Personal Financial Statement (Page 4 of 4) in pdf

PLEASE READ, DETACH, AND RETAIN FOR YOUR RECORDS

STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDER

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. 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.

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.

Executive Order 12549, Debarment and Suspension (13 C.F.R. 145)

The prospective lower tier participant certifies, by submission of the application for program participation (or

participant’s annual update) that neither it nor its principals are presently debarred, suspended, proposed for debarment,

declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

Where the prospective lower tier participant ( or active participant ) is unable to certify to any of the statements in this

certification, such participants shall attach an explanation.

SBA Form 413 (8a) (09-14) Previous Editions Obsolete

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Personal Financial Statement Page 4