SBA Form 1971 Religious Eligibility Worksheet

OMB Control No.: 3245-0348
Expiration Date: XX/XX/20XX

R eligious Eligibility Worksheet

For all 7(a) and 504 Loan Programs

The purpose of the information requested is to assist SBA and the Lender/Certified Development Company (CDC) (“SBA Lender”) with determining the eligibility of a loan application from a Small Business Applicant whose business has a religious component. Failure to submit the information would affect that determination.

Instructions for SBA Lenders: Prior to submitting an application to the SBA loan processing center (non-delegated) or processing a loan under delegated authority, the SBA Lender must submit the completed SBA Form 1971 and supporting documentation to the Associate General Counsel for Litigation for review at [email protected].

Applicant Business Legal and/or DBA Name: _________________________________________________________________

Applicant Address: ________________________________________________________________________________________

Applicant Phone: ____________________________ Applicant Website (if applicable) __________________________________

Requested Loan Amount ________________________________ Type of Loan ___________________________________

Please describe in detail what the proceeds of the loan will be used for (attach separate sheet if necessary): ________________________________________________________________________________________________________

Is Applicant connected, associated, or affiliated with a religious organization in any way?  Yes  No

If “Yes” explain the nature and extent of the relationship (attach separate sheet if necessary): _______________________________

Nature of the Religious Component (Please check all that apply)

 Sale of religious books, music, artifacts, gifts, and/or other religious items.

 Religious instruction, counseling, or indoctrination with regard to any items sold (including those listed immediately above).

 Religious instruction, indoctrination, or counseling whether to adults or children (includes use of religious material at day care facilities).

 Religious broadcasting (e.g., religious music, religious programing, including instruction, indoctrination, counseling, and religious services).

 Generation, Sale or distribution of newspaper, journal, or other religious publications.

 Creation or development of religious materials (e.g. writings, music, artifacts, computer software, religious art, etc.).

 Prayer, religious worship, or religious service

 Provision of reading room or other space to conduct lectures, readings, prayer, worship, or other activities related to religion.

 Other:________________________________________________________________________________

Explain the nature of each of the religious components checked above (attach separate sheet if necessary) _______________________

____________________________________________________________________________________________________________

Signature of Authorized Representative of Applicant: _____________________________________________Date: ______________

Print Name: __________________________________________________

Title: ___________________________________________

Authorized Lender Official Signature:_____________________________________________________Date:____________________

Print Name: _______________________________________________

Title: ______________________________________________

Lender Email _________________________________________Lender / CDC Name _____________________________________

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing the form is 5 minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small Business Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC 20416, and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Rm. 10202, Washington DC 20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 1971 (04/2024)