Form SBA Form 355 SBA Form 355 Information for Small Business Determination

OMB Approval No: 3245-0101
Expiration Date: 12/31/2022

INFORMATION FOR SMALL BUSINESS SIZE DETERMINATION
General Instructions
CAREFULLY READ ALL OF THESE INSTRUCTIONS AND THE SBA SIZE
REGULATIONS BEFORE COMPLETING THIS FORM.
Providing the information is required in order for you to obtain a size determination from SBA.
Failure to submit the information or submitting incomplete information may affect the size determination.
1.

The information provided in this form will be used by the Small Business Administration (SBA) for a size
determination of a business applying for assistance available to small businesses under any program administered
by this Agency, except for its Small Business Investment Companies (SBIC) Program, which uses SBA Form 480,
or at the request of another Federal agency for purposes of its small business program. A small business is a
concern which is independently owned and operated, not dominant in its field of operation, and does not exceed
the size standard applicable to the procurement or program for which the business is seeking participation. SBA
defines a concern to be a business entity organized for profit, with a place of business located in the United States,
and which operates primarily within the United States or which makes a significant contribution to the U.S.
economy through payment of taxes or use of American products, materials or labor. 13 CFR § 121.105.

2.

SBA is authorized to make size determinations pursuant to the Small Business Act, 15 USC 637(a), and
regulations thereunder for the purpose of deciding small business protests and to determine eligibility for program
assistance. SBA's size regulations are found generally at Title 13 of the Code of Federal Regulations, Part 121.
SBA may, at its discretion, request additional information not specifically identified on this form.

3.

The applicant must return one copy of SBA Form 355, with additional sheets attached as needed, to the same SBA
Government Contracting Area Office that provided the form. The person signing this form must be authorized to
do so. Non-employee representatives of the business, such as an attorney or accountant, must provide a letter
authorizing them to represent the business. The information provided must be complete. Failure to supply
complete information may cause delays in making a size determination or lead to an adverse inference that the
business is other than small.

4.

All affiliates of the applicant business, whether acknowledged or not, and whether foreign or domestic, must be
disclosed. SBA's criteria for defining affiliates should be carefully reviewed. In 13 CFR § 121.103, SBA
identifies various forms of affiliation. You can find this regulation on the size standards website at
http://www.sba.gov/size. Separate affiliation rules apply to the SBA Business Loan, Disaster Loan, and Surety
Bond Guarantee programs (13 CFR § 121.301) and to SBIR and STTR programs (13 CFR § 121.702). The
website also provides some examples of affiliation in the “affiliation discussion” document. Dormant or inactive
firms must be disclosed unless legally dissolved. Completion of Part V of this form does not constitute an
admission or confirmation of affiliation.

5.

Where the applicable size standard involves numbers of employees, SBA examines the applicant business's
average number of employees on payroll for the 24 completed calendar months preceding the date of application or
offer, including all employees who are hired on a full-time, part-time, temporary or other basis, including
employees of domestic and foreign affiliates. See 13 CFR § 121.106 of SBA's regulations. For purposes of
Economic Injury Disaster Loans, SBA examines the average number of employees for the 24 months preceding
the disaster.

6.

Where applicable size standards involve “average annual receipts,” the applicant business's annual receipts means
total income (or gross income in the case of a sole proprietorship) plus cost of goods sold, as these terms are
defined and reported on the business's Federal income tax return. For certifications on or before January 6, 2022,
except for the Business Loan or Disaster Loan Programs, the applicant may choose to use a 3-year average or a 5year average. After January 6, 2022, the applicant must use a 5-year average. An applicant in the Business Loan or
Disaster Loan Programs may choose to use a 3-year average or a 5-year average. Applicants with fewer than five
years in business should consult the regulation. See 13 CFR § 121.104 of SBA's regulations.

SBA FORM 355 11-19 previous editions are obsolete

7.

For certain assistance programs, SBA must determine the primary industry activity or the North American
Industry Classification System (NAICS) code of a business as part of its size determination. For this, SBA
considers the distribution of receipts, employees and costs of doing business among the different industries in
which business operations occurred for the most recently completed fiscal year. SBA may also consider other
factors, such as the distribution of patents, contract awards, and assets. See 13 CFR § 121.107.

8.

For purposes of this form, consider principal stockholders as those persons or concerns which own 10 or more
percent of the voting stock. In cases where no individual or concern owns at least 10 percent of the voting stock,
the five largest stockholders and their percentages of stock must be listed.

9.

Where certain financial assistance programs are involved, the business must state whether government funds
(loans or grants) to be received will be used in a Labor Surplus Area. Labor Surplus Areas are defined in the
Department of Labor publications "Area Trends in Employment and Unemployment." See 13 CFR § 121.301(e).

10.

Certain industries require special information. Please review the Size Standards Table and any applicable footnote
in 13 CFR § 121.201.

CRIMINAL PENALTIES FOR FALSE STATEMENTS:
Any intentional or negligent misrepresentation of the information contained in this form, or other
documents submitted for purposes of the size determination, may result in criminal, civil or administrative
sanctions including, but not limited to: 1) fines of up to $500,000, and imprisonment of up to 10 years, or
both, as set forth in 15 U.S.C. § 645 and 18 U.S.C. § 1001, as well as any other applicable criminal laws; 2)
treble damages and civil penalties under the False Claims Act; 3) double damages and civil penalties under
the Program Fraud Civil Remedies Act; and 4) suspension and/or debarment from all Federal procurement
and non-procurement transactions.
__________________________________________________________________________________________________________________

CERTIFICATION:
I hereby certify that (1) I have made diligent efforts to obtain all information needed to complete this form; (2) I have reviewed all
of the responses to the questions in this form, all exhibits and attachments submitted with this form, and all other documents and
information that may be submitted subsequently; and (3) all information, exhibits, attachments, documents, and information that I
submitted, or may be submitted subsequently, are true and correct to the best of my knowledge. I understand that the U.S. Small
Business Administration (SBA) is relying on this information in order to make a size determination so that my business may
receive assistance under the laws and regulations administered by SBA or so that my business can obtain a Federal contract.

_____________________________________________________
(name of sole proprietorship, partnership, limited liability company
or corporation)
By:__________________________________________________
Signature
Name and Title:________________________________________
Date of signing: ________________________________________
PLEASE NOTE: The estimated burden hours for the completion of this form is 4 hours. You are not required to respond to this

information collection if a valid OMB approval number is not displayed. If you have any questions or comment concerning this
estimate or any other aspect of this information collection, please contact the U.S. Small Business Administration, Director,
Records management Division, 409 3rd Street, S.W., Washington, DC 20416 and/or SBA Desk Officer, Office of Management
and Budget, New Executive Office Building, Room 10202, Washington, DC 20503. PLEASE DO NOT SEND

FORMS TO OMB.

SBA FORM 355 11-19 previous editions are obsolete

OMB Approval No: 3245-0101
Expiration Date: 12/31/2022

INFORMATION FOR SMALL BUSINESS SIZE DETERMINATION
____________________________________________________________________________________________________________________
Part I.
Information relating to applicant business only:
____________________________________________________________________________________________________________________
1a.
Name and address of applicant business
1b. Name and title of person authorized to provide
(Street, City, State & Zip Code)
information:
Telephone No.:
______________________________________
Fax No.:
______________________________________
E-mail address:
______________________________________
DUNS No. of applicant: ____________________________
____________________________________________________________________________________________________________________
1c.
If determination is needed for a financial assistance program other than surety bond guarantee, will assistance funds be
used in a labor surplus area?
yes _____ no _____
If yes, identify labor surplus area: _______________
____________________________________________________________________________________________________________________
1d.

Date applicant was established or incorporated: _________________________________
Select type of business entity and provide as an attachment the corresponding information for the business entity chosen:
□

Partnership

Attach a copy of
partnership agreement.

□

Corporation

Attach articles of
incorporation and a copy of
latest annual report to
stockholders, if any, and
bylaws.

□

LLC

Attach a copy of its articles
of organization and
operating agreement.

□

Other (including joint
ventures) _______________

Identify business legal form
and attach appropriate
documents verifying
ownership and structure.

____________________________________________________________________________________________________________________
1e.
Primary business activity by North American Industry Classification System (NAICS) code _______________
__________________________________________________________________________________________________________________
1f.

Is applicant business organized for profit? Yes ___ No ___
If business is not organized for profit, stop and check with the SBA Government Contracting Office about whether to continue.
__________________________________________________________________________________________________________________

2.

Has applicant previously been the subject of a formal SBA size determination? Yes ___ No ___
If yes, then what SBA Government Contracting

Area Office? _______________________________
Date ______________________________
____________________________________________________________________________________________________________________
3.

Does applicant operate under a franchise or license from another concern?
yes _____ no _____
If yes, attach a copy of agreement.

4.

Name and address of all owners, partners, principal stockholders, or members of business organization.
If the applicant is owned by one or more entities (i.e., not individuals), provide the names of all owners of the entities and their
percentage of ownership. This information must be provided for owners of all entities until the applicant identifies the ultimate
owners who are natural persons. Attach additional sheets if necessary.
% of ownership interest in the applicant

Name

Name of all officers of applicant. Attach additional sheets if necessary.

5.
Name

6.

Position held

Name the members of the Board of Directors, if a corporation. If an LLC, name the Manager(s) or members of the Board of
Managers, and, if an LP, name the General Partner(s). Attach additional sheets if necessary.
Name

Position held

____________________________________________________________________________________________________________________
7a.

Has the applicant issued any stock options (or is the issue of any pending)? ____ yes ____ no.
If yes, identify person or concern holding options and amount.

7b.

Has the applicant pledged any stock as collateral? ____ yes ____ no.
If yes, provide details of arrangement.

7c.

Is any of the applicant’s stock held by a trust, voting trust, or voted in accordance with a shareholder’s agreement?
___ yes ___ no.
If yes, provide relevant documents.

____________________________________________________________________________________________________________________
8.

Are there any pending or recently completed mergers, or sale of the applicant by stock or assets? ____ yes ____ no.
If yes, submit details and copies of relevant documents.

____________________________________________________________________________________________________________________

Is the applicant or any person listed in questions 4, 5, or 6 (i.e., the owner, partner, director, officer, member, employee, or principal
stockholder) an owner, officer, director, manager or employee of another business? ____ yes ____ no.
If yes, complete section 9b below.
____________________________________________________________________________________________________________________

9a.

9b. Attach additional sheets if necessary.
Name of person/business

Names of other businesses and addresses

Position held in other
business

% of ownership interest in other
business.

___________________________________________________________________________________________________________________
Part II. Information relating to employee-based size standards. Only complete if applicant is being evaluated under an employeebased size standard.
____________________________________________________________________________________________________________________

10.

Provide the average number of employees of the applicant based upon numbers of employees (full-time, part-time, temporary, or
employed on other basis) for each of the pay periods for the 24 completed calendar months preceding the date that size is being
determined.

____________________________________________________________________________________________________________________
Part III. Information relating to receipts-based size standards. Only complete if applicant is being evaluated under a receipts-based size
standard.
____________________________________________________________________________________________________________________
11.
What is the ending date of the applicant’s fiscal year?
___________________________________________________________________________________________________________________
12.

(a)

For certifications made prior to January 6, 2022 or for loan applicants, select whether the applicant elects to use a 3-year or a 5year averaging period for average annual receipts:
____ 3-year average
____ 5-year average

(b)
Annual receipts/gross income of the applicant for each of its most recently completed five fiscal years as of the date that
size is being determined. If selecting a 3-year average in (a), only provide the most recently completed three fiscal years.
Year:______

$____________________________________

Year:______

$____________________________________

Year:______

$____________________________________

Year:______

$____________________________________

Year: ______

$____________________________________

Total:

$____________________________________

Part IV:

Information about acknowledged affiliates.

13.

Affiliates (domestic and foreign)
General Instruction #4 above provides guidance on determining whether a company is considered an “affiliate” of the applicant
and whether information about the affiliate must be reported. Include as an affiliate any businesses that the applicant’s owner(s)
include on a Schedule C or Schedule E of their personal tax returns in which the owner or immediate family member has a
controlling interest.

Note: All documentary materials about affiliates, including recorded documents, operating documents, financial and tax
information are to be submitted with this form.
____________________________________________________________________________________________________________________
13a.

Acknowledged affiliates. Attach additional sheets if necessary. If acknowledged affiliation is on a basis other than ownership,
provide explanation of basis for affiliation.

Name and address of acknowledged affiliate

13 b.

% of ownership that this
affiliate has in the applicant

NAICS code of primary
product or service

Name of all owners, partners, directors, members, and principal stockholders of each business in 13a.
If any owners are entities (i.e., not individuals) provide names of the owners of the entities. This information must be provided for
owners of all entities until the applicant identifies the ultimate owners who are natural persons. Attach additional sheets if necessary.

Name of individual

13c.

% of ownership interest
that applicant has in this
affiliate

Affiliated business

Position held

Number of employees currently employed by each business listed in 13a, if applicant is being evaluated under an employeebased size standard. (Attach separate sheet if needed)

_________________________________________________________________________________________________________________

13d.

Annual receipts/gross income of each business listed in 13a for each of the most recently completed five fiscal years prior to the date
size is being determined, if applicant is being evaluated under a receipts-based size standard . If selecting a 3-year average for
certifications prior to January 6, 2022 or as a loan applicant, only provide the most recently completed three fiscal years. Attach
additional sheets if necessary.

Year

Total:

Business 1:

Business 2:

$:

$:

$:

$:

$:

$:

$:

$:

$:

$:

Total:

Total:

____________________________________________________________________________________________________________________
14a.

Are there any persons listed in question 13b who are also owners, partners, directors, members or principal stockholders in another
company? ____ yes ____ no. If yes, complete section 14b below.

14b.

Attach additional sheets if necessary.

Name of person/business

Part V.

Name of other businesses and addresses

Position held in other business

% of ownership interest held
other business

Information about alleged or possible affiliates of applicant.
In cases where you are contesting alleged or possible affiliation, you must complete questions 15 – 21. The term “contesting”
means the firm filling out this form does not agree with the allegations that it is affiliated with a firm noted in the size protest or
request for size determination. If you are not contesting an alleged or possible affiliation, include the affiliate as an
acknowledged affiliate in Part IV and complete questions 15 – 21 only if requested by SBA. For size protests relating to a
specific procurement, questions 22 – 26 must be answered. Attach a separate explanation for any question answered “yes.”

15.

Have any owners, officers, directors, key employees or managing members of the applicant ever been employed by or performed
similar work for any alleged affiliates? _____ yes ____ no

____________________________________________________________________________________________________________________
16.

Have any services been performed by the applicant for any alleged affiliates, or vice versa? ____ yes ____ no

____________________________________________________________________________________________________________________

17.

As of the date that applicant’s size is being determined, did the applicant share or lease any facilities, equipment, or personnel with,
from, or to any of the alleged affiliates (vehicles, telephone lines, office space, receptionist, etc.)?
____ yes ____ no

____________________________________________________________________________________________________________________
18.

Have there been or are there any current financial obligations between the applicant and the alleged affiliates?
____ yes ____ no

____________________________________________________________________________________________________________________
19.

Are there any individuals who have signed or are expected to sign documents to facilitate the ability of the applicant to receive
bonding, indemnifications or credit guarantees, who are not owners, officers, directors, employees, partners, members or
stockholders? _____ yes ____ no

____________________________________________________________________________________________________________________
20.

Is any family member of an individual identified in the response to #4a principal stockholder, partner, or member of any of the
alleged affiliates or another business? ____yes ____ no

____________________________________________________________________________________________________________________
21.

Has SBA ever determined the applicant to be affiliated with any of the alleged affiliates, or to the best of your knowledge,
determined any of the alleged affiliates to be affiliated with each other?
____ yes ____ no
If yes, attach a copy of the determination(s) if available, or describe the determination(s) made by SBA.

____________________________________________________________________________________________________________________
22.

Will any of the alleged affiliates, or any of their principals, provide an indemnity or guaranty to a surety to facilitate a contract
award to the applicant? ____ yes ____ no
Has such an indemnity or guaranty been provided within the past two years? ____ yes ____ no

____________________________________________________________________________________________________________________
23.

Have any of the alleged affiliates assisted in arranging for any of the subcontractors needed for performance of this contract or any
contract awarded to the applicant within the last two years? ____ yes ____ no
____________________________________________________________________________________________________________________
24.

Have there been or are there any actual or proposed subcontracts between the applicant and any of the alleged affiliates?
___ yes ____ no

____________________________________________________________________________________________________________________
25.

Will any of the alleged affiliates perform as a subcontractor on this contract? ____ yes ____ no. Attach a copy of the agreement, if
applicable.

____________________________________________________________________________________________________________________
26.

In preparing the subject bid/proposal or request for assistance, was any assistance provided by an alleged affiliate?
____yes ____ no

____________________________________________________________________________________________________________________