Information Collection

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

IC 35613 under ICR 202308-3245-001 · OMB 3245-0062.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3245-0062 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SBA Form 2181 SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire	Form and Instruction
SBA Form 2181 SBIC Program Application Instructions 3245-0062 SBA Form 2181 SBIC Program Application Instructions 8-8-2023.docx www.sba.gov/inv	Form and Instruction
SBA Form 2181 Pre-Screen SBIC MAQ short form 3245-0062 Copy of SBA Form 2181 Pre-Screen SBIC MAQ (Short Form) 8-8-2023.xlsx www.sba.gov/inv	Form
SBA Form 2181 Long SBIC MAQ Long form 3245-0062 Copy of SBA Form 2181 SBIC MAQ (Long Form) 8-8-2023.xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Activities Relationship Certification 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit A Activities Relationship Certification 8-8-2023.xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Individual Declarations 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit B Individual Declarations (8.8.2023).xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Significant Investor Declarations 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit C Significant Investor Declarations (8.8.2023).xlsx www.sba.gov/inv	Form
SBA Form 2181 MAQ Individual Legal Questionnaire 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit D Individual Legal Questionnaire (8.8.2023).xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Legal Document Certification 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit E Legal Document Certification (8.8.2023).xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Capital Certificate 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit F Capital Certificate (8.8.2023).xlsx www.sba.gov/inv	Form
SBA Form 2181 SBIC Transferors Liability Contract 3245-0062 SBA Form 2181 SBIC MAQ Exhibit G Transferors Liability Contract (8.8.2023) 8-8-2023.pdf www.sba.gov/inv	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 13 CFR 107.410

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SBA Form 2181	SBIC Program Application Instructions	3245-0062 SBA Form 2181 SBIC Program Application Instructions 8-8-2023.docx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181	Pre-Screen SBIC MAQ short form	3245-0062 Copy of SBA Form 2181 Pre-Screen SBIC MAQ (Short Form) 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 Long form	SBIC MAQ Long form	3245-0062 Copy of SBA Form 2181 SBIC MAQ (Long Form) 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit A	Activities Relationship Certification	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit A Activities Relationship Certification 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit B	Individual Declarations	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit B Individual Declarations (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit C	Significant Investor Declarations	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit C Significant Investor Declarations (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 MAQ Exhibit D	Individual Legal Questionnaire	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit D Individual Legal Questionnaire (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit E	Legal Document Certification	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit E Legal Document Certification (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit F	Capital Certificate	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit F Capital Certificate (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit G	Transferors Liability Contract	3245-0062 SBA Form 2181 SBIC MAQ Exhibit G Transferors Liability Contract (8.8.2023) 8-8-2023.pdf	www.sba.gov/inv	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 275

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 67 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	275	-100	375
Annual IC Time Burden (Hours)	17,750	-6,875	24,625
Annual IC Cost Burden (Dollars)	6,502,073	4,141,779	2,360,294

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.