OSU Lobby Activity Form

Report for through



1. Name:
2. Department or College:
3. Approximate percent of time spent on federal “lobbying activities” (including “lobbying contacts” and “efforts in support of such contacts”) during the specified period

%

4. Amount of your salary during the specified period:
(if reporting any amount during specified period)

$

5. Line 3 x Line 4: $
6. Actual out-of-pocket expenses incurred in connection with federal “lobbying activities” during the specified period: $
7. Total expenditures in connection with federal “lobbying activities” during the specified period: (Line 5 + Line 6) $