SBA Form 1010-IND 8(A) Business Development (Bd) Program Application Individual Information

What Is SBA Form 1010-IND?

SBA Form 1010-IND, 8(a) Business Development (BD) Program Application Individual Information is a form which must be completed by each individual owning more than 10% of a business applying for the Small Business Administration (SBA) 8(a) Business Development Program. Filing the form is also obligatory for all directors, management personnel, partners and officers of the firm.

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

The 8(a) Business Development Program was created to support small businesses owned by socially and economically disadvantaged people or entities and is designed to give them an opportunity to be more competitive in their field. The SBA 8a Form 1010-IND is used for collecting information about any individuals owning portions of a small business as part of the 8(a) application process.

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OMB Approval No. 3245-0331
Expiration Date: 04/30/2017
INDIVIDUAL INFORMATION
Each person owning more than 10% of the applicant firm and each director, management member, partner,
and officer of the applicant firm must complete this form and attach the documents required below.
YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU FULLY UNDERSTAND ALL QUESTIONS AND
CERTIFIES THAT ALL RESPONSES AND DOCUMENTS ARE TRUTHFUL AND ACCURATE.
Name: ___________________________________
Gender: [ ] Male [ ] Female
Home Address: _______________________________________________________________________
City: _____________________ County: _____________ State: ______________ Zip: ______________
Name of Applicant Firm (include any trade or d.b.a. names):
______________________________________________________________________________________
_____
Your Position(s) in the Business: Director [ ]
Partner [ ]
Owner [ ] percentage owned:_________
Officer [ ] position(s) ____________________________
Other: _____________________
Average Number of Hours per Week Devoted to Working at the Business: ________
Are you authorized to make withdrawals from, or have access to, the business concern’s bank account?
[ ] Yes [ ] No
Note: You must attach a detailed explanation, including supporting documentation, noting the question
number for each “yes” response to the following questions 1 - 12.
1. Have you filed for personal bankruptcy in the past 7 years? If yes, provide details and a copy
[ ]Yes
[ ]No
of the bankruptcy court’s final order or discharge.
[ ]Yes
[ ]No
2. Have you previously obtained an SBA loan? If yes, provide the name(s) of the borrower(s)
on the loan, date approved, and current status of the loan.
[ ]Yes
[ ]No
3. Have you ever been an owner, stockholder, or guarantor for a business concern which has
received an SBA loan? If yes, provide the name(s) of the borrower(s) on the loan, date
approved, and current status of the loan.
4. Are you a party to any pending civil lawsuit? If yes, summarize your interest in the suit, a
[ ]Yes
[ ]No
summary of the claims, and the current status of the suit.
[ ]Yes
[ ]No
5. Are you a former employer or an officer of a former employer, of any individual(s) claiming
disadvantage?
[ ]Yes
[ ]No
6. Other than any publicly traded stock, bonds, and mutual funds you may own, do you have
an ownership interest in any other business, and/or are you an officer or director in any
other business concern? If yes, provide the following information: (1) identify your
percentage of ownership in that(those) concern’s (s’); (2) identify the number of employees
in that(those) concern(s); (3) identify that(those) concern(s) revenues for the past three
years; and (4) identify all other owners, partners, directors, officers, and principal
stockholders in that(those) concern(s) by name, address, position held, and percentage of
SBA Form 1010-IND (03/11)
1
OMB Approval No. 3245-0331
Expiration Date: 04/30/2017
INDIVIDUAL INFORMATION
Each person owning more than 10% of the applicant firm and each director, management member, partner,
and officer of the applicant firm must complete this form and attach the documents required below.
YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU FULLY UNDERSTAND ALL QUESTIONS AND
CERTIFIES THAT ALL RESPONSES AND DOCUMENTS ARE TRUTHFUL AND ACCURATE.
Name: ___________________________________
Gender: [ ] Male [ ] Female
Home Address: _______________________________________________________________________
City: _____________________ County: _____________ State: ______________ Zip: ______________
Name of Applicant Firm (include any trade or d.b.a. names):
______________________________________________________________________________________
_____
Your Position(s) in the Business: Director [ ]
Partner [ ]
Owner [ ] percentage owned:_________
Officer [ ] position(s) ____________________________
Other: _____________________
Average Number of Hours per Week Devoted to Working at the Business: ________
Are you authorized to make withdrawals from, or have access to, the business concern’s bank account?
[ ] Yes [ ] No
Note: You must attach a detailed explanation, including supporting documentation, noting the question
number for each “yes” response to the following questions 1 - 12.
1. Have you filed for personal bankruptcy in the past 7 years? If yes, provide details and a copy
[ ]Yes
[ ]No
of the bankruptcy court’s final order or discharge.
[ ]Yes
[ ]No
2. Have you previously obtained an SBA loan? If yes, provide the name(s) of the borrower(s)
on the loan, date approved, and current status of the loan.
[ ]Yes
[ ]No
3. Have you ever been an owner, stockholder, or guarantor for a business concern which has
received an SBA loan? If yes, provide the name(s) of the borrower(s) on the loan, date
approved, and current status of the loan.
4. Are you a party to any pending civil lawsuit? If yes, summarize your interest in the suit, a
[ ]Yes
[ ]No
summary of the claims, and the current status of the suit.
[ ]Yes
[ ]No
5. Are you a former employer or an officer of a former employer, of any individual(s) claiming
disadvantage?
[ ]Yes
[ ]No
6. Other than any publicly traded stock, bonds, and mutual funds you may own, do you have
an ownership interest in any other business, and/or are you an officer or director in any
other business concern? If yes, provide the following information: (1) identify your
percentage of ownership in that(those) concern’s (s’); (2) identify the number of employees
in that(those) concern(s); (3) identify that(those) concern(s) revenues for the past three
years; and (4) identify all other owners, partners, directors, officers, and principal
stockholders in that(those) concern(s) by name, address, position held, and percentage of
SBA Form 1010-IND (03/11)
1
any ownership interest.
[ ]Yes
[ ]No
7. Are you, or is any member of your household, a Federal employee?
8. Were you born outside of the United States? If yes, provide evidence of U.S. citizenship.
[ ]Yes
[ ]No
[ ]Yes
[ ]No
9. Do you have any delinquent Federal obligations, past due taxes or liens or have you been
delinquent in filing your personal Federal or local tax returns? If yes, your explanation must
include a discussion of and copies of any tax liens or unsatisfied judgments, evidence of
repayment arrangements and proof of compliance with repayment arrangements.
10. Have you previously used your socially disadvantaged status to qualify a business concern
[ ]Yes
[ ]No
for the 8(a) BD Program or have you ever been an owner (full or partial), director, officer
or partner in another business concern that was admitted to the 8(a) BD program? If yes,
your narrative statement must include the name of the other business concern and describe
the percentage of any ownership interest in that business concern.
[ ]Yes
[ ]No
11. Has an immediate family member (see definition on Form 1010) ever been an owner (full or
partial) of another business concern that was admitted to the 8(a) BD program? If yes, your
narrative statement must include the name of the business concern and describe the
percentage of any ownership interest.
12. Have you ever been debarred, suspended, voluntarily excluded or otherwise the subject of an
[ ]Yes
[ ]No
action that rendered you ineligible for procurement or non-procurement purposes from any
department or agency of the Federal Government? If yes, provide a brief description of the
cause of action.
SBA Form 1010-IND (03/11)
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All persons signing this form must provide the following documents:
Personal Resume, including the education, technical training and business and
employment experience (employer’s name, dates of employment and nature of
employment). Your resume must include a description of your current duties
within the applicant business concern.
Copies of your personal Federal income tax returns (including all schedules and
W-2 forms) for the two years immediately preceding the application for
yourself and your spouse (if filing separately)., and an executed IRS form 4506-
T, Request for Transcript of Tax Return, for yourself and your spouse (if filing
separately). The tax returns must be signed and dated.
Note for AIT- or ANC-owned business concerns: Only individuals owning
10% or more of the applicant business concern need to submit two years of
Federal income tax returns.
A completed SBA Form 912, “Statement of Personal History,” (include required
Form FD-258, Fingerprint Card, for affirmative answers to questions 7, 8, and 9
on the SBA Form 912), a narrative providing all details for each arrest/incident,
and copies of any available court disposition(s)/document(s).
Additionally, persons claiming to be socially and economically disadvantaged in
order to qualify the applicant business concern for the 8(a) BD Program must
answer questions 13 – 15 and provide the documents listed below:
[ ]Yes
[ ]No
13. Have you transferred any personal assets during the last two years to
any immediate family member for less than fair market value? If yes,
provide a detailed explanation, including the nature and amount of the
asset(s) transferred and the recipient of each transferred asset.
14. Are you currently employed outside the applicant firm? If yes, provide
[ ]Yes
[ ]No
information on this employment and evidence that the activity does not
conflict with the day-to-day management of the applicant business concern.
Please indicate the number of hours per week and the normal working hours of
this outside employment.
15. Identify which of the following presumed socially disadvantaged group(s) you are in (you should review
C.F.R. § 124.103(b) before answering):
Black American [ ] Hispanic American [ ] Native American [ ] Asian Pacific American [ ]
Subcontinent Asian Americans [ ] None of the above [ ] (If none of the above, follow instructions on
next page)
If Native American, identify whether Federally or state recognized Indian tribe and indicate tribal card
number:_______________________________________________________________________________
If you answered “none of the above” to question 15, you are not presumed to be socially
disadvantaged, and you must provide a narrative statement – and evidence – demonstrating
discriminatory treatment sufficient to meet the social disadvantage requirement. See 13 C.F.R. §
124.103 and the 8(a) BD website (see Internet address on page 1 of the Form 1010).
A narrative statement describing your economic disadvantage. See 13 C.F.R. §
124.104.
A completed SBA Form 413, “Personal Financial Statement,” no older than 30
days, for the individual claiming disadvantage and a separate SBA Form 413 for
SBA Form 1010-IND (03/11)
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his/her spouse, dividing all assets and liabilities as appropriate. If the
individual claiming disadvantage is married and lives in a community property
state, evidence of which assets and income are community property and which
are separate must be provided.
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
I have reviewed the responses to all questions on this form and all
supporting documents required by this form, and that all responses and
documents are true and complete to the best of my knowledge.
I understand that SBA is relying on this information in making its
determination of my company’s eligibility for the 8(a) BD Program.
I have not previously used my socially and economically disadvantaged
status to qualify another company for the 8(a) BD Program.
__________________
_________________
_________
Signature
Print Name
Date
PLEASE NOTE: The estimated burden for completing this form is 1 Hour per response. 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.
SBA Form 1010-IND (03/11)
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Download SBA Form 1010-IND 8(A) Business Development (Bd) Program Application Individual Information

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SBA Form 1010-IND Instructions

All of the data provided in the form must be accurate and complete. The SBA will rely on this information when determining the business's eligibility for 8(a) Program.

The form identifies every individual co-owner and requires answering fifteen questions on previous bankruptcies, SBA loans, criminal charges and convictions and past 8(a) Program participation.

Every individual filing the SBA Form 1010-IND must provide the following paperwork with the completed form:

  1. A personal resume that covers all received education, training and employment experience. The resume must include the names of previous employers, the nature of employment and dates of employment along with the current duties within the business of the applicant applying for the 8(a) Program.
  2. Signed and dated copies of the individual's personal Federal income tax returns for the two years preceding the application.
  3. Signed and dated copies of a spouse's personal Federal income tax returns for the two years preceding the application.
  4. A signed and dated copy of the IRS form 4506-T (Request for Transcript of Tax Return) for the individual and their spouse
  5. A completed SBA Form 912 (Statement of Personal History) with Form FD-258 (Fingerprint Card) if questions 7, 8, and 9 on the SBA Form 912 have positive answers.

SBA Form 1010-IND Related Publications

  1. SBA Form 1010-ANC, 8(a) Business Development (BD) Program Application Alaskan Native Corporation-Owned Concern is a form filed by representatives of Alaskan Native Corporation-owned business applying for the 8(a) Program with the SBA.
  2. SBA Form 1010-NHO, 8(a) Business Development (BD) Program Application Native Hawaiian Organization-Owned Concern is a form completed by representatives of Native Hawaiian Organizations that own the businesses of 8(a) Program applicants.
  3. 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 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 the 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 SBA of the compensation paid for assistance with an 8(a) initial application.

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