Document Name Document Type
Form SBA Form 2181 SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire Form and Instruction
SBA Form 2181 SBIC Program Application Instructions 3245-0062 SBA Form 2181 SBIC Program Application Instructions 8-8-2023.docx www.sba.gov/inv Form and Instruction
SBA Form 2181 Pre-Screen SBIC MAQ short form 3245-0062 Copy of SBA Form 2181 Pre-Screen SBIC MAQ (Short Form) 8-8-2023.xlsx www.sba.gov/inv Form
SBA Form 2181 Long SBIC MAQ Long form 3245-0062 Copy of SBA Form 2181 SBIC MAQ (Long Form) 8-8-2023.xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Activities Relationship Certification 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit A Activities Relationship Certification 8-8-2023.xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Individual Declarations 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit B Individual Declarations (8.8.2023).xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Significant Investor Declarations 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit C Significant Investor Declarations (8.8.2023).xlsx www.sba.gov/inv Form
SBA Form 2181 MAQ Individual Legal Questionnaire 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit D Individual Legal Questionnaire (8.8.2023).xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Legal Document Certification 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit E Legal Document Certification (8.8.2023).xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Capital Certificate 3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit F Capital Certificate (8.8.2023).xlsx www.sba.gov/inv Form
SBA Form 2181 SBIC Transferors Liability Contract 3245-0062 SBA Form 2181 SBIC MAQ Exhibit G Transferors Liability Contract (8.8.2023) 8-8-2023.pdf www.sba.gov/inv Form

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 2181	SBIC Program Application Instructions	3245-0062 SBA Form 2181 SBIC Program Application Instructions 8-8-2023.docx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181	Pre-Screen SBIC MAQ short form	3245-0062 Copy of SBA Form 2181 Pre-Screen SBIC MAQ (Short Form) 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 Long form	SBIC MAQ Long form	3245-0062 Copy of SBA Form 2181 SBIC MAQ (Long Form) 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit A	Activities Relationship Certification	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit A Activities Relationship Certification 8-8-2023.xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit B	Individual Declarations	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit B Individual Declarations (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit C	Significant Investor Declarations	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit C Significant Investor Declarations (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 MAQ Exhibit D	Individual Legal Questionnaire	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit D Individual Legal Questionnaire (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit E	Legal Document Certification	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit E Legal Document Certification (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit F	Capital Certificate	3245-0062 Copy of SBA Form 2181 SBIC MAQ Exhibit F Capital Certificate (8.8.2023).xlsx	www.sba.gov/inv	Yes	Yes	Paper Only
Form	SBA Form 2181 SBIC MAQ Exhibit G	Transferors Liability Contract	3245-0062 SBA Form 2181 SBIC MAQ Exhibit G Transferors Liability Contract (8.8.2023) 8-8-2023.pdf	www.sba.gov/inv	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 275	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	275	-100	375
Annual IC Time Burden (Hours)	17,750	-6,875	24,625
Annual IC Cost Burden (Dollars)	6,502,073	4,141,779	2,360,294

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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

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

OMB: 3245-0062

IC ID: 35613

View Information Collection (IC)