Loan Application Checklist, Small Business Loan Intake Form Etc. Page 13
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15Please read the following restrictions regarding use of federal financial assistance programs. If you
understand them fully and agree to them, sign your name at the end of this document.
SBA is required to withhold or limit financial assistance, to impose special conditions on approved loans, to provide special
notices to applicants or borrowers and to require special reports and data from borrowers in order to comply with legislation
passed by the Congress and Executive Orders issued by the President and by the provisions of various inter-agency agreements.
SBA has issued regulations and procedures that implement these laws and executive orders. These are contained in Parts 112,
113, and 117 of Title 13 of the Code of Federal Regulations and in Standard Operating Procedures.
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 is the
disclosure of information maintained in SBA’s investigative files system of records when this information indicates a violation
or potential violation of law, whether civil, criminal, or administrative in nature. Specifically, SBA may refer the information 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.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) -- This is notice to you as required by the Right to Financial Privacy
Act of 1978, of SBA's access rights to financial records held by financial institutions that are or have been doing business with
you or your business, including any financial institutions participating in a loan or loan guaranty. The law provides that SBA
shall have a right of access to your financial records in connection with its consideration or administration of assistance to you in
the form of a Government guaranteed loan. SBA is required to provide a certificate of its compliance with the Act to a financial
institution in connection with its first request for access to your financial records, after which no further certification is required
for subsequent accesses. The law also provides that SBA's access rights continue for the term of any approved loan guaranty
agreement. No further notice to you of SBA's access rights is required during the term of any such agreement. The law also
authorizes SBA to transfer to another Government authority any financial records included in an application for a loan, or
concerning an approved loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a
defaulted loan guaranty.
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.
Flood Disaster Protection Act (42 U.S.C. 4011) -- Regulations have been issued by the Federal Insurance Administration (FIA)
and by SBA implementing this Act and its amendments. These regulations prohibit SBA from making certain loans in an FIA
designated floodplain unless Federal Flood insurance is purchased as a condition of the loan. Failure to maintain the required
level of flood insurance makes the applicant ineligible for any financial assistance from SBA, including disaster assistance.
SBA Form 1919 (Revised 4/14)
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