Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees

Forms and Documents

Document Name	Status
Form `SBA FORM 856 Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form	Modified
Form SBA FORM 856 Disclosure Statement Lveraged Licensees Form and Instruction	New
3245-0118 SBA Form 856 Corresponding Stat~Reg Pro 6-12.docx Supplementary Document	2012-06-01
3245-0118 SBA Form 856 Supporting Statement 6-12.doc Supporting Statement A	2012-06-01

IC Document Collections

IC ID	Document Title	Status
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form	Modified
202552	Disclosure Statement Lveraged Licensees Form and Instruction	New

ICR Details

OMB Control No: 3245-0118	ICR Reference No: 201206-3245-001
Status: Historical Active	Previous ICR Reference No: 200903-3245-001
Agency/Subagency: SBA	Agency Tracking No:
Title: Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/11/2012
	Date Received in OIRA: 06/01/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved	07/31/2012
Responses	600	0	350
Time Burden (Hours)	276	0	162
Cost Burden (Dollars)	0	0	0

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Abstract: Small Business Administration (SBA) Forms 856 and 856A are used by SBA examiners as part of their examination of licensed small business investment companies (SBICs). This information collection obtains representations from an SBIC's management regarding certain obligations, transactions and relationships of the SBIC and helps SBA to evaluate the SBIC's financial condition and compliance with applicable laws and regulations.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 77298	12/12/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 14583	03/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	SBA FORM 856A, `SBA FORM 856	DISCLOSURE STATEMENT LEVERAGED LICENSEES ,   DISCLOSURE STATEMENT NON-LEVERAGED LICENSEES
Disclosure Statement Lveraged Licensees	SBA FORM 856 , SBA FORM 856A	Disclosure Statement Leveraged Licensees; Dislosure Statement Non-Leveraged Licensees ,   Disclosure Statement NON-Leveraged Licesees

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	600	350	0	250	0	0
Annual Time Burden (Hours)	276	162	0	114	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Change in respondents

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/01/2012

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