Form SBA Form 1222 SBA Form 1222 NOTICE OF AWARD

PURPOSE: This form is used to notify grant recipients of award reporting and record keeping requirements. Grantees are
required to review and sign the form and return to SBA at the address: SBDC- SBA/OSBDC, 409 Third Street, SW 6th Floor,
Washington, DC 20416All other SBA/OGM, 409 Third Street, 5th Floor, Washington, DC 20416

NOTICE OF AWARD

U.S. Small Business Administration

2. Grant/Cooperative Agreement No.:

(Legislation/
Regulation)

1. AUTHORIZATION

OMB Approval No.: 3245-0140
Expiration Date 5/31/2015

(Mo./Day/Yr.)

4. PROJECT PERIOD (Mo./Day/Yr.)

3. RECIPIENT: (Name, Organizational Unit, Address)

From

Through
(Mo./Day/Yr.)

5. BUDGET PERIOD (Mo./Day/Yr.)
From

Through

6. FEDERAL CATALOG NO.

7. ADMINISTRATIVE CODES

8. TITLE OF PROJECT/PROGRAM (limit to 53 spaces)
9. AWARD AMOUNT

Amount of SBA Financial
Assistance

10. DIRECTOR OF PROJECT (Program or Center Director,

11. RECOMMENDED FUTURE SUPPORT(Subject to the availability of
funds and satisfactory progress of the
project)

Coordinator or Principal Investigator)

NAME
Last

First

ADDRESS:

BUDGET
YEAR

Initial

BUDGET
YEAR

a.

12. Approved Budget (Excludes SBA Direct Assistance)
SBA Funds
Only

TOTAL
DIRECT COST

Total project costs including all other financial
participation.

Federal
Share

a. Personal Service

b.

13. REMARKS (Other Terms & Conditions Attached)

Non-Federal
Share

TOTAL
DIRECT COST

Non-Federal
In-Kind

Non-Federal
Program Inc.

b. Fringe Benefits

Yes

No

14. THIS AWARD IS SUBJECT TO THE FOLLOWING
COST PRINCIPLESAND OMB UNIFORM
ADMINISTRATIVE REQUIREMENTS:

c. Consultants

2 CFR Chapter 1, Chapter II, Part 200, et al,
uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal
Awards.

d. Travel
e. Equipment
f. Supplies
g. Contractual

Part 180 - OMB Guidelines to Agencies on
government debarment and suspension (Non
Procurement)

h. Other
i. TOTAL DIRECT COSTS
j. Indirect cost
(Rate).
k. OTHER APPL. COSTS
l. TOTAL APPROVED BUDGET
*Must meet all matching or cost participation
requirements
subject to adjustment in accordance with SBA
policy

15. THIS AWARD IS SUBJECT TO THE TERMS AND CONDITIONS ON THE REVERSE SIDE
16. CRS - EIN
19a. CITY CODE

17. COUNTY NAME
b. COUNTY CODE

BUDGET CODE
20a.

c. STATE CODE

DOCUMENT NO.
b.

18. CONGRESSIONAL
DISTRICT NO.
d. PROGRAM CODE

AMT. ACTION FIN. ASST.
c.

TYPE OF ORGANIZATION
d.

21. AGENCY OFFICIAL (Signature, Name and Title)

22. DATE ISSUED (Mo./Day/Yr.)

23. RECIPIENT OFFICIAL (Signature, Name and Title)

24. DATE

SBA FORM 1222 (4-12) Previous editions obsolete

(Mo./Day/Yr.)

Note: The estimated burden completing this form is 80 hours per response. You will not be required to respond to any collection
of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to
U.S. Small Business Administration, Chief, AIB, 409, 3rd St., S.W., Washigton, D.C. 20416 and Desk Office for Small Business
Administration, Office of Management and Budget, New Executive Office Building, room 10202 Washington, D.C. 20503. OMB
Approval (3245-0140).
PLEASE DO NOT SEND FORMS TO OMB.

SBA FORM 1222 (4-12) Previous editions obsolete