SF LLL, Instructions

SFLLL_1_2-V1.2-Instructions.pdf

Grant Program to Establish a Revolving Fund Program (RFP) to Finance Water and Wastewater Projects, 7 CFR 1783

SF LLL, Instructions

OMB: 0572-0138

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Federal Agency Form Instructions
Form Identifiers
Agency Owner
Form Name
Form Version Number
OMB Number
OMB Expiration Date

Information
Grants.gov
Disclosure of Lobbying Activities (SF-LLL)
1.2
4040-0013
02/28/2022

Form Field Instructions
Field
Number
1.

Field Name
*Type of Federal Action:

Required or
Optional
Required

2.

*Status of Federal Action

Required

2-a.

a. Bid/Offer/Application

2-b.

b. Initial Award

2-c.

c. Post-Award

3.0

*Report Type

3-a.

a. Initial filing

3-b.

b. Material change

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

Check if
applicable
Check if
applicable
Check if
applicable
Required
Check if
applicable
Check if
applicable

Information
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.
Identify the status of the covered
Federal action. This field is
required.
Click if the Status of Federal Action
is a bid, an offer or an application.
Click if the Status of Federal Action
is an initial award.
Click if the Status of Federal Action
is a post-award.
Identify the appropriate
classification of this report.
Check if Initial filing.
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.

1

Field
Number

Field Name
Material Change Year

Material Change Quarter

Material Change Date of Last
Report

4.

Name and Address of Reporting
Entity
Prime

Subawardee

Tier if known:

Name
Street 1
Street 2
City
State
ZIP

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

Required or Information
Optional
Conditionally If this is a follow up report caused
Required
by a material change to the
information previously reported,
enter the year in which the change
occurred.
Conditionally If this is a follow up report caused
Required
by a material change to the
information previously reported,
enter the quarter in which the
change occurred.
Conditionally Enter the date of the previously
Required
submitted report by this reporting
entity for this covered Federal
action.
Required
Provide the information for Name
and Address of Reporting Entity.
Check if
Click to designate the organization
applicable
filing the report as the Prime
Federal recipient.
Check if
Click to designate the organization
applicable
filing the report as the
SubAwardee Federal recipient.
Subawards include but are not
limited to subcontracts, subgrants
and contract awards under grants.
Optional
Identify the tier of the
subawardee, e.g., the first
subawardee of the prime is the 1st
tier.
Required
Enter the name of reporting
entity. This field is required
Required
Enter Street 1 of the reporting
entity. This field is required.
Optional
Enter Street 2 of the reporting
entity.
Required
Enter City of the reporting entity
This field is required.
Required
Enter the state of the reporting
entity. This field is required
Required
Enter the ZIP of the reporting
entity. This field is required
2

Field
Number

Field Name
Congressional District, if known

5.

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

Street 1

Street 2

City

State

ZIP

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

Required or
Optional
Optional

Information

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.
Conditionally If Reporting Entity in No. 4 is
Required
Subaward, provide the
information for the Name and
Address of Prime
Required
If the organization filing the report
in item 4, checks "Subawardee",
enter the full name of the prime
Federal recipient.
Required
If the organization filing the report
in item 4, checks "Subawardee",
enter the address of the prime
Federal recipient.
Optional
If the organization filing the report
in item 4, checks "Subawardee",
enter the address of the prime
Federal recipient.
Required
If the organization filing the report
in item 4, checks "Subawardee",
enter the city of the prime Federal
recipient.
Required
If the organization filing the report
in item 4, checks "Subawardee",
select the appropriate state from
this pull down menu.
Required
Enter the ZIP of Prime. This field is
required

3

Field
Number

Field Name
Congressional District, if known

Required or
Optional
Optional

6.

Federal Department/Agency

Required

7.

CFDA Number:

Required

CFDA Title:

Required

8.

Federal Action Number

Optional

9.

Award Amount

Optional

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

Information
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.
Enter the name of the Federal
Department or Agency making the
award or loan commitment. This
field is 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.
Enter the Federal program name
or description for the covered
Federal action. Pre-populated
from SF-424 if using Grants.gov.
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".
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.
4

Field
Number
10.a.

10.b.

Field Name
Name And Address of Lobbying
Registrant

Required or
Optional
Required

Prefix

Optional

First Name

Required

Middle Name

Optional

Last Name

Required

Suffix

Optional

Street 1

Required

Street 2

Optional

City

Required

State

Required

ZIP Code

Required

Individual Performing Services

Required

Prefix

Optional

First Name

Required

Middle Name

Optional

Last Name

Required

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

Information
Provide the information for the
Name and Address of Lobbying
Registrant.
Enter the prefix (e.g., Mr., Mrs.,
Miss), if appropriate, for the
Lobbying Registrant.
Enter the first name of Lobbying
Registrant. This field is required.
Enter the middle name of
Lobbying Registrant.
Enter the last name of Lobbying
Registrant. This field is required.
Enter the suffix (e.g., Jr. Sr., PhD),
if appropriate, for the Lobbying
Registrant.
Enter the first line of street
address for the Lobbying
Registrant.
Enter the second line of street
address for the Lobbying
Registrant.
Enter the city of the Lobbying
Registrant.
Select the appropriate state of the
Lobbying Registrant.
Enter the Zip Code (or ZIP+4) of
the Lobbying Registrant.
Provide the information for
Individual Performing Services
Enter the prefix (e.g., Mr., Mrs.,
Miss), if appropriate, for the
Individual Performing Services.
Enter the first name of the
Individual Performing Services.
This field is required.
Enter the middle name of the
Individual Performing Services.
Enter the last name of the
Individual Performing Services.
This field is required.

5

Field
Number

11.

Field Name
Suffix

Required or
Optional
Optional

Street 1

Required

Street 2

Optional

City

Required

State

Required

ZIP Code

Required

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 semiannually 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.
Signature:

N/A

Name:

Required

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

Required

Information
Enter the suffix (e.g., Jr. Sr., PhD),
if appropriate, for the Individual
Performing Services.
Enter the first line of street
address for the Individual
Performing Services.
Enter the second line of street
address for the Individual
Performing Services.
Enter the city of the Individual
Performing Services.
Select the state for the address of
the Individual Performing Services
from this pull down menu.
Enter the Zip Code (or ZIP+4) of
the Individual Performing Services.
N/A

Completed by Grants.gov upon
submission.
Provide the information for the
Name of the Certifying Official.

6

Field
Number

Field Name
Prefix

Required or
Optional
Optional

First Name

Required

Middle Name

Optional

Last Name

Required

Suffix

Optional

Title:

Optional

Telephone No.:

Optional

Date:

Required

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

Information
Enter the prefix (e.g., Mr., Mrs.,
Miss), if appropriate, for the
Certifying Official.
Enter the first name of Certifying
Official. This field is required.
Enter the middle name of the
Certifying Official.
Enter the last name of the
Certifying Official. This field is
required.
Enter the suffix (e.g., Jr. Sr., PhD),
if appropriate, for the Certifying
Official.
Enter the title of the Certifying
Official.
Enter the telephone number of
the certifying official.
Completed by Grants.gov upon
submission.

7


File Typeapplication/pdf
File TitleDisclosure of Lobbying Activities (SF-LLL) Form Instructions
SubjectGrant application form instructions for applicants
AuthorFederal Agency
File Modified2019-03-15
File Created2019-03-15

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