Federal Agency Comment Form
Federal Agency Comment Form
Small Business Administration - Office of the National Ombudsman
PURPOSE: Small business owners may use this form to submit comments on Federal enforcement/compliance actions that they consider excessive or unfair. The National Ombudsman will use the information when it contacts the applicable Federal agency for a review of the action. Completion of this form is voluntary; however, failure to submit the requested information could impact whether SBA's Office of the National Ombudsman is able to provide you with assistance.
We are temporarily experiencing system issues. Until this is resolved, please:
  1. Save a copy of your comment form
  2. If you do not receive a response within 2 business days from the Office of the National Ombudsman, email us at ombudsman@sba.gov with a copy of your comment form
  3. Use "Comment Form 1993 Re-submission" as the subject of your email
Please submit the Federal Agency Comment Form within the 30-minute timeframe or your session will timeout due to IT security requirements.
OMB Control #3245-0313
Exp. date 8/31/2025
Case #:

Instructions
1. Complete, sign and date this form. (Signature not required if completed at Office-National-Ombudsman).
2. Provide a brief written statement on the reverse side or a separate sheet of paper regarding the specific enforcement or compliance action taken against your organization by the federal agency.
3. Submit copies of substantiating documentation such as correspondence and citation, or notice (Note: can be submitted separately from this form by email, fax or mail. Make sure to reference your name or company's name with this information).
4. If your comments concern the IRS, you must also submit a completed IRS Tax Information Authorization Form 8821, available at IRS.gov/forms (Can be sent by email, fax or mail).
5. Fax, email or send this form and requested information to: (1) Fax: (202) 481-5719; (2) Email: Ombudsman@sba.gov; (3) Address: SBA, Office of the National Ombudsman, 409 Third Street, SW, Washington, DC 20024. Telephone: (202) 205-2417.

Country:
US
Zip/Zip+4:
-
(Please Use Lookup Zip to auto populate City Name and State)
Street Address 2:
(999-999-9999)
Fax:
(999-999-9999)
Contact Name:
( )
(Middle)
( )
No. of Members Representing:
List the federal agency with which you are having a problem
 
Federal Agency Name:
Agency Contact person:
Agency Office/Division:
Did the federal agency listed above inform you of your right to contact the SBA Office of the National Ombudsman?:
Yes No
If not, how did you learn about this office?:
Other Description:

Confidentiality / Disclosure
The National Ombudsman is required to keep confidential the identity of any person or small business providing a comment about an agency's compliance or enforcement action unless that person or small business provides consent, or disclosure is determined to be unavoidable. Confidentiality is governed by the Small Business Regulatory Enforcement Fairness Act 15 U.S.C. 657(b)(2(B) and the Inspector General’s Act, 5 U.S.C. App., § 7(b). You may make a selection below to authorize SBA to share your identity with the federal agency with which you are having a problem so that agency can investigate your specific problem and offer a response tailored to your situation. By requesting confidentiality, the federal agency may not have sufficient information to investigate your specific problem, possibly delaying or preventing any potential resolution of your situation.
 
I request that my identity be shared only with the federal agency(ies) with which I am having a problem
I request that my identity be kept confidential. (Results may be limited.)
 
Your signature authorizes the SBA Ombudsman to proceed on your behalf
 
Pursue all legal options you believe are in your company's best interest. This process is not a substitute for legal action.

SBA FORM 1993 (9-22) Previous Editions Obsolete

PLEASE NOTE: The estimated burden for completing this form is 45 minutes. You are not required to respond to this information collection if a valid OMB approval number is not displayed. If you have any questions or comments concerning this estimate or other aspects of this information collection, please contact the U. S. Small Business Administration, Director, Records Management Division, 409 Third Street, SW, Washington, D.C., 20416 and/or Office of Management and Budget, SBA Desk Officer, New Executive Office Building, Rm. 10202, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB, as this will delay action on your request for assistance.

 

 

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