Information Collection

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

IC 35613 under ICR 201612-3245-003 · OMB 3245-0062.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3245-0062 can be found here:

Documents and Forms

Document Name Document Type
Form SBA Form 2182 EXD SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire Form and Instruction
3245-0062 SBIC Application Instructions 12-21-16.pdf www.sba.gov/inv Instruction
SBA Form 2181 Applicant Narrative 3245-0062 SBA Form 2181 - Narrative (Applicant Name) 12-21-16.pdf www.sba.gov/inv Form and Instruction
SBA Form 2182 Principal Exhibits 3245-0062 SBA Form 2182 - (Principal Name) 12-21-16.docx www.sba.gov/inv Form and Instruction
SBA Form 2182 EXD Exhibit D 3245-0062 2162 Exhibit D - (Applicant Name) 12-21-16.xlsx www.sba.gov/inv Form and Instruction
SBA Form 2182 Exce Excel Supplement 3245-0062 Form 2181 - Supplement (Applicant Name)_final.xlsx www.sba.gov/inv Form and Instruction
SBA Form 2183 Funds Exhibits 3245-0062 SBA Form 2183 - (Applicant Name) 12-21-16.pdf www.sba.gov/inv Form and Instruction
SBA Form 2182 Exhi Exhibit E1 3245-0062 Exhibit E1 - (YYYY Portfolio Name)_final.xlsx www.sba.gov/inv Form and Instruction

Information Collection (IC) Details

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IC Title:	SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 13 CFR 107.410

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SBA Form 2182 EXD	Exhibit D	3245-0062 2162 Exhibit D - (Applicant Name) 12-21-16.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Instruction			3245-0062 SBIC Application Instructions 12-21-16.pdf	www.sba.gov/inv	Yes	No	Paper Only
Form and Instruction	SBA Form 2182 Excel Supplement	Excel Supplement	3245-0062 Form 2181 - Supplement (Applicant Name)_final.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form and Instruction	SBA Form 2183	Funds Exhibits	3245-0062 SBA Form 2183 - (Applicant Name) 12-21-16.pdf	www.sba.gov/inv	Yes	Yes	Paper Only
Form and Instruction	SBA Form 2181	Applicant Narrative	3245-0062 SBA Form 2181 - Narrative (Applicant Name) 12-21-16.pdf	www.sba.gov/inv	Yes	Yes	Paper Only
Form and Instruction	SBA Form 2182	Principal Exhibits	3245-0062 SBA Form 2182 - (Principal Name) 12-21-16.docx	www.sba.gov/inv	Yes	Yes	Paper Only
Form and Instruction	SBA Form 2182 Exhibit E1	Exhibit E1	3245-0062 Exhibit E1 - (YYYY Portfolio Name)_final.xlsx	www.sba.gov/inv	Yes	No	Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 375	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 67 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	375	-15	390
Annual IC Time Burden (Hours)	24,625	17,255	7,370
Annual IC Cost Burden (Dollars)	2,360,294	-94,412	2,454,706

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.