SBA Form 1971 Religious Eligibility Worksheet

Religious Eligibility Worksheet
For all 7(a) and 504 Loan Programs

OMB Control No.: 3245-0348
Expiration Date: XX/XX/2023

The purpose of the information requested is to assist SBA and the Lender/Certified Development Company (CDC) (“SBA
Lender”)with determining the eligibility of a loan application from a Small Business Applicant whose business has a
religious component. Failure to submit the information would affect that determination.
Instructions for SBA Lenders: Prior to submitting an application to the SBA loan processing center (non-delegated) or
processing a loan under delegated authority, the SBA Lender must submit the completed SBA Form 1971 and supporting
documentation to the Associate General Counsel for Litigation for review at [email protected].
Applicant Business Legal and/or DBA Name: _________________________________________________________________
Applicant Address: ________________________________________________________________________________________
Applicant Phone: ____________________________ Applicant Website (if applicable) __________________________________
Requested Loan Amount ________________________________

Type of Loan ___________________________________

Please describe in detail what the proceeds of the loan will be used for (attach separate sheet if necessary):
________________________________________________________________________________________________________
Is Applicant connected, associated, or affiliated with a religious organization in any way?

 Yes  No

If “Yes” explain the nature and extent of the relationship (attach separate sheet if necessary): _______________________________
Nature of the Religious Component (Please check all that apply)
 Sale of religious books, music, artifacts, gifts, and/or other religious items.
 Religious instruction, counseling, or indoctrination with regard to any items sold (including those listed immediately above).
 Religious instruction, indoctrination, or counseling whether to adults or children (includes use of religious material at day care
facilities).
 Religious broadcasting (e.g., religious music, religious programing, including instruction, indoctrination, counseling, and
religious services).
 Generation, Sale or distribution of newspaper, journal, or other religious publications.
 Creation or development of religious materials (e.g. writings, music, artifacts, computer software, religious art, etc.).
 Prayer, religious worship, or religious service
 Provision of reading room or other space to conduct lectures, readings, prayer, worship, or other activities related to religion.
 Other:________________________________________________________________________________
Explain the nature of each of the religious components checked above (attach separate sheet if necessary) _______________________
____________________________________________________________________________________________________________
Signature of Authorized Representative of Applicant: _____________________________________________Date: ______________
Print Name: __________________________________________________
Title: ___________________________________________

Authorized Lender Official Signature:_____________________________________________________Date:____________________
Print Name: _______________________________________________
Title: ______________________________________________
Lender Email _________________________________________Lender / CDC Name _____________________________________
NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid OMB Control
Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing the form is 5
minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small Business Administration, Director, Records Management Division,
409 3rd St., SW, Washington DC 20416, and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Rm. 10202, Washington DC
20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 1971 (07/20)