Form SBIR/STTR pre-awar SBIR/STTR pre-awar SBIR/STTR pre-award

National Science Foundation
NSF SBIR/STTR Administrative Questions
Please respond to these items, including signatures by the Principal Investigator
(PI) and the Authorized Organizational Representative (AOR).
1. Please confirm that the PI will be primarily employed (51% or more) by
the company for the duration of the award.
Affirm
2. Are there tasks in this proposal that overlap with those in any prior,
current, or pending proposal or award involving the company or its
personnel? If there are overlapping proposals or awards, please give
details of all such projects, as required by the solicitation.
Yes

No

3. Does the proposing small business have any affiliated companies? If
so, please list these companies and explain how the firms are related.
For more details: https://www.sbir.gov/affiliation
Yes

No

4. Outside of their common involvement in the applicant small business, are
there any relationships (personal, professional, or financial) between any
project personnel (this includes subaward participants and consultants),
company owners, officers, or employees? If yes, please explain.
Yes

No

5. Has the current and pending support information for any person listed as a
“senior person” in the project (or subaward) budget changed since the Phase I
proposal was submitted? If the answer is yes, please send a list of current
and pending support with this form.
Yes

No

6. Please provide a list of addresses for all locations where significant
research on this SBIR/STTR project will be performed, if awarded. Please
note whether each of these facilities is owned by the small business, leased
by the small business, or neither of the above. For any of the listed
facilities not owned by the small business, please include with your email
response lease documentation (if leased) or a signed letter from the facility
owner or administrator granting access to the small business.

Address of Facility

Owned/Leased/Other

7. Please provide a list of all company officers and all significant owners
(individuals and institutions with more than a 5% equity share) along with
their percentage ownership in the company. For each person listed, also
please disclose a) any other current employers and b) expected level of
effort, in hours per week, which they will commit to small business
activities, if this project is awarded.

Name of individual/institution

Ownership
(%)

Company Officer If an individual, Phase I
time commitment (hr/wk)
(Y/N)

The above information is true and complete, to the best of my knowledge.
a) Principal Investigator

___________________
Printed Name:_________________
Signature:

__________

Date

Company Role:_________________________
b) Authorized Organizational
Representative

___________________
Printed Name:_________________
Signature:

__________

Date

Company Role:_________________________
NSF Proposal ID #

________________

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