Laserfiche WebLink
U.S. SMALL BUSINESS ADMINISTRATION OMB Approval No.. 3245-0125 <br /> Expiration Date: 8/31/92 <br /> CANDIDATE FOR <br /> (NATIONAUREGIONAUADVISORY COUNCIL); (SMALL BUSINESS PERSON OF THE YEAR) 111 <br /> SOCIAL SECURITY NO. <br /> NAME: <br /> (First) (Middle/Initial) (Last) <br /> POSITION NAME AND ADDRESS OF BUSINESS OR EMPLOYER: <br /> TYPE OF BUSINESS: PHONE: <br /> INDICATE PREVIOUS OR PRESENT FINANCIAL(INCLUDING DEVELOPMENT COMPANY),SURETY BONDS, OR CONTRACTUAL <br /> ASSISTANCE WITH SBA, FIVE APPROXIMATE DATES AND TYPE OF ASSISTANCE. <br /> HOME ADDRESS: <br /> (Please include post office and zip) <br /> SERVICE ON FEDERAL BOARDS, COUNCILS OR COMMISSIONS • <br /> (INDICATE PREVIOUS OR PRESENT): <br /> IF EMPLOYED BY A STATE GOVERNMENT, IS IT AN ELECTIVE POSITION? <br /> Yes No NA <br /> ARE YOU ON A FEDERAL PAYROLL? Yes No <br /> PLACE OF BIRTH: BIRTHDATE: <br /> CONGRESSIONAL DISTRICT: <br /> The authority to obtain this Information is contained in 5 U.S.0 301, 15 U.S C.634(b),44 U.S.0,3101 Routine uses of the information are <br /> Tn respond to a request from a member of Congress regarding information about an Advisory Council member. <br /> To disclose information about an Advisory Council member to general public. <br /> To respond to requests from the General Services Administration. <br /> Date: <br /> (Signature) <br /> (This must be signed as a condition of the appointment.) <br /> !_EASE NOTE Tne estimates ourden hours for the completion of SBA Form 898 is 8 minutes per response If you have any questions or comments • <br /> concerning this estimate or any otner aspect of this information collection please,contact William Cline.Chief Administrative Information Branch, S <br /> Small Business Adm nistrat or 1441 L St N W Washington,D C.20416 and Gary Waxman,Clearance Officer,Paperwork Reduction Project(3245-0125), <br /> Office of Manauement and Budget,Wasn ngton,D C.20503 <br /> SBA =•:SPT 1 898(S-89i PEE,SOP 90 54 3 PREVIOUS EDITIONS ARE OBSOLETE <br />