Appendix A - Cover Sheet 2024 Final

OMB Control No. 0693-0072

Expiration Date: 1/31/2024

Appendix A. COVER SHEET

(A fillable version of the Cover Sheet is available at http://www.nist.gov/sbir)

Application to National Institute of Standards and Technology (NIST) Small Business Innovation Research (SBIR) Program Phase (I or II) 2024-NIST-SBIR-01 (close date) Cover Sheet
Name & Address of Submitting Firm:
Project Title
Principal Investigator (PI) Name		PI Title
PI Phone #		PI Email
NIST may verify the following responses with information provided elsewhere in your application or by independent sources.
THE APPLICANT CERTIFIES THAT:
1. It is a small business concern (SBC) and meets the definition as stated in this Notice of Funding Opportunity (NOFO).				Yes	No
2. The primary employment of the PI will be with the SBC at the time of award and during the conduct of research.				Yes	No
3. A minimum of either two-thirds for Phase I or one-half for Phase II of the research will be performed by the SBC as determined by data provided in the Budget Narrative. See NOFO Section 1.03.01 for details on funding determination.				Yes	No
4. The applicant and/or PI ☐ has ☐ has not submitted applications for essentially equivalent work under other Federal program
FFOs and ☐ has ☐ has not received other Federal awards for essentially equivalent work. If “has”, what agency? Click here to enter text. See NOFO Section 3.02.02(14) for additional details that must be provided.
5. The applicant qualifies as a socially and economically disadvantaged SBC and meets the definition as stated in this NOFO.				Yes	No
6. The applicant qualifies as a woman-owned SBC and meets the definition as stated in this NOFO.				Yes	No
7. The applicant qualifies as a HUBZone-owned SBC and meets the SBA’s definition(see http://www.sba.gov/hubzone).				Yes	No
8. Year SBC founded:				Click here to enter text.
9. Number of Employees:				Click here to enter text.
STATEMENTS:
10. The applicant will permit the Federal Government to disclose name, address, and telephone number of the corporate official of your concern, if your application does not result in an award, to appropriate local and State-level economic development organizations that may be interested in contacting you for further information.				Yes	No
11. The applicant authorizes contact information and project title to be provided to the NIST Manufacturing Extension Partnership (MEP) after awards have been announced. If ‘Yes’ your contact information will be provided to NIST MEP. If so, you will be contacted by your local MEP to explore business-related support services that could benefit the potential of the project you proposed.				Yes	No

Signature of Company Official and typed name, title, address, telephone number, and date
Signature of Principal Investigator and typed name, title, address, telephone number, and date
TECHNICAL ABSTRACT (limit to 200 words):
POTENTIAL COMMERCIAL APPLICATION OF THE RESEARCH: (limit to 100 words)
OTHER INFORMATION:
Information contained in unsuccessful applications will remain the property of the applicant. The Federal Government may, however, retain copies of all applications. Public release of information in any application submitted will be subject to existing statutory and regulatory requirements. Applicants are discouraged from submitting proprietary information unless the information is deemed essential for proper evaluation of the application. If proprietary information provided by an applicant in a proposal constitutes trade secret, proprietary commercial or financial information, confidential personal information, or data affecting national security, it will be treated in confidence to the extent permitted by law, provided that the proposal is clearly marked by the applicant as follows: The following legend must appear on the title page of the proposal: This proposal contains information that shall not be disclosed outside the Federal Government and shall not be duplicated, used, or disclosed in whole or in part for any purpose other than evaluation of this proposal, unless authorized by law. The Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting award if award is made as a result of the submission of this proposal. The information subject to these restrictions are contained on all pages of the proposal except for pages [insert page number or other identification of pages that contain no restricted information.] (End of Legend); and The following legend must appear on each page of the proposal that contains information the applicant wishes to protect: Use or disclosure of information contained on this sheet is subject to the restriction on the title page of this proposal. The use of any other legend is unacceptable to the Government and may constitute grounds for removing the application from further consideration without assuming any liability for inadvertent disclosure.

This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Jacqueline Gray, 100 Bureau Dr., MS 2200, Gaithersburg, MD 20899.