OMB Control # 1505-0227 1

State Small Business Credit Initiative (SSBCI) Investing in America Small Business 

Opportunity Program (SBOP) Applicant Assurances

Department of the Treasury

On behalf of the applicant, and in support of this application for financial assistance, I certify 

under penalty of perjury to the U.S. Department of the Treasury (Treasury), that all of the 

following are true and correct: 

(1) I have the authority to make the following representations on behalf of myself and the 

applicant. I understand that these representations will be relied upon as material in any Treasury 

decision to make an award to the applicant based on its application. 

(2) The applicant has the legal authority to apply for the federal assistance sought by the 

application, and it has the institutional, managerial, and financial capability (including funds 

sufficient to pay any voluntary non-federal cost share of project costs) to plan, manage, and 

complete the project described in the application properly. 

(3) Throughout the period of performance for the award if made by Treasury based on the 

application—

a. the applicant will comply with all award requirements, federal statutes, Executive Orders, 

and regulations applicable to the award;

b. the applicant will require all subrecipients to comply with all applicable award 

requirements and federal statutes and regulations; and 

c. the applicant will maintain safeguards to address and prevent any organizational conflict 

of interest, and also to prohibit employees from using their positions in any manner that 

poses, or appears to pose, a personal or financial conflict of interest. 

(4) For any award resulting from this application:

a. the applicant has procedures in place for procuring property and services under this 

award that are consistent with the procurement standards that apply to federal grants. The 

applicant will not request funds under this award for any contract unless this certification 

remains true and accurate. 

b. pursuant to 2 CFR § 200.303, the applicant will establish and maintain effective internal 

control over all award agreements resulting from this application, and provide reasonable 

assurance that the applicant will manage the award in compliance with Federal statutes, 

regulations, and the terms and conditions of the award. The applicant knows of no 

material deficiencies in its internal controls. 

c. the applicant has a conflict of interest policy consistent with 2 CFR § 200.318(c) in effect 

and that covers each activity for which it seeks funding under this grant. 

(5) The applicant will give Treasury, Treasury designee, Treasury Office of Inspector General,

and the Government Accountability Office through any authorized representative, access to, and 

opportunity to examine, all paper or electronic records related to the award made by Treasury

based on the application pursuant to 2 CFR § 200.337(a).

(6) If awarded by Treasury based on the application, the applicant will—
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a. comply with the requirements of the Uniform Relocation Assistance and Real Property 

Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655), which govern the treatment of 

persons displaced as a result of federal and federally-assisted programs; and 

b. comply, as applicable with requirements of the Hatch Act (5 U.S.C. §§ 1501-1508 and 

7324-7328), which limit certain political activities of State or local government 

employees whose principal employment is in connection with an activity financed in 

whole or in part by federal assistance. 

(7) The applicant, as applicable, will perform the required financial and compliance audits in 

accordance with the Single Audit Act Amendments of 1996 (31 U.S.C. § 7501 et seq.) and 

2 CFR Part 200, Subpart F (Audit Requirements). 

(8) The applicant will comply with all applicable requirements of all other Federal laws, 

Executive Orders, regulations, and policies governing the SSBCI Investing in America SBOP.

I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or 

omission of a material fact) in this certification, or in the application that it supports, may be the 

subject of criminal prosecution and also may subject me and the applicant to civil penalties and 

administrative remedies for false claims or otherwise. 

Signature of SSBCI Investing in America SBOP Authorized Official: 

_________________________________________________________

Name: Date: 

Title: Name of Applicant: 

PAPERWORK REDUCTION ACT NOTICE

The information collections discussed in this application will be submitted to the Office of 

Management and Budget (OMB) under OMB control number 1505-0227 in accordance 

with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35). OMB approval for this 

information collection is forthcoming and the information will be collected following OMB 

approval. This document will be updated to reflect that approval.

The information collected in this application will be used by the U.S. Department of the Treasury to 

determine whether to approve an applicant for grant funding under the SSBCI Investing in America 

SBOP. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of 

information unless it displays a valid control number assigned by the Office of Management and Budget 

(OMB). The estimated burden associated with this collection of information is 6 hours per response. 

Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden 

should be directed to the Office of Privacy, Transparency, and Records, U.S. Department of the Treasury, 
OMB Control # 1505-0227 3

1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send this application form to this 

address.

PRIVACY ACT STATEMENT

The Privacy Act of 1974 (Privacy Act) protects certain information that the federal government has about 

“individuals” (United States citizens and lawfully admitted permanent residents). The Privacy Act does not 

generally apply to businesses, but some federal courts have found that this law applies to sole proprietors (they are 

deemed “individuals” under the Privacy Act).

AUTHORITY: Small Business Jobs Act of 2010 (SBJA), Title III, 12 U.S.C. § 5701 et seq., as amended by the 

American Rescue Plan Act of 2021 (ARPA), section 3301.

PURPOSE: This information is being collected and maintained by Treasury so that it can review and make funding 

decisions regarding applications submitted for grant funding under the SSBCI Investing in America SBOP 

established under the SBJA, as amended by ARPA, and communicate with applicant contacts, and otherwise carry 

out the program.

ROUTINE USE: The information you furnish may be shared in accordance with the routine uses outlined in 

Treasury .013, Department of the Treasury Civil Rights Complaints, Compliance Reviews, and Fairness in Federal 

Programs Files System of Records Notice (SORN); Treasury .015, General Information Technology Access 

Account Records, 85 Fed. Reg. 73353; and Treasury .017, Correspondence and Contact Information, 81 Fed. Reg. 

78266. For example, one routine use under Treasury .017 allows the disclosure of information to international, 

federal, state, local, tribal, or private entities for the purpose of the regular exchange of business contact information 

in order to facilitate collaboration for official business. More information about this and other routine uses can be 

found in the System of Records Notices (SORNs) listed above, which are posted on Treasury’s website.

DISCLOSURE: Providing this information is voluntary. However, failure to furnish the requested information may 

result in the denial of your application.