SBA Form 1010-NHO 8(A) Business Development (Bd) Program Application Native Hawaiian Organization-Owned Concern

What Is SBA Form 1010-NHO?

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) Business Development Program applicants.

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

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OMB Approval No. 3245-0331
Expiration Date: 02/29/2020
Native Hawaiian Organization Information
The Native Hawaiian Organization that owns the applicant business concern
must complete this form. 13 C.F.R. § 124.110.
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 Native Hawaiian Organization (NHO):
_________________________________________
Note: An NHO means any community
service organization serving Native Hawaiians in the State of Hawaii which is a non-profit
corporation that has filed articles of incorporation with the Director (or the designee thereof) of
the Hawaii Department of Commerce and Consumer Affairs, or any successor agency, is
controlled by Native Hawaiians, and whose business activities will principally benefit such
Native Hawaiians. 15 U.S.C. § 637(a)(15).
Telephone: (
)____________________
Fax: (
)_________________________
Address:
_______________________________________________________________________
City: ___________________ County: _____________ State: ______________ Zip: _____
E-mail: __________________________________________ @ _____________
Mailing Address (if different from above)
Address:
_____________________________________________________________________
City: _____________________ State: ______________ Zip: ____________
NHO percent ownership of applicant business concern: ___________
Provide the following information on each NHO member, director, and officer
(Add additional pages if necessary)
Name
Position in
U.S. Citizen
Native
Economically
NHO
Hawaiian
Disadvantaged
(Y/N)
(Y/N)
(Y/N)
OMB Approval No. 3245-0331
Expiration Date: 02/29/2020
Native Hawaiian Organization Information
The Native Hawaiian Organization that owns the applicant business concern
must complete this form. 13 C.F.R. § 124.110.
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 Native Hawaiian Organization (NHO):
_________________________________________
Note: An NHO means any community
service organization serving Native Hawaiians in the State of Hawaii which is a non-profit
corporation that has filed articles of incorporation with the Director (or the designee thereof) of
the Hawaii Department of Commerce and Consumer Affairs, or any successor agency, is
controlled by Native Hawaiians, and whose business activities will principally benefit such
Native Hawaiians. 15 U.S.C. § 637(a)(15).
Telephone: (
)____________________
Fax: (
)_________________________
Address:
_______________________________________________________________________
City: ___________________ County: _____________ State: ______________ Zip: _____
E-mail: __________________________________________ @ _____________
Mailing Address (if different from above)
Address:
_____________________________________________________________________
City: _____________________ State: ______________ Zip: ____________
NHO percent ownership of applicant business concern: ___________
Provide the following information on each NHO member, director, and officer
(Add additional pages if necessary)
Name
Position in
U.S. Citizen
Native
Economically
NHO
Hawaiian
Disadvantaged
(Y/N)
(Y/N)
(Y/N)
Please answer the following questions and provide the required documents:
1. Does the NHO or subsidiary of the NHO own 50% or more of another
[ ]Yes
[ ]No
business other than the applicant business? If yes, identify the names of
any other business concern(s), the percentage of the NHO’s ownership,
the names of the individuals who manage and control it by serving as
officers, directors, or managers, 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.
2. Has the NHO ever been an owner, stockholder or guarantor for a concern
which has received an SBA loan?
[ ]Yes
[ ]No
Please provide the following documents:
The NHO’s directors, members, officers, key managers, individuals claiming disadvantaged
status, and any hired manager(s) with authority to speak for and commit the NHO must
complete and submit the Individual Information form (See Form 1010-IND).
NHO’s Balance sheet and profit and loss statement for the preceding three (3) fiscal year-end
periods. These should be signed, certified, and dated by the NHO’s highest managing
individual.
Copy of the NHO’s corporate bylaws.
Signed copies of the NHO’s Federal tax returns, including all schedules, filed for the past
three years, if applicable.
Copy of the birth certificates of those NHO members/directors who claim to be Native
Hawaiian.
Documentation which demonstrates the legal status of the NHO, including the pertinent
documentation filed with the State of Hawaii’s Department of Commerce and Consumer
Affairs.
Copies of all minutes of NHO board of directors meetings and all resolutions of the board of
directors for the past two years.
Copies of all minutes of NHO members meetings showing the election of directors.
Documentation showing the NHO’s ownership of the applicant business concern.
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 NHO’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-NHO (3/11)

Download SBA Form 1010-NHO 8(A) Business Development (Bd) Program Application Native Hawaiian Organization-Owned Concern

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SBA Form 1010-NHO Instructions

The form requires identifying the 8(a) Program applicant and the Parent Native Hawaiian Organization (NHO) and attaching the required documents and forms. The NHO representative filing the SBA Form 1010-NHO must provide the following paperwork along with the completed form:

  1. Separate SBA Form 1010-IND (8(a) Business Development (BD) Program Application Individual Information) must be filed by all directors, members, officers and managers of the NHO and submitted with the application.
  2. The NHO's signed, dated, and certified profit and loss statement and balance sheet for the three previous fiscal year-end periods.
  3. A copy of the corporate bylaws.
  4. Signed copies of the organization's Federal tax returns filed for the past three years.
  5. Copies of the Native Hawaiian NHO members' birth certificates.
  6. Copies of all minutes of NHO board of directors meetings and meetings showing the election of directors of the board.
  7. Paperwork that demonstrates the NHO's legal status and it's ownership of the applicant's business.

The representative must then sign the completed form certifying that all information provided in the application and the supporting documents are complete and true.

SBA Form 1010-NHO Related Publications

  1. SBA Form 1010B-ANC, 8(a) Business Development (BD) Program Application Alaskan Native Corporation-Owned Concern is a form filed by a representative of an Alaskan Native Corporation-owned business applying to participate in the 8(a) Business Development Program.
  2. SBA Form 1010B-AIT 8(a) Business Development (BD) Program Application American Indian - Tribally-Owned Concern is a form completed a small business owned by American Indian Tribes applying for the 8(a) Business Development Program.
  3. SBA Form 1010B-IND, 8(a) Business Development (BD) Program Application Individual Information is a form filled out by each individual owning more than 10% of a business applying for the 8(a) Program.
  4. SBA Form 1010B-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) Business Development 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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