SSBCI-Investing-in-America-SBOP-Assurances-Template

State Small Business Credit Initiative (SSBCI) Investing in America Small Business
Opportunity Program (SBOP) Applicant Assurances
Department of the Treasury
On behalf of the applicant, and in support of this application for financial assistance, I certify
under penalty of perjury to the U.S. Department of the Treasury (Treasury), that all of the
following are true and correct:
(1) I have the authority to make the following representations on behalf of myself and the
applicant. I understand that these representations will be relied upon as material in any Treasury
decision to make an award to the applicant based on its application.
(2) The applicant has the legal authority to apply for the federal assistance sought by the
application, and it has the institutional, managerial, and financial capability (including funds
sufficient to pay any voluntary non-federal cost share of project costs) to plan, manage, and
complete the project described in the application properly.
(3) Throughout the period of performance for the award if made by Treasury based on the
application—
a. the applicant will comply with all award requirements, federal statutes, Executive Orders,
and regulations applicable to the award;
b. the applicant will require all subrecipients to comply with all applicable award
requirements and federal statutes and regulations; and
c. the applicant will maintain safeguards to address and prevent any organizational conflict
of interest, and also to prohibit employees from using their positions in any manner that
poses, or appears to pose, a personal or financial conflict of interest.
(4) For any award resulting from this application:
a. the applicant has procedures in place for procuring property and services under this
award that are consistent with the procurement standards that apply to federal grants. The
applicant will not request funds under this award for any contract unless this certification
remains true and accurate.
b. pursuant to 2 CFR § 200.303, the applicant will establish and maintain effective internal
control over all award agreements resulting from this application, and provide reasonable
assurance that the applicant will manage the award in compliance with Federal statutes,
regulations, and the terms and conditions of the award. The applicant knows of no
material deficiencies in its internal controls.
c. the applicant has a conflict of interest policy consistent with 2 CFR § 200.318(c) in effect
and that covers each activity for which it seeks funding under this grant.
(5) The applicant will give Treasury, Treasury designee, Treasury Office of Inspector General,
and the Government Accountability Office through any authorized representative, access to, and
opportunity to examine, all paper or electronic records related to the award made by Treasury
based on the application pursuant to 2 CFR § 200.337(a).
(6) If awarded by Treasury based on the application, the applicant will—
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a. comply with the requirements of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655), which govern the treatment of
persons displaced as a result of federal and federally-assisted programs; and
b. comply, as applicable with requirements of the Hatch Act (5 U.S.C. §§ 1501-1508 and
7324-7328), which limit certain political activities of State or local government
employees whose principal employment is in connection with an activity financed in
whole or in part by federal assistance.
(7) The applicant, as applicable, will perform the required financial and compliance audits in
accordance with the Single Audit Act Amendments of 1996 (31 U.S.C. § 7501 et seq.) and
2 CFR Part 200, Subpart F (Audit Requirements).
(8) The applicant will comply with all applicable requirements of all other Federal laws,
Executive Orders, regulations, and policies governing the SSBCI Investing in America SBOP.
I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or
omission of a material fact) in this certification, or in the application that it supports, may be the
subject of criminal prosecution and also may subject me and the applicant to civil penalties and
administrative remedies for false claims or otherwise.
Signature of SSBCI Investing in America SBOP Authorized Official:
_________________________________________________________
Name:

Date:

Title:

Name of Applicant:

PAPERWORK REDUCTION ACT NOTICE

The information collections discussed in this application will be submitted to the Office of
Management and Budget (OMB) under OMB control number 1505-0227 in accordance
with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35). OMB approval for this
information collection is forthcoming and the information will be collected following OMB
approval. This document will be updated to reflect that approval.
The information collected in this application will be used by the U.S. Department of the Treasury to
determine whether to approve an applicant for grant funding under the SSBCI Investing in America
SBOP. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid control number assigned by the Office of Management and Budget
(OMB). The estimated burden associated with this collection of information is 6 hours per response.
Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be directed to the Office of Privacy, Transparency, and Records, U.S. Department of the Treasury,

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1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send this application form to this
address.
PRIVACY ACT STATEMENT
The Privacy Act of 1974 (Privacy Act) protects certain information that the federal government has about
“individuals” (United States citizens and lawfully admitted permanent residents). The Privacy Act does not
generally apply to businesses, but some federal courts have found that this law applies to sole proprietors (they are
deemed “individuals” under the Privacy Act).
AUTHORITY: Small Business Jobs Act of 2010 (SBJA), Title III, 12 U.S.C. § 5701 et seq., as amended by the
American Rescue Plan Act of 2021 (ARPA), section 3301.
PURPOSE: This information is being collected and maintained by Treasury so that it can review and make funding
decisions regarding applications submitted for grant funding under the SSBCI Investing in America SBOP
established under the SBJA, as amended by ARPA, and communicate with applicant contacts, and otherwise carry
out the program.
ROUTINE USE: The information you furnish may be shared in accordance with the routine uses outlined in
Treasury .013, Department of the Treasury Civil Rights Complaints, Compliance Reviews, and Fairness in Federal
Programs Files System of Records Notice (SORN); Treasury .015, General Information Technology Access
Account Records, 85 Fed. Reg. 73353; and Treasury .017, Correspondence and Contact Information, 81 Fed. Reg.
78266. For example, one routine use under Treasury .017 allows the disclosure of information to international,
federal, state, local, tribal, or private entities for the purpose of the regular exchange of business contact information
in order to facilitate collaboration for official business. More information about this and other routine uses can be
found in the System of Records Notices (SORNs) listed above, which are posted on Treasury’s website.
DISCLOSURE: Providing this information is voluntary. However, failure to furnish the requested information may
result in the denial of your application.

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