Disclosure of Lobbying Activities

Complete and submit a Disclosure of Lobbying Activities only if the applicant is lobbying the SBIR/STTR agency and/or someone in Congress regarding the application.

If a subawardee of the application is lobbying the SBIR/STTR agency and/or someone in Congress regarding the application, a form will also be required for their firm/organization.

Disclosure of Lobbying Activities Instructions
Field	Instructions
4. Name and Address of Reporting Entity	Enter the name of the business or organization. Enter the address of the business or organization, including city, state, and zip code. Enter the Congressional District of the business or organization.
5. Name and address of Prime	This field is only applicable if the information included in No. 4 pertains to a subawardee. If subawardee information entered in No. 4, enter the name and address of the Prime in the space provided at No. 5.
6. Federal Department/Agency	Enter the name of the Federal Department or Agency making the award.
7. Federal Program Name/Description	Enter the Name of the Federal Program, i.e., SBIR or STTR. Enter the CFDA number.
8. Federal Action Number	Enter the FOA number.
9. Award Amount	Enter the award amount.
10.a. Name and Address of Lobbying Registrant	Enter the first and last name of the lobbying registrant. Enter the address of the lobbying registrant, including street, city, state, and zip code.
10.b. Individual Performing Services	Enter the first and last name of the individual performing services. Enter the address of the individual performing services, including street, city, state, and zip code.
11. Signature	Provide a signature at the signature line. Enter the first and last name of the authorized representative signing the document. Indicate the title of the authorized representative. Enter the date signed.

Blank & Sample Forms:

A blank Disclosure of Lobbying Activities form:

A sample Disclosure of Lobbying Activities form:

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Disclosure of Lobbying Activities