Form SBA Form 3173 SBA Form 3173 RRF Post Award Report

Restaurant Revitalization Fund Program
Post Award Report

OMB Control No.: 3245-0424
Expiration Date: XX/XX/XXXX

See page 3 of this form for instructions.
Business Legal Name (“Recipient”)
Business Address

DBA or Tradename, if applicable
Business TIN (EIN,
SSN, ITIN)
Primary Contact

Business Phone
(

)
E-mail Address

Indicate how much of your Restaurant Revitalization Fund (RRF) funds you have spent in the following
eligible categories for the period beginning on February 15, 2020 and ending on March 11, 2023.
Amount (If none, enter 0)

Eligible Categories

$

Payroll (including paid sick leave)

$

Rent / Mortgage

$

Utilities

$

Debt Service

$

Construction of Outdoor Seating

$

Maintenance

$

Supplies

$

Food and Beverage (including raw materials)

$

Covered Supplier Costs

$

Funds Returned to SBA

$

Other Business Expenses

$

TOTAL

WARNING: Any false statement or misrepresentation to SBA may result in criminal, civil or administrative sanctions
including, but not limited to: 1) fines and imprisonment, or both, under 15 U.S.C. 645, 18 U.S.C. 1001, 18 U.S.C. 1014,
18 U.S.C. 1040, 18 U.S.C. 3571, and any other applicable laws; 2) treble damages and civil penalties under the False
Claims Act, 31 U.S.C. 3729; 3) double damages and civil penalties under the Program Fraud Civil Remedies Act, 31
U.S.C. 3802; and 4) suspension and/or debarment from all Federal procurement and non-procurement transactions.
Statutory fines may increase if amended by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of
2015.
☐ I hereby certify UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES that
the above is true and correct.
SBA Form 3173 (03/22)

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Restaurant Revitalization Fund Program
Post Award Report

OMB Control No.: 3245-0424
Expiration Date: XX/XX/XXXX

Deadlines: Submit your Post Award Report through the portal (Portal) at https://restaurants.sba.gov by the
following dates:
• Your first submission of this report is due no later than December 31, 2021. If you fully expend funds
on or prior to your submission on or before December 31, 2021, you should certify in the Portal that
you used all funds in eligible categories, and you do not need to file any additional reports.
• If you do not fully expend award funds in eligible categories prior to submitting your report due
December 31, 2021, you must submit another report no later than December 31, 2022. If you have not
fully expended your funds by December 31, 2022, you have until March 11, 2023 to expend your
funds and you must file your final report no later than April 30, 2023.
SBA reserves the right to require documentation to validate the information submitted to SBA as part of its
review process. If you fail to account for using all funds in eligible categories, or if you fail to submit reports
by reporting deadlines or other documentation requested by SBA, SBA may require you to return some or all
of the RRF funds to the U.S. Treasury.
Following submission of this report, your business must retain all records necessary to prove compliance with
Restaurant Revitalization Fund Program Rules for 3 years.
_____________________________________________________
Signature of Authorized Representative of Recipient

____________________________
Date

_____________________________________________________
Print Name

____________________________
Title

SBA Form 3173 (03/22)

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Restaurant Revitalization Fund Program
Post Award Report

OMB Control No.: 3245-0424
Expiration Date: XX/XX/XXXX

Purpose of this form:
This form is to be completed by the authorized representative of the Recipient and submitted in accordance with pages 1
and 2 of the report. Submission of the requested information is required to make a determination regarding compliance
with RRF program requirements. Failure to submit the information would affect that determination.
Instructions for Recipients:
Tax Identification Numbers: You must provide tax identification numbers (TIN) for your business. TINs may be
Employer Identification Numbers, Social Security Numbers, or Individual Taxpayer Identification Numbers assigned
by the Internal Revenue Service.
Primary Contact: Enter the name of the individual who is signing the form on behalf of the Recipient and who will
receive all communication from SBA. This person must have the authority to execute legal documents on behalf of the
recipient business.
Email Address: Enter the email address for the Primary Contact. This is where SBA will send official communication
regarding this report.
Eligible Categories Table: Indicate how much of your Restaurant Revitalization Fund (RRF) funds you have spent in
the following eligible categories for the period beginning on February 15, 2020 and ending on March 11, 2023. Enter
zero if you haven’t spent any funds in a category. Eligible uses of funds are:
(1) Payroll (including paid sick leave): Business payroll costs, including sick leave and costs related to the
continuation of group health care, life, disability, vision, or dental benefits during periods of paid sick, medical, or
family leave, and group health care, life, disability, vision, or dental insurance premiums; Payroll costs consist of
compensation to employees (whose principal place of residence is the United States) in the form of salary, wages,
commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips or, in the
absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental,
family, medical, or sick leave (except qualified wages (as defined in subsection (c)(3) of section 2301 of the CARES
Act) taken into account in determining the credit allowed under such section 2301; or premiums taken into account in
determining the credit allowed under section 6432 of the Internal Revenue Code of 1986); allowance for separation or
dismissal; payment for the provision of employee benefits (including insurance premiums) consisting of group health
care coverage, group life, disability, vision, or dental insurance, and retirement benefits; payment of state and local
taxes assessed on compensation of employees; and, for an independent contractor or sole proprietor, wage,
commissions, income, or net earnings from self-employment or similar compensation.
(2) Rent / Mortgage: Payments of principal or interest on any business mortgage obligation (which may not include
any prepayment of principal on a mortgage obligation) and Business rent payments, including rent under a lease
agreement (which may not include any prepayment of rent).
(3) Utilities: Business utility payments for the distribution of electricity, gas, water, telephone, or internet access for
which service began before February 15, 2020.
(4) Debt Service: Business debt service.
(5) Construction of Outdoor Seating
(6) Maintenance: Business maintenance expenses including maintenance on walls, floors, deck surfaces, furniture,
fixtures, and equipment.
(7) Supplies: Business supplies, including protective equipment and cleaning materials.
(8) Food and Beverage (including raw materials): Business food and beverage expenses including raw materials for
beer or spirits.
(9) Covered Supplier Costs: Business expenditures made by the recipient for the purchase of goods that: Are
essential to the operations of the entity at the time at which the expenditure is made; and is made pursuant to a
contract, order, or purchase order in effect at any time before the receipt of funds; or with respect to perishable goods,
in effect before or at any time during the covered period.
(10) Other Business Expenses: Other business expenditures made by the recipient that are not covered by the other
categories.
SBA Form 3173 (03/22)

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Restaurant Revitalization Fund Program
Post Award Report

OMB Control No.: 3245-0424
Expiration Date: XX/XX/XXXX

(11) Funds Returned to SBA: If applicable, enter the amount of any RRF award funds that were returned to SBA.
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 time for completing this report, including gathering data needed, is 30 minutes. Comments about this time or the
information requested should be sent to: 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, Washington DC 20503. PLEASE DO NOT SEND
COMPLETED FORMS TO THESE ADDRESSES.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit, or privilege to which you are entitled. (But see Debt Collection Notice
regarding taxpayer identification number below.) Disclosures of name and other personal identifiers are required to provide SBA with sufficient
information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, and disposition toward
criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to section 7(a)(1)(B), 15 U.S.C.
Section 636(a)(1)(B) of the Small Business Act.
Disclosure of Information – Requests for information about another party may be denied unless SBA has the written permission of the individual
to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act. The Privacy
Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of information
maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil, criminal, or
administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or foreign, charged
with responsibility for, or otherwise involved in investigation, prosecution, enforcement, or prevention of such violations. Another routine use is
disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to the requesting agencies’
function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine uses. In addition, the CARES
Act, requires SBA to register every loan made under the Paycheck Protection Program using the Taxpayer Identification Number (TIN) assigned to
the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayer identification
number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report the status of your
loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts due to you from the
Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5) refer your loan to the
Department of Justice, or (6) take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights to financial records
held by financial institutions that are or have been doing business with you or your business including any financial institutions participating in a
loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financial institution in connection with its first
request for access to your financial records. SBA’s access rights continue for the term of any approved loan guaranty agreement. SBA is also
authorized to transfer to another Government authority any financial records concerning an approved loan or loan guarantee, as necessary to
process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) – This law provides, with some exceptions, that SBA must supply information reflected in agency files
and records to a person requesting it. Information about approved loans that is generally released includes, among other things, statistics on our
loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers, the amount of
the loan, and the type of the loan. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this
Act are to be addressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can require businesses
to modify facilities and procedures to protect employees. Businesses that do not comply may be fined and required to abate the hazards in their
workplaces. They may also be ordered to cease operations posing an imminent danger of death or serious injury until employees can be protected.
Signing this form is certification that the applicant, to the best of its knowledge, is in compliance with the applicable OSHA requirements, and will
remain in compliance during the life of the loan.
Civil Rights (13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any business practice,
including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of SBA Regulations.
All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race, color,
religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because all or part of
the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the
Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549 (2 C.F.R. Part 180 and Part 2700) – By submitting this loan report, you certify that neither the
Applicant or any owner of the Applicant have within the past three years been: (a) debarred, suspended, declared ineligible or voluntarily excluded
from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a final determination still pending; (c)
indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in the regulations or (d) delinquent on any amounts
owed to the U.S. Government or its instrumentalities as of the date of execution of this certification.

SBA Form 3173 (03/22)

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