Fillable Certification And Disclosure Regarding Payments To Influence Certain Federal Transations (U.S. Office of Personnel Management)

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Certification And Disclosure Regarding Payments To Influence Certain Federal Transations (U.S. Office of Personnel Management)

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About The Enclosed
CERTIFICATION AND DISCLOSURE REGARDING
PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS
In accordance with Public Law 101-121 (The Anti-Lobbing Act) which became effective
on December 23, 1989; any Contractor who requests or receives a Federal contract
exceeding $100,000 shall submit with his/her offer, the required certification and
disclosures regarding payments to influence certain transactions with the offer.
Therefore, we are requesting that you submit the required certification and disclosures, in
order that they may be filed with your application for consideration for participation in
the Federal Employees Health Benefits (FEHB) Program, beginning January 1 next year.
The Act was incorporated into the Federal Acquisition Regulation (FAR) on September
6, 1990, and affects all Federal contracts and subcontracts exceeding $100,000 and paid
for by appropriated funds. The FAR clauses applicable to the FEHB contracts are:
Sections 52.203-11 and 52.203-12.
The Act has two major provisions which may affect contractors. One, the Anti-Lobbying
Act prohibits Federal contractors from using appropriated funds to pay any person for
influencing or attempting to influence an officer or employee of any agency, a Member
of Congress, or an employee or officer of the Congress. Two, the Act requires disclosure
of any lobbying activities paid for by any other funds (including fees or profit). This
disclosure must be made to the responsible FEHB Program Contracting Officer on OMB
Form LLL (Disclosure of Lobbying Activities).
Disclosure forms must be updated on a quarterly basis if a material event occurs that
would affect the accuracy of the form on file. Material events include:
1. A cumulative increase of $25,000 or more in the amount paid or expected
to be paid for influencing or attempting to influence a covered Federal
action; or
2. A change in the person(s) or individual(s) influencing or attempting to
influence a covered Federal action; or
3. A change in the officer(s), employee(s), or member(s) contacted to
influence or attempt to influence a covered Federal action.
Any person who makes an expenditure prohibited under this provision or fails to file or
amend the disclosure form required by this law, shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
Enclosed are 1) A certification form to be signed by an authorized Contracting Official of
the Plan, and 2) OMB Standard Form LLL (NOTE: copy as necessary). Please include a
completed and signed certification form, and Form LLL, if applicable, to the responsible
FEHB Contracting Officer in your Plan’s application for participation in the FEHB
Program.
Applicant Plan __________________________ For Contract Year ___________
CERTIFICATION AND DISCLOSURE REGARDING
PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS
(A) The definitions and prohibitions contained in the clause at FAR Section 52.203-
12, Limitation on Payments to Influence Certain Federal Transactions are hereby
incorporated by reference in paragraph (B) of this certification.
(B) The applicant plan, signing its application, hereby certifies to the best of his/her
knowledge and belief that on or after December 23, 1989:
1. No Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress on his or her behalf in connection with
the awarding of any Federal Contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment or modification of any
Federal contract, grant, loan, or cooperative agreement;
2. If any funds other than Federal appropriated funds (including profits or fees
received under a covered Federal Transaction), have been paid, or will be
paid, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress on his or her behalf in
connection with this application, the applicant plan shall complete and submit,
with its application, OMB Standard Form LLL to the responsible Contracting
Officer; and
3. He/She will include the language of this certification in all subcontract award
at any tier and require that all recipients of subcontract awards in excess of
$100,000 shall certify and disclose accordingly.
(C) Submission of this certification and disclosure is a prerequisite for making or
entering into this contract imposed by Section 1352, Title 31, United States Code.
Any person who makes an expenditure prohibited under this provision, or who
fails to file or amend the disclosure form to be filed or amended by this provision,
shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000, for each such failure.
Signature of Certifier Date
Typed Name of Certifier Title of Certifier
Plan Name
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Certification And Disclosure Regarding Payments To Influence Certain Federal Transations (U.S. Office of Personnel Management)

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Completed 24 July 2020

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