Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SBA Form 856 A Disclosure Sstatement Non-LEVERAGED Licensees	Form and Instruction	Modified	Available
Form SBA Form 856 Disclosure Statement Leveraged Licensees	Form and Instruction	Modified	Available
Form SBA FORM 856A Disclosure Statement NON-Leveraged Licesees	Form and Instruction	Unchanged	Available
Form SBA FORM 856 Disclosure Statement Leveraged Licensees; Dislosure Statement Non-Leveraged Licensees	Form and Instruction	Unchanged	Available
3245-0118 PRA Renewal Suppl Stmt (Final) 5-20-15.docx	Supporting Statement A	Uploaded 2015-05-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	Form and Instruction	Modified	Disclosure Sstatement Non-LEVERAGED Licensees
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	Form and Instruction	Modified	Disclosure Statement Leveraged Licensees
202552	Disclosure Statement Lveraged Licensees	Form and Instruction	Unchanged	Disclosure Statement NON-Leveraged Licesees
202552	Disclosure Statement Lveraged Licensees	Form and Instruction	Unchanged	Disclosure Statement Leveraged Licensees; Dislosure Statement Non-Leveraged Licensees

ICR Details

OMB Control No: 3245-0118	ICR Reference No: 201505-3245-003
Status: Historical Active	Previous ICR Reference No: 201206-3245-001
Agency/Subagency: SBA	Agency Tracking No:
Title: Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/08/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/20/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	36 Months From Approved	07/31/2015
Responses	598	0	600
Time Burden (Hours)	276	0	276
Cost Burden (Dollars)	0	0	0

---

Abstract: Small Business Administration (SBA) Forms 856 and 856A are used by SBA examiners as part of their examination of licensed small business investment companies (SBICs). This information collection obtains representations from an SBIC's management regarding certain obligations, transactions and relationships of the SBIC and helps SBA to evaluate the SBIC's financial condition and compliance with applicable laws and regulations.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 10202	02/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 29143	05/20/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Disclosure Statement Lveraged Licensees	SBA FORM 856 , SBA FORM 856A	Disclosure Statement Leveraged Licensees; Dislosure Statement Non-Leveraged Licensees ,   Disclosure Statement NON-Leveraged Licesees
Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	SBA Form 856 , SBA Form 856 A	Disclosure Statement Leveraged Licensees ,   Disclosure Sstatement Non-LEVERAGED Licensees

---

ICR Summary of Burden

table that charts list of burden

	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	598	600	0	-2	0	0
Annual Time Burden (Hours)	276	276	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/20/2015

---