Fillable Sba Form 1081 - Statement Of Personal History (For Use By Lenders) (Page 4 of 4) in pdf

Paperwork Reduction Act (44 U.S.C. Chapter 35) (USE OF INFORMATION)

SBA is collecting the information on this form to make a character determination regarding Associates of Lenders and other individuals

or entities that propose to hold an equity interest of at least 10% of the economic interest in certain Lenders. An Associate is defined as

an officer, director, key employee, or holder of 20 percent or more of the value of the Lender’s stock or debt instruments, or an agent

involved in the loan process (13 CFR §120.10, Definitions). The information also provides the Agency with background data which is

evaluated to determine if the institution’s key personnel have sufficient qualifications in commercial lending activities. The information

collected may be checked against criminal history indices of the Federal Bureau of Investigation.

Privacy Act (5 U.S.C. 552a)

Any person can request to see or get copies of any personal information that SBA has in his or her file when that file is retrieved by

individual identifiers such as name or social security numbers. Requests for information about another party 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.

Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to provide your social

security number may not affect any right, benefit or privilege to which you are entitled. Disclosures of name and other personal

identifiers are, however, required for a benefit, as SBA requires an individual seeking assistance from SBA to provide it with sufficient

information for it to make a character determination. In determining whether an individual is of good character, SBA considers the

person's integrity, candor, and disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal

history, or lack thereof, pursuant to section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act). Further, for all

forms of assistance, SBA is authorized to make all investigations necessary to ensure that a person has not engaged in acts that violate

or will violate the Act or the Small Business Investment Act, 15 USC Sections 634(b)(11) and 687(b)(a), respectively. For these

purposes, you are asked to voluntarily provide your social security number to assist SBA in making a character determination and to

distinguish you from other individuals with the same or similar name or other personal identifier.

The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use for SBA's

investigative files system of records is that when this information indicates a violation or potential violation of law, whether civil, criminal,

or administrative in nature, SBA may refer it 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; 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.

Freedom of Information Act (5 U.S.C. 552)

This law provides, with some exceptions, that SBA must supply information reflected in agency files and records to a person requesting

it. Information about approved loans that will be automatically released includes, among other things, statistics on our loan programs

(individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (and their officers,

directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms and the

maturity.

Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be addressed to

the nearest SBA office and be identified as a Freedom of Information request.

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SBA Form 1081 (9-16) Previous Edition is Obsolete

Sba Form 1081 - Statement Of Personal History (For Use By Lenders) Page 4