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Consolidated Agreement FY23 Page 27 of 28 Disclosure of Lobbying Activities (Approved by OMB 0348-0046) Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ❑ a. contract ❑ a. Bid/offer/application ❑ a. initial filing ❑ b. grant ❑ b. Initial Award ❑ b. material change ❑ c. cooperative agreement ❑ c. Post-Award ❑ d. loan For Material Change Only: ❑ e. loan guarantee ❑ f. loan insurance Year Quarter Date of Last Report: 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee, Enter Name El Prime and Address of Prime: ❑ Subawardee Tier , (if known) Congressional District(if known) Congressional District(if known) 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number(if applicable) 8. Federal Action Number(if known) 9. Award Amount(if known) : 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individual, last name, first name, Ml): different from No. 10a.)(last name, first name. Ml): (attach Continuation Sheet(s) SF-LLL-A, if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ € actual€ planned ❑ a. retainer ❑ b. one-time fee 12. Form of Payment(check all that apply): ❑ c. commission ❑ d. contingent fee ❑ a. cash ❑ e. deferred ❑ b. In-kind;specify: Nature ❑ f. other; specify: Value 14. Brief Description of Services Performed or to be Performed and Date(s)of Services, including officer(s), employee(s), or Member(s)contacted, for Payment Indicated in Item 11(attach Continuation Sheet(s) SF-LLL-A. if necessary): 15. Continuation Sheet(s)SF-LLL-A attached: ❑ Yes ❑ No 16. Information requested through this form is authorized by title 31 U. S. C. section 1352. This disclosure of lobbying Signature. activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: was made or entered into. This disclosure is required pursuant to 31 U. S. C. 1352. This information will be Title: reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file Telephone No: Date: 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. Federal Use Only Authorized for Local Reproduction Standard Form - LLL 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,D.C.20503