Statement of Personal History

ICR 201302-3245-005

OMB: 3245-0178

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2013-02-19
Supporting Statement A
2013-02-19
IC Document Collections
IC ID
Document
Title
Status
35707 Modified
ICR Details
3245-0178 201302-3245-005
Historical Active 200912-3245-004
SBA
Statement of Personal History
Revision of a currently approved collection   No
Regular
Approved with change 04/24/2013
Retrieve Notice of Action (NOA) 02/20/2013
  Inventory as of this Action Requested Previously Approved
04/30/2016 36 Months From Approved 04/30/2013
142,000 0 142,000
35,500 0 35,500
0 0 0

Small Business Administration SBA Form 912 is used to collect information needed to make character determinations with respect to applicants for monetary loan assistance or applicants for participation in SBA programs. The information collected is used as the basis for conducting name checks at national Federal Bureau of Investigations (FBI) and local levels.

None
None

Not associated with rulemaking

  77 FR 43410 07/24/2012
78 FR 11263 02/15/2013
No

1
IC Title Form No. Form Name
Statement of Personal History SBA Form 912 Statement of Personal History

  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 142,000 142,000 0 0 0 0
Annual Time Burden (Hours) 35,500 35,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Travis Farris 202 205-7178 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/20/2013


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