ac-Certification of Lobbying Activities-SFLLL

DISCLOSURE OF LOBBYING ACTIVITIES
Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
 0348-0046
(See reverse for public burden disclosure.)
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
        For Material Change Only:
           d. loan
              year _________ quarter _________
           e. loan guarantee
              date of last report ______________
           f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
   and Address of Prime:
                                      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, MI):
     different from No. 10a)
     (last name, first name, MI):
11.
Signature: 
Print Name: 
Title:
Telephone No.: _______________________   Date: 
                                                                   Authorized for Local Reproduction
                                                                Standard Form LLL (Rev. 7-97)
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 this 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 that $10,000 and not more than $100,000 for
each such failure.
Prime
Subawardee
Federal Use Only:
b
b
a

City of Chandler Housing Authority 
235 S. Arizona Ave. 
Chandler, AZ 85225
4c 5
5
Office of Public and Indian Housing (PIH)
14.872
Not known
1,186,653.00
None
None
Mayor Kevin Hartke
Public Housing Authority Commission Chairman
(480) 782-3207
Mayor Kevin Hartke

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
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.
2. Identify the status of the covered Federal action.
3.
4.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8.
9. 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 for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
     entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
     Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a materialchange to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make
payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof
Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
Identify the appropriateclassification of this report. If this is a followup 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 last previouslysubmitted report by this reporting entity for this covered Federal
action.
Enter the full name, address, city, State and zip code of the reportingentity. Include CongressionalDistrict, if known. Check the appropriateclassification
of the reportingentity that designatesif it is, or expects to be, a prime or subawardrecipient. Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
Enter the most appropriate Federal identifying number availablefor 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."
According to the PaperworkReduction Act, as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 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 Managementand Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.