SBA Form 1010-ANC 8(A) Business Development (Bd) Program Application Alaskan Native Corporation-Owned Concern

What Is SBA Form 1010-ANC?

SBA Form 1010-ANC, 8(a) Business Development (BD) Program Application Alaskan Native Corporation-Owned Concern is a form filed by representatives of Alaska Native Corporation-owned business applying for the 8(a) Business Development Program with the Small Business Administration (SBA).

The latest edition of the form was released by the SBA in March 2011 with all previous editions obsolete. An up-to-date SBA Form 1010-ANC fillable version is available for download and digital filing below.

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OMB Approval No. 3245-0331
Expiration Date: 02/29/2020
Alaska Native Corporation Information
The Alaska Native Corporation that owns the applicant business concern
must complete this form. 13 C.F.R. § 124.109(a).
YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU FULLY UNDERSTAND
ALL QUESTIONS AND CERTIFIES THAT ALL RESPONSES AND DOCUMENTS
ARE TRUTHFUL AND ACCURATE. Please submit this form with the 8(a) Business
Development Program Application – SBA Form 1010. The information will be used as
part of the program eligibility determination.
Name of Applicant Business Concern (include any trade or d.b.a. names):
__________________________________________________________________________
Name of Parent Alaska Native Corporation (ANC):
_________________________________________
Note: An ANC means any Regional Corporation, Village Corporation, Urban Corporation, or
Group Corporation organized under the laws of the State of Alaska in accordance with the
Alaska Native Claims Settlement Act, as amended 43 U.S.C. 1601, et seq. 13 C.F.R. § 124.3.
Telephone: (
)____________________
Fax: (
)_________________________
Address:
_______________________________________________________________________
City: _____________________ County: _____________ State: ______________ Zip:
______________
E-mail: __________________________________ @ ___________
Mailing Address (if different from above)
Address:
_____________________________________________________________________
City: _____________________ State: ______________ Zip: ____________
ANC percent ownership of applicant business concern: ___________
Please answer the following questions and provide the required documents:
1. Does the ANC or subsidiary of the ANC own 50% or more of another
[ ]Yes
[ ]No
business concern other than the applicant business concern? If yes,
identify the names of any other business concern(s), the primary NAICS
code of the other business concern(s), and which (if any) of the other
business concerns have ever participated in the 8(a) BD Program.
[ ]Yes
[ ]No
2. Does the ANC own the applicant business concern directly (rather than
through a subsidiary)?
OMB Approval No. 3245-0331
Expiration Date: 02/29/2020
Alaska Native Corporation Information
The Alaska Native Corporation that owns the applicant business concern
must complete this form. 13 C.F.R. § 124.109(a).
YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU FULLY UNDERSTAND
ALL QUESTIONS AND CERTIFIES THAT ALL RESPONSES AND DOCUMENTS
ARE TRUTHFUL AND ACCURATE. Please submit this form with the 8(a) Business
Development Program Application – SBA Form 1010. The information will be used as
part of the program eligibility determination.
Name of Applicant Business Concern (include any trade or d.b.a. names):
__________________________________________________________________________
Name of Parent Alaska Native Corporation (ANC):
_________________________________________
Note: An ANC means any Regional Corporation, Village Corporation, Urban Corporation, or
Group Corporation organized under the laws of the State of Alaska in accordance with the
Alaska Native Claims Settlement Act, as amended 43 U.S.C. 1601, et seq. 13 C.F.R. § 124.3.
Telephone: (
)____________________
Fax: (
)_________________________
Address:
_______________________________________________________________________
City: _____________________ County: _____________ State: ______________ Zip:
______________
E-mail: __________________________________ @ ___________
Mailing Address (if different from above)
Address:
_____________________________________________________________________
City: _____________________ State: ______________ Zip: ____________
ANC percent ownership of applicant business concern: ___________
Please answer the following questions and provide the required documents:
1. Does the ANC or subsidiary of the ANC own 50% or more of another
[ ]Yes
[ ]No
business concern other than the applicant business concern? If yes,
identify the names of any other business concern(s), the primary NAICS
code of the other business concern(s), and which (if any) of the other
business concerns have ever participated in the 8(a) BD Program.
[ ]Yes
[ ]No
2. Does the ANC own the applicant business concern directly (rather than
through a subsidiary)?
3. Does the ANC own the applicant business concern through a
[ ]Yes
[ ]No
subsidiary(ies)? If yes, provide the name(s) and address(es) for the
concern(s).
Please provide the following documents:
Copy of the ANC’s Articles of Incorporation and Bylaws (including any amendments).
Copies of the governing documents of the subsidiary(ies) identified in Question 3 above.
For Corporations: Articles of Incorporation, Bylaws (including any amendments),
and stock certificates and register.
For Limited Liability Companies: Articles of Organization and Operating Agreement
(including all amendments).
Copies of minutes or other documentation from the ANC and/or the business concerns
identified in Question 3 above that relate to the applicant business concern (e.g., delegation of
authority, designation of representatives or directors, authorization for capitalization and/or
formation, etc.).
Copies of Federal tax returns, including all schedules, filed for the past three years for the
ANC and any business concern identified in Question 3 above.
Copies of the balance sheet and profit and loss statement for each of the three most recent
fiscal year-end periods, signed, certified, and dated by the highest managing individual for
the ANC and any business concern identified in Question 3 above.
NOTICE OF CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR
FALSE STATEMENTS: Under Title 18 U.S.C. § 1001 and Title 15 U.S.C. § 645, any
person who misrepresents a business concern’s status as an 8(a) Program participant, or
makes any other false statement in order to influence the certification process in any way,
or to obtain a contract awarded under the preference programs established pursuant to
section 8(a), 8(d), 9 or 15 of the Small Business Act, or any other provision of Federal Law
that reference Section 8(d) for a definition of program eligibility shall be: (1) Subject to
fines and imprisonment of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2)
subject to fines of up to $500,000 and imprisonment of up to 10 years, or both, as stated in
Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including
suspension and debarment; and (4) Ineligible for participation in programs conducted under
the authority of the Small Business Act.
CERTIFICATIONS: By signing this form, I certify that all information in this
application, including all supporting documents, is true and complete to the best of my
knowledge, and that I understand that SBA is relying on this information in making its
determination of my company’s eligibility for 8(a) BD Program.
Form must be signed by the ANC’s President or CEO.
___________________________
________________________
_________
Signature
Print Name
Date
The estimated burden for completing this form, including reading the instructions and
gathering the information, is 1 hour for initial application and each annual update. (A
submission for reconsideration is estimated to require approximately 30 minutes). You are
not required to respond to any collection of information unless it displays a currently valid
OMB approval number. Comments on the burden should be sent to U.S. Small Business
Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416, and/or SBA Desk
Officer, Office of Management and Budget, New Executive Office Building, Room 10202,
Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.
SBA Form 1010-ANC (3/11)

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SBA Form 1010-ANC Instructions

The SBA Form 1010-ANC provides information about a business owned by an Alaska Native Corporation (ANC) applying for participation in the 8(a) Program. ANCs include any Regional, Village, Urban, or Group Corporation organized under Alaska State in compliance with the Alaska Native Claims Settlement Act.

The form requires the representative of the ANC to identify the name of the applicant business along with the name, address and contact information of the ANC. Additional required paperwork includes the following:

  1. A copy of the ANC's Articles of Incorporation and Bylaws with all amendments.
  2. Copies of Federal tax returns and schedules filed for the past three years.
  3. Copies of certified and signed balance sheet and profit and loss statement for the three recent fiscal year-end periods.
  4. For subsidiaries through which the ANC owns the applicant business:
  • Copies of governing documents. These include stock certificates and register, Articles of Incorporation, and Bylaws (for Corporations) and Articles of Organization and an Operating Agreement (for Limited Liability Companies).
  • Copies of minutes, delegations of authority, designations of representatives or directors, authorization for capitalization and formation.
  • Copies of all Federal tax returns filed for the past three years.
  • Copies of the balance sheet and profit and loss statement for the past three fiscal year-end periods.

The completed form must be signed by the President or CEO of the ANC and submitted to the SBA.

SBA Form 1010-ANC Related Publications

  1. SBA Form 1010-NHO, 8(a) Business Development (BD) Program Application Native Hawaiian Organization-Owned Concern is a form completed by a representative or representatives of Native Hawaiian Organizations applying to participate in the 8(a) Business Development Program.
  2. SBA Form 1010-AIT 8(a) Business Development (BD) Program Application American Indian - Tribally-Owned Concern is a form completed by American Indian Tribes that owns 51% or more of a small business applying for the SBA 8(a) Business Development Program.
  3. SBA Form 1010-IND, 8(a) Business Development (BD) Program Application Individual Information is a form filled out by an individual that owns more than 10% of a small business applying for the 8(a) Program.
  4. SBA Form 1010-CDC, 8(a) Business Development (BD) Program Application Community Development Corporation-Owned Concern is a form filed by a representative of a Certified Development Company (CDC) that owns the business of an 8(a) program applicant.
  5. SBA Form 1010, Representative Form 1010 Business is a form used by businesses to inform the Small Business Administration (SBA) of the representatives and compensation paid for assistance with their 8(a) initial application.
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