SBA Form 2511 Microloan Program Intermediary Lenders

OMB Control Number 3245-0365

Expiration Date XX/XX/XXXX

District Office Site Visit Checklist for Microloan Intermediaries

Intermediary Name	     
*DBA or *FKA	*DBA: Doing Business As | *FKA: Formally Known As
	     
Location Visited	Street Address 1
	     
	Street Address 2
	     
	City				State	Zip Code
	     				     	     
Visited Multiple Locations	Yes	No		If “Yes”, enter additional location/s in section: Additional Site Visit Locations.
Website Address	     
Site Visit Type	Onsite		Virtual/Remote
Site Visit Date	Date format: MM/DD/YYYY
	Click or tap to enter a date.
Description of Office Visited	Please provide a brief description of the office and any notable observations of the building.
	     
Participants
	Name				Title
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     
	     				     

Contacts
Please provide contact information for 1) Board of Directors – Chair and 2) CEO, Executive Director and/or President.
	Position	Permanent	Interim	Vacant	NA
Board of Directors - Chair		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Email	     
	Phone	     
	Position	Permanent	Interim	Vacant	NA
Chief Executive Officer		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Email	     
	Phone	     
		OCRM Primary Contact
		OCRM Alternate Contact
	Position	Permanent	Interim	Vacant	NA
President		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Email	     
	Phone	     
		OCRM Primary Contact
		OCRM Alternate Contact
	Position	Permanent	Interim	Vacant	NA
Executive Director		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Email	     
	Phone	     
		OCRM Primary Contact
		OCRM Alternate Contact

Contacts (continued)
A minimum of two OCRM contacts is required. If a Primary and Alternate contact was identified on the previous page, please skip to the next section; otherwise, please provide additional contact information below.
	Position	Permanent	Interim	Vacant	NA
OCRM Primary Contact		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Title	     
	Email	     
	Phone	     
	Position	Permanent	Interim	Vacant	NA
OCRM Alternate Contact		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Title	     
	Email	     
	Phone	     
*Optional	Position	Permanent	Interim	Vacant	NA
OCRM Alternate Contact		If “Vacant” or “Interim”, provide details on plan to fill below (e.g., timeline efforts, etc.):
		     
	Name	     
	Title	     
	Email	     

District Office Site Visit Checklist for Microloan Intermediaries

Loan Note Review (#1)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
1.1.	Review performed and the following statement in its entirety appears in the body of the Microloan Note or as an addendum initialed by Microloan Borrower. “This note has been pledged to the U.S. Small Business Administration (SBA) as collateral. Further assignment cannot be made without prior written consent of SBA.”		Yes	No
	If “No”: Partial verbiage was present. No verbiage was present.
	If the answer is “No”, please provide the specific verbiage stated on the Note.
	     
a)	Review performed and the Microloan Note contains original signature(s).		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
b)	Verified the original Microloan Note is kept in a “disaster proof” cabinet.		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     

Loan Note Review (#2)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
1.2.	Review performed and the following statement in its entirety appears in the body of the Microloan Note or as an addendum initialed by Microloan Borrower. “This note has been pledged to the U.S. Small Business Administration (SBA) as collateral. Further assignment cannot be made without prior written consent of SBA.”		Yes	No
	If “No”: Partial verbiage was present. No verbiage was present.
	If the answer is “No”, please provide the specific verbiage stated on the Note.
	     
a)	Review performed and the Microloan Note contains original signature(s).		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
b)	Verified the original Microloan Note is kept in a “disaster proof” cabinet.		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
1.3.	Review performed and the following statement in its entirety appears in the body of the Microloan Note or as an addendum initialed by Microloan Borrower. “This note has been pledged to the U.S. Small Business Administration (SBA) as collateral. Further assignment cannot be made without prior written consent of SBA.”		Yes	No
	If “No”: Partial verbiage was present. No verbiage was present.
	If the answer is “No”, please provide the specific verbiage stated on the Note.
	     
a)	Review performed and the Microloan Note contains original signature(s).		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
b)	Verified the original Microloan Note is kept in a “disaster proof” cabinet.		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
1.4.	Review performed and the following statement in its entirety appears in the body of the Microloan Note or as an addendum initialed by Microloan Borrower. “This note has been pledged to the U.S. Small Business Administration (SBA) as collateral. Further assignment cannot be made without prior written consent of SBA.”		Yes	No
	If “No”: Partial verbiage was present. No verbiage was present.
	If the answer is “No”, please provide the specific verbiage stated on the Note.
	     
a)	Review performed and the Microloan Note contains original signature(s).		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     
b)	Verified the original Microloan Note is kept in a “disaster proof” cabinet.		Yes	No
	If “No”, please provide a summary of the contributing factors to non-compliance below.
	     

Paid-in-Full (PIF) /Charged Off (CO) Loan File Review
2.	Files are maintained in records for a duration of six years following the final disposition of each loan.	Yes	No
	Comments
	     

PIF/CO Loan File Review (#1)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
2.1.	The PIF/CO loan file contains relevant documents and records. (e.g., application, credit memo, eligibility determination, CAIVRS, Sam.gov search, no credit elsewhere>$20,000, evidence of legal status, TA records, Microloan Note, Note Modification(s) if applicable, evidence of use of proceeds, payment history, evidence of payment history, evidence of payment in full, business revenue, jobs created and retained, cause for charge off, etc.).		Yes	No
	Comments
	     

PIF/CO Loan File Review (#2)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
2.2.	The PIF/CO loan file contains relevant documents and records. (e.g., application, credit memo, eligibility determination, CAIVRS, Sam.gov search, no credit elsewhere>$20,000, evidence of legal status, TA records, Microloan Note, Note Modification(s) if applicable, payment history, evidence of payment history, evidence of payment in full, business revenue, jobs created and retained, cause for charge off, etc.).		Yes	No
	Comments
	     

PIF/CO Loan File Review (#3)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
2.3.	The PIF/CO loan file contains relevant documents and records. (e.g., application, credit memo, eligibility determination, CAIVRS, Sam.gov search, no credit elsewhere>$20,000, evidence of legal status, TA records, Microloan Note, Note Modification(s) if applicable, payment history, evidence of payment history, evidence of payment in full, business revenue, jobs created and retained, cause for charge off, etc.).		Yes	No
	Comments
	     

PIF/CO Loan File Review (#4)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
2.4.	The PIF/CO loan file contains relevant documents and records. (e.g., application, credit memo, eligibility determination, CAIVRS, Sam.gov search, no credit elsewhere>$20,000, evidence of legal status, TA records, Microloan Note, Note Modification(s) if applicable, payment history, evidence of payment history, evidence of payment in full, business revenue, jobs created and retained, cause for charge off, etc.).		Yes	No
	Comments
	     

PIF/CO Loan File Review (#5)
Loan Sequence Number		     
Closing Date		     
Loan Amount		     
Borrower Name		     
2.5.	The PIF/CO loan file contains relevant documents and records. (e.g., application, credit memo, eligibility determination, CAIVRS, Sam.gov search, no credit elsewhere>$20,000, evidence of legal status, TA records, Microloan Note, Note Modification(s) if applicable, payment history, evidence of payment history, evidence of payment in full, business revenue, jobs created and retained, cause for charge off, etc.).		Yes	No
	Comments
	     

Loan Request Denials by the Intermediary
3.	Files are maintained in records for a duration of three years following the Intermediary’s decline of the loan request.	Yes	No
	If “No”: Partial information was present. No information was present.
	Comments
	     

Declined Application Review (#2)
Date of Application		     
Requested Loan Amount		     
Borrower Name		     
Purpose of Loan		     
Reason for the loan decline		     
3.2.	Denied Credit Documentation includes loan application (e.g., date, applicant’s information, amount requested, purpose of the loan request) AND decision letter/memo.		Yes	No
	If “No”, summarize any potential reasons or challenges that may have contributed to the failure to retain declined application records consistently below:
	     

Declined Application Review (#3)
Date of Application		     
Requested Loan Amount		     
Borrower Name		     
Purpose of Loan		     
Reason for the loan decline		     
3.3.	Denied Credit Documentation includes loan application (e.g., date, applicant’s information, amount requested, purpose of the loan request) AND decision letter/memo.		Yes	No
	If “No”, summarize any potential reasons or challenges that may have contributed to the failure to retain declined application records consistently below:
	     

Declined Application Review (#4)
Date of Application		     
Requested Loan Amount		     
Borrower Name		     
Purpose of Loan		     
Reason for the loan decline		     
3.4.	Denied Credit Documentation includes loan application (e.g., date, applicant’s information, amount requested, purpose of the loan request) AND decision letter/memo.		Yes	No
	If “No”, summarize any potential reasons or challenges that may have contributed to the failure to retain declined application records consistently below:

Declined Application Review (#5)
Date of Application		     
Requested Loan Amount		     
Borrower Name		     
Purpose of Loan		     
Reason for the loan decline		     
3.5.	Denied Credit Documentation includes loan application (e.g., date, applicant’s information, amount requested, purpose of the loan request) AND decision letter/memo.		Yes	No
	If “No”, summarize any potential reasons or challenges that may have contributed to the failure to retain declined application records consistently below:
	     

Technical Assistance Record Examination (#1) Select the borrower from the Note review sample and retrieve Intermediary’s records to start the review.
Loan Sequence Number		     
Borrower Name		     
TA Recipient Name		     
4.	Does the Intermediary have a Technical Assistance (TA) Record for this recipient?		Yes	No
4.1.	Did the Intermediary track TA hours delivered?		Yes	No
4.2.	Did the Intermediary track what was taught?		Yes	No
4.3	Did the Intermediary show who delivered the TA?		Yes	No
4.4.	Did the Intermediary track how the TA was delivered, i.e., online, one-on-one, classroom?		Yes	No
4.5.	Did the Intermediary break out hours by Pre-loan and Post-loan?		Yes	No

Technical Assistance (TA) Detailed Examination

4.6

Contacted microloan borrower to confirm receipt of the TA as reported. [Optional]

Yes

No

Meeting Method:

Phone

In-person

Email

Virtual

Drive by

4.7

Is recipient a microloan borrower?

Yes

No

4.8

Indicate type of TA borrower received.

Check all that apply:

Pre TA

Post TA

None

4.9

What subjects have they been taught? (Please list all relevant subjects below.)

Date Received. (Please list all relevant dates below.)

     

.

Total number of hours Technical Assistance Borrower received.

Pre-TA Total Hours

Post TA Total Hours

     

     

Please explain any challenges encountered in reaching the borrower and/or any issues identified during the review process.

     

Technical Assistance Record Examination (#2) Select the borrower from the Note review sample and retrieve Intermediary’s records to start the review.
Loan Sequence Number		     
Borrower Name		     
TA Recipient Name		     
4.	Does the Intermediary have a Technical Assistance (TA) Record for this recipient?		Yes	No
4.1.	Did the Intermediary track TA hours delivered?		Yes	No
4.2.	Did the Intermediary track what was taught?		Yes	No
4.3	Did the Intermediary show who delivered the TA?		Yes	No
4.4.	Did the Intermediary track how the TA was delivered, i.e., online, one-on-one, classroom?		Yes	No
4.5.	Did the Intermediary break out hours by Pre-loan and Post-loan?		Yes	No

Technical Assistance (TA) Detailed Examination

4.6

Contacted microloan borrower to confirm receipt of the TA as reported. [Optional]

Yes

No

Meeting Method:

Phone

In-person

Email

Virtual

Drive by

4.7

Is recipient a microloan borrower?

Yes

No

4.8

Indicate type of TA borrower received.

Check all that apply:

Pre TA

Post TA

None

4.9

What subjects have they been taught? (Please list all relevant subjects below.)

Date Received. (Please list all relevant dates below.)

     

.

Total number of hours Technical Assistance Borrower received.

Pre-TA Total Hours

Post TA Total Hours

     

     

Please explain any challenges encountered in reaching the borrower and/or any issues identified during the review process.

     

Technical Assistance Record Examination (#3) Select the borrower from the Note review sample and retrieve Intermediary’s records to start the review.
Loan Sequence Number		     
Borrower Name		     
TA Recipient Name		     
4.	Does the Intermediary have a Technical Assistance (TA) Record for this recipient?		Yes	No
4.1.	Did the Intermediary track TA hours delivered?		Yes	No
4.2.	Did the Intermediary track what was taught?		Yes	No
4.3	Did the Intermediary show who delivered the TA?		Yes	No
4.4.	Did the Intermediary track how the TA was delivered, i.e., online, one-on-one, classroom?		Yes	No
4.5.	Did the Intermediary break out hours by Pre-loan and Post-loan?		Yes	No

Technical Assistance (TA) Detailed Examination

4.6

Contacted microloan borrower to confirm receipt of the TA as reported. [Optional]

Yes

No

Meeting Method:

Phone

In-person

Email

Virtual

Drive by

4.7

Is recipient a microloan borrower?

Yes

No

4.8

Indicate type of TA borrower received.

Check all that apply:

Pre TA

Post TA

None

4.9

What subjects have they been taught? (Please list all relevant subjects below.)

Date Received. (Please list all relevant dates below.)

     

.

Total number of hours Technical Assistance Borrower received.

Pre-TA Total Hours

Post TA Total Hours

     

     

Please explain any challenges encountered in reaching the borrower and/or any issues identified during the review process.

     

Microloan Intermediary Operations Overview
7.	Has Intermediary’s primary market been subject to any natural disasters? (e.g., fires, earthquake, tornado, flood, etc. Note: COVID-19 is not classified as a natural disaster.) If “Yes”, summarize negative impacts Intermediary has experienced below:			Yes		No		NA
	     
8.	Intermediary is enrolled in Lender Match to receive requests for loans. If “No”, summarize discussion that took place with Intermediary below:			Yes		No		NA
	     
9.	Describe Intermediary’s use of technology. Loan Administration (e.g., loan origination, closing, servicing, etc.)
			     
	Accounting IT system (e.g., disbursement of loans, loan status, payment history, etc.)
			     
	Technical Assistance IT system (e.g., recording or TA activities, etc.)
			     
	Overall, IT system has adequate data security measures (e.g., access controls, encryption protocols, firewalls, and intrusion detection system), privacy and data protection to safeguard sensitive information, and business continuity and disaster recovery strategies to recover from IT disruptions (e.g., system failures, natural disasters, or cyber incidents, etc.). Comments				Yes		No
			     

10.	Intermediary wishes to request or has requested an expansion of its regions.		Yes	No
	Comments
	     
11.	District Office has a recommendation for any training that would benefit the Intermediary. If “Yes”, summarize training needs Intermediary has below:		Yes	No
	     
12.	Intermediary attended Microlending and/or Technical Assistance related conferences in the past two years. If “Yes”, name the conference(s) below:		Yes	No
		     
	Intermediary has plans to attend any Microlending and/or Technical Assistance related conferences within the next 12 months. If “Yes”, name the conference(s) below:		Yes	No
		     
13.	Intermediary has Microloan Program related issues they want to discuss. If “Yes”, summarize related issues Intermediary wants to discuss below:		Yes	No
	     

Additional Site Visit Locations

Additional Site Visit Location (#1) Notes	     
Intermediary Site Visit Location Address	Street Address 1
	     
	Street Address 2
	     
	City	State	Zip Code
	     	     	     

Additional Site Visit Location (#2) Notes	     
Intermediary Site Visit Location Address	Street Address 1
	     
	Street Address 2
	     
	City	State	Zip Code
	     	     	     

District Office Name	     
Summary of Deficiencies: Briefly list and explain the key deficiencies discussed during the exit meeting
Future Improvements: Note how the organization plans to strengthen its processes to prevent similar issues moving forward
General Comments and Observations: Highlight any material changes, noteworthy developments or other information the Reviewer wishes to convey to the HQ
Reviewer Name	     
Signature	     
Date	     

Time Allocation: Travel Time and Duration of Review

Please provide the round-trip travel time from [origin] to the visited site.	     
Please indicate the duration of time it took to complete the review.	     

You have completed the Site Visit Checklist.

Save and submit to ocrmmicro@sba.gov

Note: According to the Paperwork Reduction Act, you are not required to respond to any collection of information unless it displays a currently valid OMB Control Number. The number for this collection of information is 3245-0365. The total estimated time to respond to this collection of information, including gathering and maintaining the data needed, and completing and reviewing the collection of information, is 210 minutes. You may send comments or questions regarding this estimated time or any other aspect of this collection of information including suggestions for reducing the time or other burden to: Director, Records Management Division, 409 Third Street, S.W., Washington D. C. 20416, and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington DC 20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

Disclosure of Information – Requests for information contained herein may be denied unless SBA has the written permission of the individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act, 5 U.S.C. §552. The Privacy Act, 5 U.S.C. §552a, authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil, criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or foreign, charged with responsibility for, or otherwise involved in investigation, prosecution, enforcement, or prevention of such violations. Another routine use is disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to the requesting agencies’ function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine uses.

SBA Form 2511 [EFFECTIVE DATE] Previous edition is obsolete.