(revised 05/11/11) 

Application Instructions

Applying to participate in the Small Business Lending Fund is easy.

To determine if your institution is eligible to participate in the Small Business Lending Fund (SBLF), please review the 

applicable eligibility criteria outlined in the following term sheets1

, which can be found at www.treasury.gov/SBLF: 

• C Corporation (apply under “Senior Preferred Stock” terms)

• C Corporation CPP or CDCI Refinance (apply under “Senior Preferred Stock terms for CPP and CDCI Participants”) 

• Subchapter S Corporation (apply under “Subchapter S Corporation Senior Securities” terms)

• Mutual Institution (apply under “Mutual Institution Senior Securities” terms)

• Mutual Holding Company with Mid-Tier Stock Holding Company (apply under “Senior Preferred Stock” terms)

• Mutual Holding Company without Mid-Tier Stock Holding Company (apply under “Mutual Institution Senior 

Securities” terms) 

If your institution is eligible and wants to apply, it must submit a completed version of the attached application to the 

U.S. Department of the Treasury (Treasury) via email at SBLFApps@treasury.gov. The application deadlines are as follows:

• C Corporation banks – May 16, 2011 

• Subchapter S Corporations and Mutual Institutions – June 6, 2011

Treasury encourages eligible institutions to submit their application as soon as possible to allow sufficient time for 

processing. 

Your institution must also submit a small business lending plan to its primary federal regulator and to its state regulator, if 

applicable. If the institution is a holding company, the institution must also submit the lending plan to the primary federal 

regulator (and state regulator, if applicable) of each of its insured depository institution subsidiaries.

The lending plan should not be sent directly to Treasury. (Your institution’s regulator will forward the plan to Treasury.) 

Guidance and a form for an applicant's lending plan can be found at www.treasury.gov/SBLF. 

If you have general questions about the application process, please call the Small Business Lending Fund information line at 

888-832-1147 (Monday-Friday, 9:00 AM-7:00 PM ET).

For communications pertaining to a specific institution, please email SBLFInstitutions@treasury.gov, a Treasury email 

address.

 

1 Note: If you are an eligible CDLF looking to apply for SBLF funding, please see the separate terms and application posted on the 

SBLF website. 
 

Treasury Department Form: TD F 102.1 (revised 05/11/11) OMB Number: 1505-0228

Application

This application is for eligible institutions that are insured depository institutions or holding companies.

Name of Institution: _______________________________________________________ 

If the institution is a subsidiary of a bank holding company or of a savings and loan holding company, the holding company must apply.

FDIC Certificate Number, OTS Docket Number, or Federal Reserve RSSD Number: ___________________________ 

Address: ________________________________________________________________ 

City: _________________________ State: ______________________ Zip Code: ____________

Primary Contact Name: ____________________________________________________ 

Primary Contact Telephone: ________________________ Primary Contact Email: ____________________________ 

Asset Size: $________________ (round to nearest thousand)

Asset size is the amount of total assets reported in the applicant’s Call Report as of the end of the fourth quarter of calendar year 2009. If the applicant is a 

holding company, the question applies to the applicant’s total consolidated assets. Institutions and holding companies with assets of $10 billion or greater 

are not eligible to participate in the Small Business Lending Fund. 

Requested Investment Amount: $ ____________________________________________ 

The range of permissible amounts depends in part on whether the applicant’s asset size is greater than $1 billion.

Corporate Structure:

___ C Corporation (apply under “Senior Preferred Stock” terms)

___ C Corporation CPP or CDCI Refinance (apply under “Senior Preferred Stock terms for CPP and CDCI Participants”) 

___ Subchapter S Corporation (apply under “Subchapter S Corporation Senior Securities” terms)

___ Mutual Institution (apply under “Mutual Institution Senior Securities” terms)

___ Mutual Holding Company with Mid-Tier Stock Holding Company (apply under “Senior Preferred Stock” terms)

___ Mutual Holding Company without Mid-Tier Stock Holding Company (apply under “Mutual Institution Senior 

Securities” terms) 

CPP/CDCI Refinance? ___ Yes ___ No If yes, list outstanding CPP/CDCI balance $___________________

Answer yes if the applicant will refinance an existing Capital Purchase Program or Community Development Capital Initiative investment with the SBLF funding. 

If yes, specify the outstanding CPP/CDCI balance as of the date of this application.

Primary Federal Regulator of Insured Depository: ___ FDIC ___ OCC ___ OTS ___ Federal Reserve

If there are multiple insured depository institutions, please note all of the applicable primary federal and state regulators.

Is Applicant a Holding Company? ___ Yes ___ No

 If yes, specify holding company regulator: ___ Federal Reserve ___ OTS

Is the Insured Depository State Chartered? ___ Yes ___ No If yes, by which state? ____________________

Small Business Lending Plan Sent to Regulator(s) ___ Yes ___ No

Guidance and a form for an applicant's small business lending plan can be found at www.treasury.gov/SBLF. 

Signature of Authorized Official: _____________________________________________ 

Name of Authorized Official: ________________________________________________ 

Title of Authorized Official: _________________________________________________ 

Date: ___________________________________________________________________