SF LLL.pdf

OMB Number: 4040-0013 1 OMB Expiration Date: 02/28/2022

Federal Agency Form Instructions Form Identifiers Information

Agency Owner Grants.gov

Form Name Disclosure of Lobbying Activities (SF-LLL)

Form Version Number 1.2

OMB Number 4040-0013

OMB Expiration Date 02/28/2022

Form Field Instructions Field Number

Field Name Required or Optional

Information

1. *Type of Federal Action: Required Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

2. *Status of Federal Action Required Identify the status of the covered Federal action. This field is required.

2-a. a. Bid/Offer/Application Check if applicable

Click if the Status of Federal Action is a bid, an offer or an application.

2-b. b. Initial Award Check if applicable

Click if the Status of Federal Action is an initial award.

2-c. c. Post-Award Check if applicable

Click if the Status of Federal Action is a post-award.

3.0 *Report Type Required Identify the appropriate classification of this report.

3-a. a. Initial filing Check if applicable

Check if Initial filing.

3-b. b. Material change Check if applicable

If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

OMB Number: 4040-0013 2

Field Number

Field Name Required or Optional

Information

Material Change Year Conditionally Required

If this is a follow up report caused by a material change to the information previously reported, enter the year in which the change occurred.

Material Change Quarter Conditionally Required

If this is a follow up report caused by a material change to the information previously reported, enter the quarter in which the change occurred.

Material Change Date of Last Report

Conditionally Required

Enter the date of the previously submitted report by this reporting entity for this covered Federal action.

4. Name and Address of Reporting Entity

Required Provide the information for Name and Address of Reporting Entity.

Prime Check if applicable

Click to designate the organization filing the report as the Prime Federal recipient.

Subawardee Check if applicable

Click to designate the organization filing the report as the SubAwardee Federal recipient.

Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known: Optional Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.

Name Required Enter the name of reporting entity. This field is required

Street 1 Required Enter Street 1 of the reporting entity. This field is required.

Street 2 Optional Enter Street 2 of the reporting entity.

City Required Enter City of the reporting entity This field is required.

State Required Enter the state of the reporting entity. This field is required

ZIP Required Enter the ZIP of the reporting entity. This field is required

OMB Number: 4040-0013 3

Field Number

Field Name Required or Optional

Information

Congressional District, if known Optional Enter the primary Congressional District of the reporting entity.

Enter in the following format: 2 character state abbreviation – 3 characters district number, e.g., CA-005 for California 5th district, CA-012 for California 12th district, NC-103 for North Carolina’s 103rd district.

5. If Reporting Entity in No. 4 is Subaward, Enter Name and Address of Prime

Conditionally Required

If Reporting Entity in No. 4 is Subaward, provide the information for the Name and Address of Prime

Name Required If the organization filing the report in item 4, checks "Subawardee", enter the full name of the prime Federal recipient.

Street 1 Required If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.

Street 2 Optional If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.

City Required If the organization filing the report in item 4, checks "Subawardee", enter the city of the prime Federal recipient.

State Required If the organization filing the report in item 4, checks "Subawardee", select the appropriate state from this pull down menu.

ZIP Required Enter the ZIP of Prime. This field is required

OMB Number: 4040-0013 4

Field Number

Field Name Required or Optional

Information

Congressional District, if known Optional Enter the Congressional District of Prime. Enter in the following format: 2 character state abbreviation – 3 characters district number, e.g., CA-005 for California 5th district, CA-012 for California 12th district, NC-103 for North Carolina’s 103rd district.

6. Federal Department/Agency

Required Enter the name of the Federal Department or Agency making the award or loan commitment. This field is required.

7. CFDA Number: Required Enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. Pre-populated from SF-424 if using Grants.gov.

CFDA Title: Required Enter the Federal program name or description for the covered Federal action. Pre-populated from SF-424 if using Grants.gov.

8. Federal Action Number Optional Enter the most appropriate Federal identifying number available for the Federal action, identified in item 1 (e.g., Request for Proposal (RFP) number, invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".

9. Award Amount Optional For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment of the prime entity identified in item 4 or 5.

OMB Number: 4040-0013 5

Field Number

Field Name Required or Optional

Information

10.a. Name And Address of Lobbying Registrant

Required Provide the information for the Name and Address of Lobbying Registrant.

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Lobbying Registrant.

First Name Required Enter the first name of Lobbying Registrant. This field is required.

Middle Name Optional Enter the middle name of Lobbying Registrant.

Last Name Required Enter the last name of Lobbying Registrant. This field is required.

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Lobbying Registrant.

Street 1 Required Enter the first line of street address for the Lobbying Registrant.

Street 2 Optional Enter the second line of street address for the Lobbying Registrant.

City Required Enter the city of the Lobbying Registrant.

State Required Select the appropriate state of the Lobbying Registrant.

ZIP Code Required Enter the Zip Code (or ZIP+4) of the Lobbying Registrant.

10.b. Individual Performing Services Required Provide the information for Individual Performing Services

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Individual Performing Services.

First Name Required Enter the first name of the Individual Performing Services.

This field is required.

Middle Name Optional Enter the middle name of the Individual Performing Services.

Last Name Required Enter the last name of the Individual Performing Services.

This field is required.

OMB Number: 4040-0013 6

Field Number

Field Name Required or Optional

Information

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Individual Performing Services.

Street 1 Required Enter the first line of street address for the Individual Performing Services.

Street 2 Optional Enter the second line of street address for the Individual Performing Services.

City Required Enter the city of the Individual Performing Services.

State Required Select the state for the address of the Individual Performing Services from this pull down menu.

ZIP Code Required Enter the Zip Code (or ZIP+4) of the Individual Performing Services.

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.

N/A N/A

Signature: Required Completed by Grants.gov upon submission.

Name: Required Provide the information for the Name of the Certifying Official.

OMB Number: 4040-0013 7

Field Number

Field Name Required or Optional

Information

Prefix Optional Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Certifying Official.

First Name Required Enter the first name of Certifying Official. This field is required.

Middle Name Optional Enter the middle name of the Certifying Official.

Last Name Required Enter the last name of the Certifying Official. This field is required.

Suffix Optional Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Certifying Official.

Title: Optional Enter the title of the Certifying Official.

Telephone No.: Optional Enter the telephone number of the certifying official.

Date: Required Completed by Grants.gov upon submission.