SBA Form 3314 Small Business Investment Company of the Year

OMB Control Number 3245-0360
Expiration Date: ______________

National Small Business Week SBA Form 3314, Small Business Investment Company of the Year

Instructions:

This form must be completed by the nominee or by the nominator. The completed form must be submitted with the nomination package as noted in the award guidelines. Answer each question as fully as possible; if it is not applicable, state N/A.

Small Business Investment Company of the Year

1. SBIC Information:

   1. Name:

   2. Address:

   3. Phone number:

   4. Email address:

   5. Website URL:

2. SBIC CEO/Director Information:

1. Name:

2. Phone number:

3. Email address:

3. Nominator Information (if applicable):

1. Nominator name:

2. Title:

3. Address:

4. Phone number:

5. Email address:

4. How long has the fund been in the SBIC Program?

5. Describe the size of the fund by private capital commitment.

6. How much has been invested?

7. How many companies have been financed?

8. How many jobs have been sustained and created?

Answer each of the following questions in 400 words or less.

9. Provide a narrative that includes SBIC’s commitment to supporting the growth and expansion of small businesses, including but not necessarily limited to job creation and retention, penetration in underserved markets, and commitment to communities served:

10. Provide a narrative that includes the SBIC’s commitment not just to financial return on investment, but to public focus and well-being. Although the entire body of work of the SBIC will be considered, this might also be demonstrated by a specific achievement reflecting positively upon the program and the Agency:

11. Describe how the fund’s participation directly added value to a small concern.  For example, has the SBIC been able to attract other sources of capital with which to partner in order to provide a small concern additional equity, senior debt or subordinated debt and thus more financing capacity?  Or, has the SBIC contributed as a board member in a manner that helped a small concern come up with new products or processes?

12. Provide the qualities and performance of the SBIC that merit the award:

Caution:
Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a denial of program participation or other benefits awarded by the agency. A false statement is punishable under 18 USC 1001 by imprisonment of not more than five years and/or a fine of not more than $10, 000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally insured institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000.

Paperwork Reduction Act Notice:

SBA will use the information collected on this form, along with other information submitted by award nominees as part of the nomination package, to determine the nominee's eligibility for a particular small business award; to identify any actual or apparent conflict of interest and, to make eventual award determinations. Responding to this request for information is voluntary. However, failure to provide the requested information may affect SBA’s ability to make a decision regarding your eligibility for an award.

You are not required to respond to any collection of information unless it displays a currently valid OMB control number (3245-0360). The estimated burden for completing this form is 1 hour and 45 minutes, including the time for reviewing the instructions, and gathering and compiling data. Combined with the time for completing the Form 3300, the total estimated time to prepare and submit the nomination package for each nominee is 90 minutes. Comments on this burden estimate should be sent to the U.S. Small Business Administration, Chief, AIB 409 3rd St., SW, Washington, DC 20416, and Desk Officer for the U.S. Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, DC 20503. DO NOT SEND COMPLETED FORMS TO OMB. Submit them to the location indicated in the nomination guide.

SBA Form 3314 (08/2015)