Form SBA FORM 1790 SBA FORM 1790 Semi-Annual Report on Representatives Used and Compensat

OMB Approval No.: 3245-0270

Expiration Date:

SEMI-ANNUAL REPORT ON REPRESENTATIVES USED AND COMPENSATION PAID

FOR SERVICES IN CONNECTION WITH OBTAINING FEDERAL CONTRACTS

FOR THE PERIOD ____________________ TO _____________________.

As required by 15 USC 637(a)(20) (a) and 13 CFR Part 124.601, all 8(a) Participants are required to semiannually report to SBA information on compensation provided to any Agents or Representatives (hereafter referred to as “Representatives”), including attorneys,  accountants, and consultants, for assisting the Participants to obtain a Federal contract.  The information includes the amount of compensation provided to the Representative and a description of the services performed in return for such compensation.  The information is used to ensure that Participants do not engage in any improper or illegal activity in connection with obtaining a contract.

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 beginning ________________________ and 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 (6-12) Previous Edition Obsolete