SBA Form 3304 Phoenix Award for Outstanding Contributions to Disaster

OMB Control Number 3245-0360
Expiration Date: 11/30/2023

National Small Business Week
SBA Form 3304, Phoenix Award for Outstanding
Contributions to Disaster Recovery, Public Official
Instructions: Refer to the National Small Business Week Award Nominations Guidelines
for detailed instructions for submitting nominations.
This form must be completed by the nominee or by the nominator. The completed form must be
submitted with the nomination package as noted in the award guidelines. Answer each question
as fully as possible; if it is not applicable, state N/A.
1. Nominee Information:
a. Name:

b. Title:

c. Address:

d. Phone number:

e. Email address:

2. Nominator Information (if you are nominating yourself, write n/a):
a. Nominator name:

b. Title:

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

c. Address:

d. Phone number:

e. Email address:

Answer each of the following questions in 200 words or less.
3. Provide a biography of the nominee:

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

4. Describe the nominee’s business and/or professional occupation:

5. Did the nominee take quick, proactive steps to establish calm in the aftermath of the disaster?
If yes, please explain:

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

6. Did the nominee communicate effectively with local and federal emergency responders while
coordinating rescue and recovery efforts? If yes, please explain.

7. Describe how the nominee effectively utilized disaster preparedness and readiness measures.

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

8. Did the nominee selflessly provide his or her time, energy, and skills to protect and reassure
the public? If yes, please explain.

9. Was the nominee involved in the long-term recovery and future disaster preparedness of his
or her community? If yes, please explain.

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

Answer the following question in 400 words or less.
10. Provide a narrative detailing how the nominee responded to the needs of the community in
the aftermath of the disaster:

SBA Form 3304 (09/2021) (Previous Editions Obsolete)

Caution: Penalties for False Statements
Knowingly making a false statement on this form is a violation of Federal law and could result in
criminal prosecution, significant civil penalties, and a denial of program participation or other
benefits awarded by the agency. A false statement is punishable under 18 U.S.C. §§ 1001 and
3571by imprisonment of not more than five years and/or a fine of not more than $250, 000 , and
under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more
than $5,000.
Paperwork Reduction Act Notice:
SBA will use the information collected on this form, along with other information submitted
by award nominees as part of the nomination package, to determine the nominee's eligibility
for a particular small business award; to identify any actual or apparent conflict of interest
and, to make eventual award determinations. Responding to this request for information is
voluntary. However, failure to provide the requested information may affect SBA’s ability
to make a decision regarding your eligibility for an award.
You are not required to respond to any collection of information unless it displays a currently
valid OMB control number (3245-0360). The estimated burden for completing this form is 1
hour and 15 minutes, including the time for reviewing the instructions, and gathering and
compiling data. Combined with the time for completing the Form 3300, the total estimated time
to prepare and submit the nomination package for each nominee is 90 minutes. Comments on
this burden estimate should be sent to the U.S. Small Business Administration, Chief, AIB 409
3rd St., SW, Washington, DC 20416, and Desk Officer for the U.S. Small Business
Administration, Office of Management and Budget, New Executive Office Building, Room
10202, Washington, DC 20503. DO NOT SEND COMPLETED FORMS TO OMB. Submit
them to the location indicated in the nomination guide.

SBA Form 3304 (09/2021) (Previous Editions Obsolete)