Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	Removed
279717	Disclosure Statement - Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	New
202552	Disclosure Statement Lveraged Licensees Form and Instruction	Removed

ICR Details

OMB Control No: 3245-0118	ICR Reference No: 202603-3245-008
Status: Received in OIRA	Previous ICR Reference No: 202204-3245-002
Agency/Subagency: SBA	Agency Tracking No:
Title: Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/31/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	323	0
Time Burden (Hours)	307	0
Cost Burden (Dollars)	52,778	0

---

Abstract: The information in SBA Forms 856 and 856A is collected by the Office of SBIC Examinations in advance of an SBIC’s examination and is used by SBA examiners in all examinations of SBICs as a means of gathering information relevant to the examination.

---

Authorizing Statute(s): US Code: 15 USC Section 687b(c)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20201	05/12/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14899	03/27/2026
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Disclosure Statement - Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	SBA Form 856A, SBA Form 856	DISCLOSURE STATEMENT NON-LEVERAGED LICENSEES ,   DISCLOSURE STATEMENT LEVERAGED LICENSEES
Disclosure Statement Lveraged Licensees	SBA FORM 856 , SBA FORM 856A	Disclosure Statement Leveraged Licensees; Dislosure Statement Non-Leveraged Licensees ,   Disclosure Statement NON-Leveraged Licesees
Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees	SBA Form 856A, SBA Form 856	DISCLOSURE STATEMENT LEVERAGED LICENSEES ,   DISCLOSURE STATEMENT NON-LEVERAGED LICENSEES

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	323	0	0	323	-571	571
Annual Time Burden (Hours)	307	0	0	307	-390	390
Annual Cost Burden (Dollars)	52,778	0	0	52,778	-6,935	6,935

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Figures have been adjusted to reflect the current estimates for yearly examinations of 254 leveraged examinations plus 69 non-leveraged examinations (total 323 examinations), based upon the expected examination schedule.

---

Annual Cost to Federal Government: $29,700

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/31/2026

---

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].