Form Hud 50071 - Certification Of Payments To Influence Federal Transactions - Office Of Public And Indian Housing - U.s. Department Of Housing And Urban Development
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1OMB Approval No. 2577-0157 (Exp. 3/31/2010)
U.S. Department of Housing
Certification of Payments
and Urban Development
to Influence Federal Transactions
Office of Public and Indian Housing
Applicant Name
Program/Activity Receiving Federal Grant Funding
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1)
No Federal appropriated funds have been paid or will be
(3)
The undersigned shall require that the language of this
paid, by or on behalf of the undersigned, to any person for
certification be included in the award documents for all subawards
influencing or attempting to influence an officer or employee of
at all tiers (including subcontracts, subgrants, and contracts
an agency, a Member of Congress, an officer or employee of
under grants, loans, and cooperative agreements) and that all
Congress, or an employee of a Member of Congress in connec-
subrecipients shall certify and disclose accordingly.
tion with the awarding of any Federal contract, the making of any
This certification is a material representation of fact upon which
Federal grant, the making of any Federal loan, the entering into
reliance was placed when this transaction was made or entered
of any cooperative agreement, and the extension, continuation,
into. Submission of this certification is a prerequisite for making
renewal, amendment, or modification of any Federal contract,
or entering into this transaction imposed by Section 1352, Title
grant, loan, or cooperative agreement.
31, U.S. Code.
Any person who fails to file the required
(2)
If any funds other than Federal appropriated funds have
certification shall be subject to a civil penalty of not less than
been paid or will be paid to any person for influencing or
$10,000 and not more than $100,000 for each such failure.
attempting to influence an officer or employee of an agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL,
Disclosure Form to Report Lobbying, in accordance with its
instructions.
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Name of Authorized Official
Title
Signature
Date (mm/dd/yyyy)
form HUD 50071 (3/98)
Previous edition is obsolete
ref. Handboooks 7417.1, 7475.13, 7485.1, & 7485.3
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