Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage

Forms and Documents

Document Name	Status
Form SBA FORM 1941 C Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage Form and Instruction	Modified
3245-0301 SBA Form 1941 A-C Statutory and Regulatory 4-12-17.docx Supplementary Document	2017-04-13
3245-0360 SBA Form 1941 A-C Supporting Statement 4-12-17.docx Supporting Statement A	2017-04-13

IC Document Collections

IC ID	Document Title	Status
35752	Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage Form and Instruction	Modified

ICR Details

OMB Control No: 3245-0301	ICR Reference No: 201704-3245-002
Status: Historical Active	Previous ICR Reference No: 201312-3245-006
Agency/Subagency: SBA	Agency Tracking No:
Title: Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage
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: 05/15/2017
	Date Received in OIRA: 04/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	10	0	50
Time Burden (Hours)	15	0	100
Cost Burden (Dollars)	0	0	0

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Abstract: Small Businesses seeking financing from specialized small business investment companies will complete this form for the purpose of demonstrating their eligibility for such financing based on their ownership by individuals who either socially or economically disadvantaged. Written certification of eligibility is required by the Small Business e Investment of 1958.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 75896	11/01/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 16466	04/04/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Financing Eligibility Statement - Social Disadvantage/Economic Disadvantage	SBA Form 1941 A , SBA FORM 1941 B, SBA FORM 1941 C	FINANCING ELIGIBILITY STATEMENT - "ECONOMIC DISADVANTAGE" ,   FINANCING ELIGIBILITY STATEMENT - "SOCIAL DISADVANTAGE" ,   FINANCING ELIGIBILITY STATEMENT - "SOCIAL DISADVANTAGE" (FOR INDIVIDUALS WHO ARE NOT MEMBERS OF A DESIGNATED GROUP)

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ICR Summary 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	10	50	0	-40	0	0
Annual Time Burden (Hours)	15	100	0	-85	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Decrease in burden estimates reflect the anticipated number of respondents based upon the current number of active SSBIC licensees.

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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

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Common Form ICR:  No

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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: 04/13/2017

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