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

Forms and Documents

Document Name	Status
Form SBA Form 856 Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	Modified
Form SBA FORM 856 Disclosure Statement Lveraged Licensees Form and Instruction	Unchanged
3245-0118 SBA Form 856 Supporting Statement 7-31-18.docx Supporting Statement A	2018-07-31

IC Document Collections

IC ID	Document Title	Status
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	Modified
202552	Disclosure Statement Lveraged Licensees Form and Instruction	Unchanged

ICR Details

OMB Control No: 3245-0118	ICR Reference No: 201807-3245-001
Status: Active	Previous ICR Reference No: 201505-3245-003
Agency/Subagency: SBA	Agency Tracking No:
Title: Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/14/2018
	Date Received in OIRA: 07/31/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	36 Months From Approved	11/30/2018
Responses	571	0	598
Time Burden (Hours)	393	0	276
Cost Burden (Dollars)	0	0	0

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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.

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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:
	83 FR 4113	03/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 35526	07/26/2018
Did the Agency receive public comments on this ICR? No

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

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

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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	571	598	0	-27	0	0
Annual Time Burden (Hours)	393	276	0	117	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Additionally, the burden hours for preparing responses have been increased by 0.5 hours per response to account for the additional information required for the management consulting services

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Annual Cost to Federal Government: $0

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 07/31/2018

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