Information Collection

Statement of Personal History

IC 35707 under ICR 201905-3245-005 · OMB 3245-0178.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3245-0178 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SBA Form 912 Statement of Personal History	Form and Instruction
SBA Form 912 Statement of Personal History 3245-0178 SBA Form 912 5-29-19.pdf www.sba.gov	Form and Instruction

IC Title:

Statement of Personal History

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SBA Form 912	Statement of Personal History	3245-0178 SBA Form 912 5-29-19.pdf	www.sba.gov	Yes	No	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 142,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	142,000	0	142,000
Annual IC Time Burden (Hours)	35,500	0	35,500
Annual IC Cost Burden (Dollars)	298,200	298,200	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.