SBA Form 3314 Small Business Investment Company of the Year Award

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

National Small Business Week

SBA Form 3314
Small Business Investment Company of the Year
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.

Small Business Investment Company of the Year
1. SBIC Information:
a. Name:

b. Address:

c. Phone number:

d. Email address:

e. Website URL:
2. SBIC CEO/Director Information:
a. Name

b. Phone number:

c. Email address:
SBA Form 3314 (09/2021) (Previous Editions Obsolete)

3. Nominator Information (if applicable):
a. Nominator name:

b. Title:

c. Address:

d. Phone number:

e. Email address:

4. How long has the fund been in the SBIC Program?

5. Describe the size of the fund by private capital commitment.

6. How much has been invested?

7. How many companies have been financed?

8. How many jobs have been sustained and created?

SBA Form 3314 (09/2021) (Previous Editions Obsolete)

Answer each of the following questions in 400 words or less.
9. Provide a narrative that includes SBIC’s commitment to supporting the growth and
expansion of small businesses, including but not necessarily limited to job creation and
retention, penetration in underserved markets, and commitment to communities served:

SBA Form 3314 (09/2021) (Previous Editions Obsolete)

10. Provide a narrative that includes the SBIC’s commitment not just to financial return on
investment, but to public focus and well-being. Although the entire body of work of the
SBIC will be considered, this might also be demonstrated by a specific achievement
reflecting positively upon the program and the Agency:

SBA Form 3314 (09/2021) (Previous Editions Obsolete)

11. Describe how the fund’s participation directly added value to a small concern. For
example, has the SBIC been able to attract other sources of capital with which to partner
in order to provide a small concern additional equity, senior debt or subordinated debt
and thus more financing capacity? Or, has the SBIC contributed as a board member in a
manner that helped a small concern come up with new products or processes?

SBA Form 3314 (09/2021) (Previous Editions Obsolete)

12. Provide the qualities and performance of the SBIC that merit the award:

SBA Form 3314 (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
3571 by 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 3314 (09/2021) (Previous Editions Obsolete)