INSTRUCTIONS FOR THE DISCLOSURE OF LOBBYING ACTIVITIES FORM
2
This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal
recipient, at the invitation or receipt of a covered federal action, or a material change to a previous filing,
pursuant to Title 31 U.S.C., Section 1352. The filing of a form is required for each payment or agreement
to make payment to any lobbying registrant 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 in connection with a covered federal action.
For
your convenience, the items that require standardized information have been completed for you.
Complete only the items that are requested below. Refer to the implementing guidance published by the
Office of Management and Budget for additional information.
1.
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.
4.
Enter the full name, street address, city, state,
and zip code of the reporting entity. Include
Congressional District, if known.
7.
Enter the Federal program name or description for
the covered Federal action (item1). If known,
enter
the full Catalog of Federal Domestic Assistance
(CFDA) number for grants or cooperative
agreements.
9.
Enter the Federal amount of the award commitment for
the prime entity identified in item 4 or 5.
10.
(a) Enter the full name, street address, city, state, and zip code of the
registrant under the
Lobbying
Disclosure Act of 1995 engaged by the reporting entity
identified in item 4 to influence the
covered federal action (If none, enter N/A).
(b)
Enter the full names of the individual(s) performing
services, and include full address(es) if
different
from 10 (a). Enter Last Name, First Name,
and Middle Initial (MI) (If none, enter N/A).
11.
The certifying official shall sign and date the form,
print his/her name, title, and telephone number.
The
public reporting burden for this collection of information is estimated to average 30 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction
Project (0348-0046), Washington, DC 20503.
NEA/G&C-012; rev. 12/17