Form SBA Form 1790 SBA Form 1790 Representatives Used and Compensation Paid for Services

OMB Approval No.: 3245-0270

Expiration Date: 3/31/2009

REPRESENTATIVES USED AND COMPENSATION PAID FOR SERVICES IN CONNECTION WITH OBTAINING FEDERAL CONTRACTS

As required by 15 USC 637(a)(20) (a) and 13 CFR Part 124.601, please provide SBA with a list of any agents, representatives, attorneys, accountants, consultants and other parties (other than employees) receiving fees, commissions, or compensation of any kind for purposes of assisting the Participant in obtaining a Federal contract. Failure to provide this information is good cause for SBA to initiate proceedings to terminate your 8(a) Program participation.

Representative’s Name: Address: City:

State: ZIP Code:

Fees, Commissions or Compensation:

Amount Paid (If any)	$
Amount Due (If any)	$
Total Amount of Compensation	$

Description of Services Provided:

Representative’s Name: Address: City:

State: ZIP Code:

Fees, Commissions or Compensations:

Amount Paid (If any)	$
Amount Due (If any)	$
Total Amount of Compensation	$

Description of Services Provided:

The undersigned hereby certifies that the information for the six-month period ending , as provided above is accurate and complete. (If necessary, the statement of services may be continued on a separate page).

Name of 8(a) Participant Firm: Principals’ Printed Name: 8(a) Case # Principals’ Printed Title:

Principals’ Signature: Date:

The total estimated time to respond to this form, including time to read instructions, and compile the information needed to respond, is

15 minutes. You are not required to respond to this or any collection of information unless it displays a currently valid OMB approval

number and expiration date. Comments on the burden should be sent to: U.S. Small Business Administration, Chief, AIB, 409 Third

St., S.W., Washington, DC 20416 and Desk Officer for the U.S. Small Business Administration, Office of Management and Budget,

New Executive Office Building, Room 10202, Washington, DC 20503

PLEASE DO NOT SEND FORMS TO OMB.

SBA Form 1790 (3-09) Previous Editions Obsolete