Disclosure of Lobbying Activities.pdf
PDF 93 KB Posted
- Attached to
- Take Back Your Health Campaign
- Solicitation number
- 75P00125R00028
About this file
The Disclosure of Lobbying Activities form is a standard government document (Standard Form - LLL) used to report lobbying activities pursuant to 31 U.S.C. 1352. The form requires disclosure of lobbying activities related to a federal action, which in this case is associated with the Department of Health and Human Services' "Take Back Your Health Campaign" solicitation (Solicitation Number 75P00125R00028). The form captures details about the reporting entity, type of federal action, lobbying registrant, and individual performing lobbying services. The document emphasizes that providing this information is mandatory, with potential civil penalties of $10,000 to $100,000 for failure to disclose, and that the information will be reported to Congress and made available for public inspection.
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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: 02/28/2025
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:
CFDA 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. 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.
* Last Name Suffix
* Signature:
Completed on submission to Grants.gov
Completed on submission to Grants.gov
*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 .