5700-53 Lobbying and Litigation Certificate

United States

ENVIRONMENTAL PROTECTION AGENCY

OMB Control No. 2030-0020
Approval expires MM/DD/YYYY

Washington, DC 20460

LOBBYING AND LITIGATION CERTIFICATION FOR GRANTS
AND COOPERATIVE AGREEMENTS*
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2030-0020). Responses to this collection of information
are required to obtain an assistance agreement (40 CFR Part 30, 40 CFR Part 31, and 40 CFR Part 33 for awards made prior to December 26, 2014, and 2 CFR 200, 2 CFR 1500, and 40 CFR
Part 33 for awards made after December 26, 2014). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently
valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 minutes per response. Send comments on the Agency’s need
for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S.
Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed
form to this address.

INSTRUCTIONS:
*At project completion, complete this form pursuant to the 2001 Department of Veterans Affairs and Housing and Urban
Development, and Independent Appropriations Act, Public Law 106-377, Section 424 and 2000 Department of Veterans
Affairs and Housing and Urban Development, and Independent Appropriations Act, Public Law 106-74, Section 426 and
any other subsequent Appropriation Act requirements.
Please mail this form to your EPA Grant Specialist within 90 days of project completion. DO NOT send this information
to the Office of Management & Budget.
Assistance Agreement Number(s):
________________________________________
________________________________________
________________________________________
I hereby certify that none of these funds have been used to engage in the lobbying of the Federal
Government or in litigation against the United States unless authorized under existing law.
__________________________________________
Signature of the Chief Executive Officer
__________________________________________
Print Name

EPA Form 5700-53 (Rev. 06/2014)

____________________________
Date