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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