SBA Form 468 Shc. LOW INCOME ENTERPRISE FINANCINGH IMPACT ASST.

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OMB No: 3245-0332

Exp. Date: XX/XX/XXX

EW MARKETS VENTURE CAPITAL PROGRAM
INVESTMENT DIVISION
U. S. SMALL BUSINESS ADMINISTRATION
409 Third Street, S.W. Washington, DC 20416 Tel: (202) 205-6510; Fax: (202) 205-6959

SBA Form 468

Schedule 10

Low-Income Enterprise Financing Impact Assessment

Instructions: New Markets Venture Capital Companies (NMVCCs) must file this Schedule 10 of SBA Form 468 for each Financing made to a Low-Income (LI) Enterprise. (See 13 CFR 108.50 and 108.630(f).) Specialized Small Business Investment Companies (SSBICs) that have received an Operational Assistance grant under the NMVC program must file this Schedule 10 of SBA Form 468 for each Financing made to a LI Enterprise with Regulatory Capital raised under the NMVC program. (See 13 CFR 108.50 and 108.2040(b).)

Both NMVCCs and SSBICs must file this Schedule 10 with SBA annually, together with the remainder of SBA Form 468, as required in 13 CFR 108.630. Limit your responses to each question in this Schedule to no more than 10 lines. Please attach to this Schedule 10 a copy of the specific Performance Goals you outlined in your application for assistance under the NMVC program (for NMVCCs, in Question 206.5 of SBA Form 2184, Part I, Questionnaire; for SSBICs, in your Plan for providing Operational Assistance, per 13 CFR 108.2005).

NMVCC/SSBIC

NMVCC/SSBIC Name

NMVCC #/ SSBIC #

Portfolio Concern

Business name

EIN #

Low-Income Geographic Area (LI Area) in which Concern’s Principal Office is located (i.e., census tract number or specific qualifying criteria; or attach a print-out of search result from SBA’s web site at http://www.sba.gov/INV/NMVC/):

1. Describe, and quantify whenever possible, the social, economic or community development benefits achieved as a result of this Financing.

2. How and to what extent have these benefits fulfilled the indicators or goals you specified in your application?

3. Have the results of this Financing fulfilled the objectives of the NMVC program? Please explain.

4. Describe whether and, if so, how you achieved accountability to the residents of the LI Area in which this Portfolio Concern’s Principal Office is located. (Ways in which you might achieve such accountability include having on your governing or advisory boards low-income individuals who reside in those LI Areas; having on your governing or advisory boards representatives of organizations that primarily serve those LI Areas (e.g. staff or board members of a non-profit organization that principally serves low-income individuals from those geographic areas); and hosting or participating in focus groups or community meetings and/or conducting client surveys, to gather information concerning LI Areas and then using such information in making investment decisions that affect those areas.)

SBA is collecting the information on this Schedule 10 of SBA Form 468 in accordance with section 361(1) of the Small Business Investment Act (15 USC 689j(1)) for the purpose of evaluating the NMVCC’s or SSBIC’s performance related to the performance goals that it proposed in its application for assistance under the NMVC program. The information collected on this form is required in order for the NMVCC or SSBIC to continue to receive SBA assistance.

Please note: The estimated burden for completing this form is 2 hours. You are not required to respond to this form unless it displays a current Office of Management and Budget (OMB) approval number. The information collected on this form will be kept confidential to the extent permitted by law. 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, Washington, D.C. 20503. OMB Approval Number 3245-0332. Please do not send forms to OMB.

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SBA Form 468, Schedule 10 (7/02) Previous edition obsolete