National/Regional/ Advisory Council Or Small Business Person Of The Year (United States)
This is a Small Business Administration (SBA) small business person of the year application. The form provided here is simply a sample of what the actual Form 898 looks like.
OMB Approval No. 3245-0125
U.S. SMALL BUSINESS ADMINISTRATION
CANDIDATE FOR
NATIONAL/REGIONAL/ ADVISORY COUNCIL
or SMALL BUSINESS PERSON OF THE YEAR
SOCIAL SECURITY NO. _____________________________
NAME:
_____________________________ (First)
_____________________________ (Middle/Initial)
_____________________________ (Last)
POSITION NAME AND ADDRESS OF BUSINESS OR EMPLOYER:
Name _____________________________
Address _____________________________
City _____________________________
State _____________________________
Zip Code _____________________________
TYPE
BUSINESS: _____________________________
PHONE: _____________________________
INDICATE PREVIOUS OR PRESENT FINANCIAL (INCLUDING DEVELOPMENT COMPANY), SURETY BONDS, OR CONTRACTUAL ASSISTANCE WITH SBA. GIVE APPROXIMATE DATES AND TYPE OF ASSISTANCE.
_____________________________
HOME ADDRESS:
Address _____________________________
City _____________________________
State _____________________________
Zip Code _____________________________
SERVICE ON FEDERAL BOARDS, COUNCILS OR COMMISSIONS PRESENT):
_____________________________
IF EMPLOYED BY A STATE GOVERNMENT, IS IT AN ELECTIVE POSITION?
____ YES ____ NO ____ N/A
ARE YOU ON A FEDERAL PAYROLL? ____ YES ____ NO
BIRTH: _____________________________
BIRTH DATE: _____________________________
CONGRESSIONAL DISTRICT: _____________________________
The authority to obtain this information is contained in 5 U.S.C. 301, 15 U.S.C. 634(b), 44 U.S.C., 3101. Routine uses of the information are:
To respond to a request from a member of Congress regarding information about an Advisory Council member.
To disclose information about an Advisory Council Member to general public.
To respond to requests from the General Services Administration.
_____________________________ (Signature)
_____________________________ (Date)
(This must be signed as a condition of the appointment.)
PLEASE NOTE: The estimated burden hours for the completion of SBA Form 898 is 8 minutes per response. You will not be required to respond to this information collection if a valid OMB approval number is not displayed. If you have questions or comments concerning this estimate or other aspect of this information collection, please contact the U.S. Small Business Administration, Chief, Administrative Information Branch, Washington, D.C. 20416 and/or Office of Management and Budget, Clearance Officer, Paperwork Reduction Project (3245-0125), Washington, D.C. 20503.