Certification for the Women-Onwed Small Business Federal Contract Program

Attachment 3
WOSB or EDWOSB Certification Questionnaire Screenshots
Accept Page:

OMB Approval No: 3245-0374
Expiration Date: XX-XX-XXXX

1

8(a)

Third Party

Yes/No with attachment required on ‘Yes’

Yes/No with attachment required on ‘Yes’

2

Changes in Eligibility

Non-qualification

Yes/No

Yes/No with attachment required on ‘Yes’

3

Partnership
Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’
(These questions show if the firm is registered as a Partnership)

Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’

4

Corporation & S-Corp
Yes/No
Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’
(These questions show if the firm is registered as a Corporation & S-Corp)

Yes/No

Yes/No

Yes/No

5

Corporation & S-Corp
Yes/No

Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’

6

LLC
Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’
(These questions show if the firm is registered as a LLC)

Citizenship
Yes/No: Attachment required on ‘Yes’

Yes/No: Attachment required on ‘Yes’, Comment required on ‘No’

7

Ownership
Yes/No

Yes/No/NA: Comment required on ‘No’

Yes/No

8

Management
Yes/No

Yes/No

Yes/No: Attachment required on ‘Yes’

Yes/No

9

Management
Yes/No

Yes/No

10

SBA Exam
Yes/No

11

Review Page

12

Review Page

13

Review Page

14

Privacy Statements Page

15

Signature Page

1 hour.

16

Additional Questions Required for an EDWOSB
Net Worth Page
Yes/No

17

Adjusted Gross Income Page
Yes/No
Yes/No

18

Assets Page
Yes/No

Yes/No

19

Assets Page
Yes/No

20

Economic Disadvantage Page
Yes/No: Attachment required on ‘Yes’

21

Financial Data Page
Additional Information Required on Add New Person

Yes/No; Supporting Documents Required on Yes

22

Cash on Hand Page

23

Other Sources of Income Page

24

Notes Payable Page
Yes/No; Additional Information Required on Yes

Additional Information Required on New

25

Retirement Accounts Page
Yes/No; Additional Information and Supporting Documents Required on
Yes

Additional Information Required on New

26

Retirement Accounts Page
Yes/No; Supporting Documents and Additional Information Required on
Yes

Additional Information Required on New

27

Life Insurance Page
Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

Additional Information Required on New

28

Stocks & Bonds Page
Yes/No; Additional Information Required on Yes

Additional Information Required on New

29

Primary Residence Page

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

30

Primary Residence Page

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

31

Primary Residence Page
Yes/No; Additional Information Required on Yes

32

Other Real Estate Page
Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

33

Other Real Estate Page

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

34

Other Real Estate Page
Yes/No; Additional Information Required on Yes

35

Personal Property Page

Yes/No; Additional Information Required on Yes

Yes/No; Additional Information Required on Yes

Additional Information Required on New
Additional Information Required on New

36

Notes Payable and Other Liabilities Page
Yes/No; Additional Information Required on Yes

Additional Information Required on New

37

Assessed Taxes Page
Yes/No; Additional Information Required on Yes

Additional Information Required on New

38

Adjusted Gross Income Page

39

Financial Data Summary Page

40

Privacy Statements Page

41

Review Page

42

Review Page

43

Review Page

44

Review Page

45

Signature Page

1 hour.

46