Form 1 Form

HHS Small Business Innovation Research Program
Life Cycle Certification
Public reporting burden for this collection of information is estimated to average 15 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0001). Do not return the completed form to this
address.

All SBIR Phase I and Phase II awardees must complete this certification at all times set forth in the funding
agreement (see §8(h) of the SBIR Policy Directive). This includes checking all of the boxes and having an
authorized officer of the awardee sign and date the certification each time it is required.
A certification is required at the following times:
•

For SBIR Phase I Awardees: At the time of receiving final payment or disbursement from the
Payment Management System or via contract.

•

For SBIR Phase II Awardees: prior to receiving more than 50% of the total award amount and prior
to final payment or disbursement from the Payment Management System or via contract.

SBIR grant recipients are required to submit the Life Cycle Certifications within the I-RPPR and the F-RPPR
under Section G.1: Special Notice of Award and Funding Opportunity Announcement Reporting Requirements.
SBIR recipients should not select the "Nothing to Report" box in this section. The F-RPPR and I-RPPR must be
submitted via eRA Commons no later than 120 calendar days from the period of performance end date. I-RPPR
or F-RPPR will not be accepted unless all completed Life Cycle Certification(s) are received. Failure to provide
all required completed certification(s) may cause NIH to take one or more actions that may include, but are not
limited to, corrective actions, withholding of further awards, suspension or termination.
This does not impact the SBIR Funding Agreement Certification required by all SBIR applicants for new or
renewal grants that is required prior to award of a new award or a competing renewal award.
In addition, SBIR awardees indicate compliance with these certification requirements by drawing or requesting
funds from the Payment Management System. If the grantee cannot complete this certification or cannot ensure
compliance with the certification process, it should notify the funding agreement officer immediately. If
resolution cannot be reached, the funding agreement officer will void or terminate the award, as appropriate.
Grant or Contract Number:
Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)):
Please read carefully the following certification statements. The Federal government relies on the information
to ensure compliance with specific program requirements during the life of the funding agreement. The
definitions for the terms used in this certification are set forth in the Small Business Act, the SBIR Policy
Directive, and also any statutory and regulatory provisions referenced in those authorities.
If the funding agreement officer believes that the business is not meeting certain funding agreement
requirements, the agency may request further clarification and supporting documentation in order to assist in the
verification of any of the information provided.
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Even if correct information has been included in other materials submitted to the Federal government, any
action taken with respect to this certification does not affect the Government’s right to pursue criminal, civil or
administrative remedies for incorrect or incomplete information given in the certification. Each person signing
this certification may be prosecuted if they have provided false information.
The undersigned has reviewed, verified and certifies that (all boxes must be checked except where otherwise
directed):
1. The Principal Investigator/Project Manager spent more than one half of his/her time (based on a 40 hour
work week) as an employee of the Awardee or the Awardee has requested and received a written
deviation from this requirement from the Grants Management Officer (the NIH’s Funding Agreement
officer).
Yes

No Deviation approved in writing by Funding Agreement officer:

%

2. All, Essentially Equivalent Work, or a portion of the work performed under this project (check the
applicable line):
Has not been submitted for funding to this Agency or another Federal Agency.
Has been submitted for funding to this Agency or another Federal Agency but has not been
funded under any other grant, contract, subcontract, or other transaction.
A portion has been funded by another grant, contract, or subcontract as described in detail in the
proposal and approved in writing by the Grants Management Officer .
3. Upon completion of the award, the Awardee will have performed the applicable percentage of work,
unless a deviation from this requirement is approved in writing by the Grants Management Officer
(check the applicable line and fill in if needed):
SBIR Phase I: at least two-thirds (66 2/3%) of the research
SBIR Phase II: at least half (50%) of the research
Deviation approved in writing by the Grants Management Officer :

%

4. The work is completed and the small business awardee has performed the applicable percentage of
work, unless a deviation from this requirement is approved in writing by the Grants Management Officer
(check the applicable line and fill in if needed).
SBIR Phase I: at least two-thirds (66 2/3%) of the research
SBIR Phase II: at least half (50%) of the research
Deviation approved in writing by the Grants Management Officer:

%

N/A because work is not completed
5. The research/research and development is performed in the United States unless a deviation is approved
in writing by the Funding Agreement officer.
Yes

No

Waiver has been granted

6. The research/research and development is performed at the Awardee’s facilities by the Awardee’s
employees, except as otherwise indicated in the SBIR application and approved in the Notice of Award
or Contract Award.
Yes

No

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I will notify this Agency immediately if all or a portion of the work authorized and funded under this award
is subsequently funded by another Federal Agency.
I understand that the information submitted may be given to Federal, State and local agencies for
determining violations of law and other purposes.
I am an officer of the Awardee business concern authorized to represent it and sign this certification on its
behalf. By signing this certification, I am representing on my own behalf, and on behalf of the business concern
that the information provided in this certification, the application, and all other information submitted in
connection with the award, is true and correct as of the date of submission. I acknowledge that any intentional
or negligent misrepresentation of the information contained in this certification may result in criminal, civil or
administrative sanctions, including but not limited to: (1) fines, restitution and/or imprisonment under 18 U.S.C.
§ 1001; (2) treble damages and civil penalties under the False Claims Act (31 U.S.C. § 3729 et seq.); (3) double
damages and civil penalties under the Program Fraud Civil Remedies Act (31 U.S.C. §3801 et seq.); (4) civil
recovery of award funds; (5) suspension and/or debarment from all Federal procurement and nonprocurement
transactions (FAR Subpart 9.4 or 2 C.F.R. part 180); and (6) other administrative penalties including
termination of SBIR/STTR awards.

Date
Signature
Printed Name (First, Middle, Last)
Title
Business Name

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