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

Forms and Documents

Document Name	Status
Form SBA Form 856 Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	Modified
Form SBA FORM 856 Disclosure Statement Lveraged Licensees Form and Instruction	Unchanged
3245-0118 CORRESPONDING STATUTORY AND REGULATORY PROVISIONS INFORMATION COLLECTION 3-23-2022.docx Supplementary Document	2022-04-05
3245-0118 SBA Form 856~856A PRA Renewal Suppl Stmt FINAL 3-23-2022.docx Supporting Statement A	2022-04-05

IC Document Collections

IC ID	Document Title	Status
35671	Disclosure Statement-Leveraged Licensees; Disclosure Statement Non-leveraged Licensees Form and Instruction	Modified
202552	Disclosure Statement Lveraged Licensees Form and Instruction	Unchanged

ICR Details

OMB Control No: 3245-0118	ICR Reference No: 202204-3245-002
Status: Received in OIRA	Previous ICR Reference No: 201807-3245-001
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: 04/05/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	571	0
Time Burden (Hours)	390	0
Cost Burden (Dollars)	6,935	0

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Abstract: Small Business Administration (SBA) Forms 856 and 856A are used by SBA examiners as part of their examination of licensed small business investment companies (SBICs). This information collection obtains representations from an SBIC's management regarding certain obligations, transactions and relationships of the SBIC and helps SBA to evaluate the SBIC's financial condition and compliance with applicable laws and regulations.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 26597	05/14/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18052	03/29/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
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

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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	571	0	0	0	0	571
Annual Time Burden (Hours)	390	0	0	-3	0	393
Annual Cost Burden (Dollars)	6,935	0	0	6,935	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden decrease is due to program change.

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Annual Cost to Federal Government: $23,985

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

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Common Form ICR:  No

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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: 04/05/2022

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