Small Business Innovation Research (SBIR) Program Application Cover Sheet

OMB Control No. 0693-0072
Expiration Date: 5/31/2027

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
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).
2. The primary employment of the PI will be with the SBC at the time of award and during
the conduct of research.
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

☐ Yes

☐ No

☐ Yes

☐ No

4. The applicant and/or PI ☐ has ☐ has not submitted applications for essentially equivalent work Federal program
under other 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
☐ Yes
definition as stated in this NOFO.
6. The applicant qualifies as a woman-owned SBC and meets the definition as stated in this NOFO.
☐ Yes
☐ Yes

☐ No
☐ No
☐ No

7. The applicant qualifies as a HUBZone-owned SBC and meets the SBA’s definition(see
http://www.sba.gov/hubzone).
8. Year SBC founded:

Click here to enter text.

9.

Click here to enter text.

Number of Employees:

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

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☐ 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 may be provided to NIST MEP. You can also find your local
MEP Center at www.nist.gov/mep/centers to contact and 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:
(A) 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
(B) 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.

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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.

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