SBIR Program Application Cover Sheet

Application to National Institute of Standards and Technology (NIST) Small Business Innovation Research (SBIR) Program [Insert relevant FFO number] Cover Sheet
Name of Submitting Firm:		Click here to enter text.
Subtopic Number	Click here to enter text.	Project Title	Click here to enter text.
Principal Investigator (PI) Name	Click here to enter text.		PI Title	Click here to enter text.
PI Phone #	Click here to enter text.		PI E-mail	Click here to enter text.
NIST may verify the following responses with information provided elsewhere in your application or by independent sources.
THE APPLICANT CERTIFIES THAT:
It is a small business concern (SBC) and meets the definition as stated in this Federal Funding Opportunity (FFO).					☐ Yes ☐ No
The primary employment of the PI will be with the SBC at the time of award and during the conduct of research.					☐ Yes ☐ No
A minimum of two-thirds of the research will be performed by the SBC in Phase I as determined by data provided in the Budget Narrative. See FFO Section [insert relevant section #] for details on funding determination.					☐ Yes ☐ No
The applicant and/or PI ☐ has / ☐ has not submitted applications for essentially equivalent work under other Federal program FFOs and ☐ has / ☐ has not received other Federal awards for essentially equivalent work. If “has”, what agency? Click here to enter text. See FFO Section [insert relevant section #] for additional details that must be provided.
THE FOLLOWING ITEMS ARE FOR STATISTICAL PURPOSES:
The applicant qualifies as a socially and economically disadvantaged SBC and meets the definition as stated in this FFO.					☐ Yes ☐ No
The applicant qualifies as a woman-owned SBC and meets the definition as stated in this FFO.					☐ Yes ☐ No
The applicant qualifies as a HUBZone-owned SBC and meets the SBA’s definition (see http://www.sba.gov/hubzone).					☐ Yes ☐ No
The applicant qualifies as a veteran-owned SBC. The applicant qualifies as a service-disabled veteran-owned SBC.					☐ Yes ☐ No ☐ Yes ☐ No
Year SBC founded: Click here to enter text.
Number of Employees: Click here to enter text.
STATEMENTS:
The applicant will permit the Government to disclose contact information if this application does not result in an award, to appropriate local and State-level economic development organizations that may be interested in contacting you for further information.					☐ Yes ☐ No
The applicant authorizes contact information and project title to be provided to the NIST Manufacturing Extension Partnership (MEP) after awards have been announced. If ‘Yes’ your contact information will be provided to NIST MEP. If so, you will be contacted by your local MEP to explore business-related support services that could benefit the potential of the project you proposed.					☐ Yes ☐ No
TECHNICAL ABSTRACT (limit to 200 words):
Click here to enter text.
POTENTIAL COMMERCIAL APPLICATION OF THE RESEARCH:
Click here to enter text.
OTHER INFORMATION:
Information contained in unsuccessful applications will remain the property of the applicant. The government may, however, retain copies of all applications. Public release of information in any application submitted will be subject to existing statutory and regulatory requirements. Applicants are discouraged from submitting proprietary information unless the information is deemed essential for proper evaluation of the application. If proprietary information provided by an applicant in an application constitutes trade secret, proprietary commercial or financial information, confidential personal information, or data affecting national security, it will be treated in confidence to the extent permitted by law. This information must be clearly marked by the applicant with the term ‘confidential proprietary information’ and the following legend must appear in this section of the application. PROPRIETARY NOTICE “These data shall not be disclosed outside the Government and shall not be duplicated, used, or disclosed in whole or in part for any purpose other than evaluation of this proposal. If a funding agreement is awarded to this applicant as a result of or in connection with the submission of these data, the Government shall have the right to duplicate, use, or disclose the data to the extent provided in the funding agreement and pursuant to applicable law. This restriction does not limit the Government's right to use information contained in the data if it is obtained from another source without restriction. The data subject to this restriction are contained on pages _________________of this proposal.” The use of any other legend is unacceptable to the Government and may constitute grounds for removing the application from further consideration without assuming any liability for inadvertent disclosure.

This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Mary Clague, 100 Bureau Dr., MS 2200, Gaithersburg, MD 20899.

OMB Control No. 0693-XXXX

Expiration Date: XX-XX-XXXX