SBA FORM 2419 Itermediary Leading Program Electronic Reporting System

O MB Control Number: 3245-0376

Expiration Date: 04/30/2014

Intermediary Lending Program Electronic Reporting System (ILPERS)

System Description and Submisison Information:

The Intermediary Lending Program Electronic Reporting System (ILPERS) is a web-enabled system that is accessed through the General Login System (GLS). https://eweb.sba.gov/gls/dsp_login.cfm. Portfolio Identification Reports and Portfolio Status Reports will be submitted through this electronic system. Submission: To access GLS, Intermediaries must providing certain identifying and contact information (including, name, date of birth, taxpayer’s identification number, address and telephone number) for the person accessing the system.

Purpose of Data Collection:

In order to verify that the statutory purposes of the Intermediary Lending Program (ILP) are being met, SBA must collect data described below relating to the ILP Intermediaries as well as the small businesses that receive loans through the program.

Data collected through ILERPS will help to monitor the disbursement of the loans provided to the intermediaries and track activities on the loans to the small businesses, including use of proceeds, terms of such loans, repayment history and impact of loans on jobs created or retained. SBA will also use the information to report to its various oversight authorities regarding the number, dollar volume, portfolio payment performance, and demographic characteristics of ILP Intermediaries and small business borrowers.

NOTE: Additional data collected using SBA Form 2418, ILP Program Activities Report are also reported using ILPERS.

Confidentiality:

Some of the requested business and personal information may implicate the Trade Secrets Act and the Privacy Act respectively. SBA will keep such information confidential to the extent permitted by law, including the Freedom of Information Act, 5 USC 552 and the Privacy Act, 5 USC 552a.

Paperwork Reduction Act:

You are not required to respond to this request for information unless it displays a current Office of Management and Budget (OMB) control number. The estimated burden for completing this information collection is 3.5 hours. If you have questions or comments concerning this estimate or other aspects of this information collection, please contact the U.S. Small Business Administration, Chief, Administrative Information Branch, Washington, DC 20416 and/or Office of Management and Budget, SBA Desk Officer, New Executive Office Building, Room 10202, Washington, DC 20503.

Reporting Requirements: Intermediaries must submit a two-part Portfolio Identification Report to show information regarding the small business borrower detail and the small business loan detail, and a Quarterly Portfolio Status Report to show payments and outstanding balance information and outcome data.

1. Portfolio Identification Report:

1. Small Business Borrower Detail

Enter the following information within 7 days of loan closing:

1. Business name

2. Business located in Underserved Market

• HUBZone

• Enterprise Community Empowerment Zone (EC/EZ)

• Low to Moderate Income

3. Employer Identification Number (EIN)

4. Owners of business

• Name

• % of ownership

• Demographic information on each owner

  • Gender: Male, Female, Unknown/Not Stated.

  • Veteran Status: Non-Veteran, Veteran, Unknown/Not Stated.

  • Service-Disabled Veteran: Yes, No, Unknown/Not Stated.

  • Ethnicity: Hispanic or Latino, Not Hispanic or Latino, Unknown/Not Stated.

  • Race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, Unknown/Not Stated.

• Low income borrower, as defined by the Department of Health and Human Services (yes/no)

2. Small Business Loan Detail

Enter the following information for each loan within 7 days of loan closing:

5. Loan Purposes and amounts

   Use of proceeds	Total $
   Materials
   Supplies
   Inventory
   Equipment
   Working Capital
   Real Estate
   Total	0

6. Closing Date

7. Interest Rate

8. Payment amount

9. Payment frequency (annually, quarterly, monthly, etc.)

10. Term: length in months

11. Total fees charged

Fee amount
Percentage of Loan

12. Lender’s loan number

13. NAICS Code

14. NAICS Description

15. Collateral to Loan Ratio

16. Credit Elsewhere test applied (yes/no)

17. Meets SBA Definition of Small Business (yes/no)

18. Meets SBA Definition of Eligible Business (yes/no)

19. Business Status - (existing/start-up)

20. Organization type (sole proprietorship, partnership, corporation, LLC, joint venture)

21. Existing FTEs (at time of loan closing)

22. Jobs created

23. Jobs retained

24. Annual gross revenues

25. Annual net profits (loss)

2. Quarterly Portfolio Status Report

Enter the following information for each loan in your organization’s ILP portfolio on a quarterly basis:

1. Current payment status of loan

• 0—30 days

• 31—60 days

• 61—90 days

• 91—120 days

• Over 120 days

• Paid in Full

• Charged Off

2. Outstanding principal balance

3. If certifying no change in prior principal balance, provide a reason as to why there has been no change.

4. When a small business loan is identified as either Paid in Full or Charged Off, provide the following data:

• Business still in existence at end of loan period (yes/no)

• Existing FTEs

• Annual gross revenues

• Net profit/loss for most recently completed fiscal year

Note: Any number in green is a calculated number, not an input number.

NOTE: According to the Paperwork Reduction Act, you are not required to respond to collection of information unless it displays a currently valid OMB control number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing the form is 3.5 hour per response. Comments or questions on the burden estimate should be sent to U.S. Small Business Administration, Chief, Administrative Information Branch, Washington, DC 20416. PLEASE DO NOT SEND FORMS TO THIS ADDRESS.

SBA Form 2419 (04/2014)