Name/Description:
Assistance Listing Number, if applicable:
8. Federal Action Number, if known:
b. Individual Performing Services (including address if different from No. 10a)
Prefix * First Name Middle Name
* Street 1
* City State Zip
Street 2
11.
* Last Name Suffix
Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported 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 $10,000 and not more than $100,000 for each such failure.
* Signature:
*Name: Prefix * First Name Middle Name
* Last Name Suffix
Title: Telephone No.: Date:
Federal Use Only: Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)
File details come from the government source that posted it. Updated .