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Please note that this document is not the application and can be used as a reference for 

planning purposes. An online application portal is forthcoming.

PROGRAM OVERVIEW INTRO PAGE 

On March 11, 2021, President Biden signed into law the American Rescue Plan Act of 2021, 

which provided $10 billion to fund the State Small Business Credit Initiative (SSBCI). Through 

SSBCI, Treasury will provide funds to states, the District of Columbia, territories, and Tribal 

governments for small business credit support and investment programs. 

This program builds on the initial version of the SSBCI, which was developed in 2011 and under 

which nearly $1.5 billion in capital supported over $8 billion in new lending and investment

activity across 142 different programs in its first five years. 

For more info on SSBCI, visit 

https://home.treasury.gov/policy-issues/small-business-programs/state-small-business-creditinitiative-ssbci.

PRELIMINARY ELIGIBILITY 

Please populate the information below to determine if you are eligible to submit a capital 

program application for the SSBCI program administered by the U.S. Department of the 

Treasury (Treasury).

If you are a Tribal government submitting a joint application, only one application is required.

You must identify one eligible Tribal government in your application in the section below in 

order to proceed. You may list the additional Tribal governments associated with your 

Application in Section 4: Application Overview.

• Applicant Type: [dropdown of State; Tribal Government; Territory; the District of

Columbia]

• Applicant Name: [dropdown of all eligible states, Tribal governments, the District of

Columbia, and territories depending on applicant type]

o Has an electronic Notice of Intent (NOI) been submitted via Treasury’s

website on or before the applicable deadline on behalf of the Applicant?

[Y/N] If No, show “If an NOI has not been submitted and you are a Tribal

government,, please complete a Tribal government NOI by December 11 at 11:59

ET, 2021 <link> or contact the SSBCI program at

ssbci_information@treasury.gov to inquire. Please use the subject line NOI

INQUIRY – [INSERT APPLICANT NAME].”

• What is the Unique Identifier (ID) associated with the submitted NOI? [Lookup field

for Applicant to enter ID]

• According to our records, the NOI ID you have entered is associated with the

following jurisdiction. [Will show name associated with NOI ID]
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• Please confirm this is the state, territory, the District of Columbia, or Tribal 

government you intend to apply on behalf of. [Y/N] 

o If No, show “If an NOI has not been submitted or you are unsure, please contact 

the SSBCI program at ssbci_information@treasury.gov to inquire. Please use the 

subject line NOI INQUIRY – [INSERT APPLICANT NAME].”
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SECTION 1: USER INSTRUCTIONS

Welcome to the U.S. Department of the Treasury’s Application Submission Portal for the State 

Small Business Credit Initiative (SSBCI). Based on the limited information you have entered on 

the previous tab, you have been determined to be potentially eligible for this program. For your 

application to be evaluated by Treasury, please follow the instructions below.

OMB Control Number 1505-0227

PAPERWORK REDUCTION ACT NOTICE

The information collected in this application will be used by the U.S. Government to process 

requests for approval. 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 

OMB. The estimated burden associated with this collection of information is 5 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, 1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO 

NOT send this application form to this address.

The SSBCI application consists of the following 10 sections:

1. User Instructions

2. Application Documents

3. Definitions of Terms

4. Application Overview

5. Entity Information

6. Awardable Amount

7. Program Overview

8. Program Details

9. Compliance & Oversight

10. Application Certification

Sections 1 through 3 provide instructions and background information. 

Sections 4 through 9 include questions to answer or fields to populate. Please answer each 

question or enter information in each field in accordance with the instructions in the section. As 

you progress through the application, you will also be required to upload certain documents – for 

a complete list, see section 2 titled “Application Documents.”

As indicated in the Notice Regarding Applications for State Small Business Credit Initiative on 

September 27, 2021 on Treasury’s website, applications for SSBCI capital programs must be 

initiated by December 11, 2021. This “Initiated Application” is defined as the sections listed 

below and requires applicants to complete and submit the sections by December 11, 2021 at 

11:59 p.m. ET.

1. Section 4.1: Applicant Overview

2. Section 4.1A: Joint Application (if applicable)
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3. Section 4.2: Application Contacts

4. Section 5.1: Implementing Entity

5. Section 5.2: Authorized Official

6. Section 6.1: Applicant Awardable Amount: Statement on Legal Actions

7. Section 7.1: Program Overview

The Initiated Application is not considered complete until you have clicked the “Submit Initiated 

Application” button in Section 10: Application Certification.

All remaining sections, also referred to as the “Full Application,” of the capital program 

application are due by February 11 at 11:59 p.m. ET, 2022. Applicants may also amend their 

submitted “Initiated Application” from December 12, 2021, to February 11 at 11:59 p.m. ET, 

2022.

There is a separate application for technical assistance funding. Please see Treasury’s website for 

more information.

After completing a section, you must click the NEXT button at the bottom right corner of the 

screen to save your responses and advance to the next section. 

At any time, you may also click the SAVE button on the bottom right corner of the screen to 

save an application in progress. Once an Initiated or Full application in progress is saved, you 

may return to it later to amend or complete your Application.

The last section “Certification and Signature” will require an Authorized Official of your 

implementing entity to certify and electronically sign the application using a DocuSign electronic 

signature. After you finish filling out the application, an email with a DocuSign link will be sent 

to the email address of the Authorized Official you identify in Section 5.2 allowing them to 

electronically sign and submit the application. Your application is not complete until the 

Authorized Official has certified and submitted the application. Please be sure to monitor the 

email address identified in Section 5.2 during the submission process.

After the application is completed, electronically signed, and submitted successfully, the primary 

and secondary contacts identified in Section 4.2 will receive an automated confirmation email 

from Treasury.

If you have any additional questions, please contact ssbci_information@treasury.gov. 

For additional information on SSBCI, please see the SSBCI homepage. 

SECTION 2: APPLICATION DOCUMENTS

To complete the application, you will need to upload the following documents. If you do not 

upload the following documents, your application will not be considered complete and cannot be 

processed. Documents with an asterisk (*) indicate those that may be optional based on applicant 
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circumstances. Descriptions and examples can be found within the application and templates. It 

is the responsibility of the applicant to upload documents where required throughout the 

application. Please refer to the instructions within the application for guidance on what these 

documents should entail. Links to templates are provided below for download as well as

throughout the application in the sections that the documents are required.

• 1 – Implementing Entity Letter of Designation

• 2 – Joint Application Delegation Documentation*

• 3 – Delegation of Authority*

• 4 – Statement on Legal Actions

• 5 – Underserved Narrative

• 6 – Swap Facility Commitment Letter or Narrative*

• 7 – Enrolled Loan Data Table* Click here to download template

• 8 – OCSP Program Information* Click here to download template

• 9 – OCSP Additional Considerations * Click here to download template

• 10 – OCSP Independent Financial Audit or Program Financial Statements*

• 11 – Leverage Ratio Data Table(s) Click here to download template

• 12 – Compliance and Oversight Narrative Click here to download template

• 13 – Assurances of Compliance with Civil Rights Requirements* Click here to download

template

SECTION 3: DEFINITIONS OF TERMS

The terms defined below are used in various parts of the application. These definitions 

supplement and interpret certain terms in the American Rescue Plan Act of 2021 (Public Law 

No. 117-2). Please take time to review these definitions and refer to this section as necessary to 

complete your application fully and accurately.

• APPLICANT

o The term “applicant” means:

▪ a State of the United States;

▪ the District of Columbia, the Commonwealth of Puerto Rico,

the Commonwealth of Northern Mariana Islands, Guam,

American Samoa, and the United States Virgin Islands;

▪ when designated by a State of the United States, a political

subdivision of that State that the Secretary determines has the

capacity to participate in the Program;

▪ under the circumstances described in section 3004(d) of the

Small Business Jobs Act of 2010, as amended by the American

Rescue Plan Act of 2021 (SBJA) (12 U.S.C. § 5703(d)), a

municipality of a State of the United States to which the

Secretary has given a special permission under section 3004(d)

(12 U.S.C. § 5703(d)); and
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▪ a Tribal government, or a group of Tribal governments that 

jointly apply for an allocation.

• ENROLLED LOAN

o The term “enrolled loan” means a loan made by a financial institution lender 

that is enrolled by a participating jurisdiction in an approved capital access 

program in accordance with this title.

• FEDERAL CONTRIBUTION

o The term “Federal contribution” means the portion of the contribution made 

by a participating jurisdiction to, or for the account of, an approved program 

that is made with Federal funds allocated to the jurisdiction by the Secretary 

under section 3003 of the SBJA (12 U.S.C. § 5702).

• FINANCIAL INSTITUTION

o The term “financial institution” means any insured depository institution, 

insured credit union, or community development financial institution, as those 

terms are each defined in section 103 of the Riegle Community Development 

and Regulatory Improvement Act of 1994 (12 U.S.C. 4702).

• PARTICIPATING JURISDICTION

o The term “participating jurisdiction” means any jurisdiction that has been 

approved for participation in the Program under section 3004 of the SBJA (12 

U.S.C. § 5703).

• PROGRAM

o The term “Program” means the State Small Business Credit Initiative 

established under this title.

• QUALIFYING LOAN OR SWAP FUNDING FACILITY

o The term “qualifying loan or swap funding facility” means a contractual 

arrangement between a participating jurisdiction and a private financial entity 

under which --

▪ the participating jurisdiction delivers funds to the entity as collateral;

▪ the entity provides funding from the arrangement back to the 

participating jurisdiction; and

▪ the full amount of resulting funding from the arrangement, less any 

fees and other costs of the arrangement, is contributed to, or for the 

account of, an approved program.

• RESERVE FUND

o The term “reserve fund” means a fund, established by a participating 

jurisdiction, dedicated to a particular financial institution lender, for the 

purposes of --

▪ depositing all required premium charges paid by the financial 

institution lender and by each borrower receiving a loan under 

an approved program from that financial institution lender;

▪ depositing contributions made by the participating jurisdiction

including contributions made with Federal contributions; and
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▪ covering losses on enrolled loans by disbursing accumulated 

funds

• Jurisdiction

o The term “Jurisdiction” means --

▪ a State of the United States;

▪ the District of Columbia, the Commonwealth of Puerto Rico, 

the Commonwealth of Northern Mariana Islands, Guam, 

American Samoa, and the United States Virgin Islands;

▪ when designated by a State of the United States, a political 

subdivision of that State that the Secretary determines has the 

capacity to participate in the Program;

▪ under the circumstances described in section 3004(d) of the 

SBJA (12 U.S.C. § 5703(d)), a municipality of a State of the 

United States to which the Secretary has given a special 

permission under section 3004(d) (12 U.S.C. § 5703(d)); and

▪ a Tribal government, or a group of Tribal governments that 

jointly apply for an allocation.

• CAPITAL ACCESS PROGRAM (CAP)

o The term “capital access program” means a program of that --

▪ uses public resources to promote private access to credit; and

▪ meets the eligibility criteria in section 3005(c) of the SBJA (12 

U.S.C. § 5704(c)).

• OTHER CREDIT SUPPORT PROGRAM (OCSP)

o The term “other credit support program”

▪ means a program that --

• uses public resources to promote private access to credit;

• is not a capital access program; and

• meets the eligibility criteria in section 3006(c) of the SBJA

(12 U.S.C. § 5705(c)); 

▪ includes, collateral support programs, loan participation programs, 

venture capital fund programs, and credit guarantee programs.

• SECRETARY- The term “Secretary” means the Secretary of the Treasury.

• MEET THE NEEDS OF BUSINESS ENTERPRISES OWNED AND 

CONTROLLED BY SOCIALLY AND ECONOMICALLY DISADVANTAGED 

INDIVIDUALS (SEDI-OWNED BUSINESSES)

o The term “meet the needs of SEDI-owned businesses” means that the 

SSBCI funds are expended for:

▪ business enterprises which certify that they are owned and 

controlled by individuals that have had their access to credit on 

reasonable terms diminished as compared to others in comparable 

economic circumstances, due to their (1) membership of a group 

that has been subjected to racial or ethnic prejudice or cultural bias 

within American society, (2) gender, (3) veteran status, (4) limited 
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English proficiency, (5) physical handicap, (6) long-term residence 

in an environment isolated from the mainstream of American 

society, (7) membership of a federally or state recognized Indian 

Tribe, (8) long-term residence in a rural community, (9) residence in 

a U.S. territory, (10) residence in a community undergoing 

economic transitions (including communities impacted by the shift 

towards a net-zero economy or deindustrialization), or (11) 

membership of another “underserved community” as defined in 

Executive Order 13985; 

▪ business enterprises which certify that they are owned and 

controlled by individuals whose residences are in CDFI Investment 

Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii);

▪ business enterprises which certify that they will operate a location in 

a CDFI Investment Area, as defined in 12 C.F.R. § 

1805.201(b)(3)(ii); or

▪ business enterprises that are located in CDFI Investment Areas, as 

defined in 12 C.F.R. § 1805.201(b)(3)(ii). 

• The CDFI Fund evaluates Puerto Rico, but not other territories, in identifying CDFI 

Investment Areas. For purposes of the SSBCI, Treasury has also evaluated American 

Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands and has 

determined that these territories in their entirety constitute CDFI Investment Areas, 

because each of these territories has a poverty rate of at least 20 percent. See 12 

C.F.R. § 1805.201(b)(3)(ii)(D)(1).COMMUNITY DEVELOPMENT FINANCIAL 

INSTITUTION (CDFI)

o The term “community development financial institution” or “CDFI” has the 

meaning given that term under section 103 of the Riegle Community 

Development and Regulatory Improvement Act of 1994.

• TRIBAL GOVERNMENT

o The term “Tribal government” means the recognized governing body of any 

Indian or Alaska Native tribe, band, nation, pueblo, village, community, 

component band, or component reservation, individually identified (including 

parenthetically) in the list published most recently as of March 11, 2021,

pursuant to section 104 of the Federally Recognized Indian Tribe List Act of 

1994 (25 U.S.C. 5131).

SECTION 4: APPLICATION OVERVIEW

SECTION 4.1: APPLICANT OVERVIEW

The following information has been pre-populated based on the information you entered in the 

Preliminary Eligibility page.

• Applicant Type: [pre-populated]

• Applicant Name: [pre-populated]
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(IF Applicant Type <> Tribal government, go to section 4.2) 

For SSBCI funds allocated to Tribal governments, in-state transactions include the following:

• Transactions with businesses on Tribal lands.

• Transactions with businesses in states where the Tribe is physically located or within 

which the Tribe exercises jurisdiction. For example, a Tribe located in Montana with 

Treaty rights in Wyoming can include Montana and Wyoming as “in-state” jurisdictions. 

• Transactions with Tribal enterprise-operated businesses, businesses owned by Tribal 

members, and businesses in the states in which Tribal members reside. For example, an 

Arizona Tribe may have the bulk of its members in a town on the border of Nevada and 

Arizona. Because the Tribe is exercising jurisdiction over its members in both states, it 

may invest in both states. 

Tribal SSBCI program transactions that do not fall into the above categories constitute out-ofstate investments, loans, or other credit or equity support. Please select which state(s) the 

Tribal government or multiple Tribal governments (if submitting a joint application) in 

which in-state transactions, as specified above, will take place. [dropdown of all states]

Eligible Tribal governments may submit a joint application. 

• Is this a joint application on behalf of multiple Tribal governments? [Y/N]

(IF YES ABOVE) go to SECTION 4.1A: JOINT APPLICATION

SECTION 4.1A: JOINT APPLICATION

You have indicated that you are submitting a joint application on behalf of multiple Tribal 

governments. If this is not correct, please revisit the prior question. If this is correct, please 

populate the following information for each Tribal government you are submitting on behalf of.

In Section 5.2, you will be asked to populate the contact information for the Authorized Official 

responsible for making decisions on behalf of multiple Tribal governments regarding this joint 

application. 

• Applicant Name: [dropdown of eligible Tribal governments]

• Applicant DUNS Number: [9-digit numeric field – reject if alpha or less than 9 digits] 

• Applicant TIN/EIN: [9-digit numeric field – reject if alpha or less than 9 digits]

After you have populated the requested information, select “Create Another Entity” button to 

save information for the current entity and populate information for additional entities.

• Co-Applicant: [dropdown of eligible Tribal governments]

• Did this Co-Applicant submit a separate NOI from the NOI entered in the Eligibility 

page? [Y/N]
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o If Yes, What is the Unique Identifier (ID) associated with the Co-Applicant’s 

submitted NOI? [Lookup field for Applicant to enter ID]

• Co-Applicant DUNS Number: [9-digit numeric field – reject if alpha or less than 9 digits] 

• Co-Applicant TIN/EIN: [9-digit numeric field – reject if alpha or less than 9 digits]

SECTION 4.2: APPLICATION CONTACTS

Please enter information for the primary and secondary contacts who will be notified regarding 

this application. These contacts will be contacted with any status updates for this application. 

These contacts may or may not have authorizing authority and thus, may or may not be the same 

individuals identified in Sections 5.2 and 5.2A. You will be asked to provide program level 

contact information later in the application. 

• Primary First Name: [alphanumeric]

• Primary Last Name: [alphanumeric]

• Primary Title: [alphanumeric]

• Primary Email: [email format check]

• Primary Phone: [3-3-4 numeric]

• Secondary First Name: [alphanumeric]

• Secondary Last Name: [alphanumeric]

• Secondary Title: [alphanumeric]

• Secondary Email: [email format check]

• Secondary Phone: [3-3-4 numeric]

SECTION 4.2A: PERMISSION TO SHARE CONTACT INFORMATION

• Do you permit Treasury to share your application contacts’ information in Section 4.2

with other states, the District of Columbia, Tribal governments, and territories for 

program collaboration purposes? [Y/N]

SECTION 5: ENTITY INFORMATION

SECTION 5.1: IMPLEMENTING ENTITY

Please enter information below for each department, agency, or political subdivision that has 

been designated to implement program(s) described in this application. The term “agency” 

includes government corporations and other entities authorized or supervised by the jurisdiction; 

this would include, for example, Alaska Native Corporations. Once created and saved, the entity 

information will appear in the table below.

• Implementing Entity Name: [alphanumeric]

• Implementing Entity DUNS Number: [9-digit numeric field – reject if alpha or less than 9 

digits] 

• Implementing Entity TIN/EIN: [9-digit numeric field – reject if alpha or less than 9 digits]
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• Does the implementing entity have an active SAM.gov registration? [Y/N]

• Street Address 1: [alphanumeric field – reject P.O. Boxes]

• Street Address 2: [alphanumeric field – reject P.O. Boxes]

• City: [alpha field]

• State: [dropdown of eligible states & territories]

• Zip Code: [5-digit numeric field – reject if alpha or less than 5 digits]

• Zip Code +4: [4-digit numeric field] optional

<Section below will only be visible if Joint Application is not selected in Section 4.1>

Implementing Entity Letter of Designation: You are required to submit a letter of designation 

from the governor of the state or a governing official of the territory, the District of Columbia, or 

Tribal government. This letter must expressly state that the governor or governing official has 

designated the Implementing Entity named above to accept the SSBCI allocation behalf of the 

state, territory, the District of Columbia, or Tribal government; the entity designated above will 

implement and oversee the state, territory, the District of Columbia, or Tribal government’s

program(s), and has the legal authority to enter into an Allocation Agreement with Treasury.

<Section below will only be visible if Joint Application is selected in Section 4.1>

Joint Application Designation Documentation: Each Co-Applicant is required to submit 

Designation Documentation expressly stating that the governing officials of the Co-Applicant 

Tribal governments have designated the Implementing Entity named above and expressly state 

that the Implementing Entity has the authority to do the following on behalf of all CoApplicants:

• Submit complete and accurate information

• Certify the SSBCI Application

• Collect and distribute all documents and notifications associated with this joint

Application

• Receive and disburse SSBCI funds on behalf of its Co-Applicants, if approved

• Certify and submit an Allocation Agreement which commits each Co-Applicant to all of

the obligations and requirements associated with receiving SSBCI funds

• Comply with reporting requirements

The Designation Documentation must include Tribal resolutions or other actions taken by each 

participating Tribal government to delegate such authority to the Implementing Entity. You may either 

submit one letter of designation listing all eligible Tribal governments in your joint application or 

submit letters of designation for each eligible Tribal government within your application. 

Upload the Implementing Entity Letter of Designation or Designation Documentation below.
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SECTION 5.2: AUTHORIZED OFFICIAL

Please enter information for the official who is part of the Implementing Entity and authorized to 

sign and make decisions on behalf of the state, the District of Columbia, Tribal government, or 

territory regarding this application (Authorized Official). This individual will be asked to 

authorize the application using a DocuSign electronic signature at the completion of this 

application in Section 10. If you are submitting a joint application on behalf of multiple eligible 

Tribal governments, please populate the following information for the Authorized Official 

permitted to apply on behalf of all Co-Applicants.

• First Name: [alphanumeric]

• Last Name: [alphanumeric]

• Title: [alphanumeric]

• Email: [email format check]

• Phone: [3-3-4 numeric]

• Organization: [alphanumeric]

• Street Address 1: [alphanumeric field – reject P.O. Boxes]

• Street Address 2: [alphanumeric field – reject P.O. Boxes]

• City: [alpha field]

• State: [dropdown of eligible states & territories]

• Zip Code: [5-digit numeric field – reject if alpha or less than 5 digits]

• Zip Code +4: [4-digit numeric field] optional

• Has the Authorized Official in Section 5.2 delegated to an another official the authority 

to certify and electronically sign the application on their behalf? [Y/N]

(IF YES ABOVE) go to Section 5.2A: DELEGATION OF AUTHORITY

SECTION 5.2A: DELEGATION OF AUTHORITY

If the Authorized Official named in Section 5.2 has delegated the authority to another official to 

certify and electronically sign the application on their behalf, the Applicant must submit 

documentation to support the delegation of authority. You must include the name, title, 

signature, telephone number, and email address for each official who has been delegated 

authority to act on the Authorized Official’s behalf in ￼the Letter of Designation or Designation 

Documentation for the Implementing Entity. The delegation of authority documentation must 

include:

• The scope of the delegation including any specific signatory authority

• The name, title, telephone number, and email address for each official who has been 

delegated authority

• The effective date of the delegation or the period that the delegation is valid for
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• References to applicable laws and statutes of the state, the District of Columbia, Tribal 

government, or territory that permit the delegation of authority. 

Additional information on this delegation of authority may be uploaded here.

SECTION 5.3: CONTRACTED ENTITY

Please enter information below for each organization or entity that is not a department, agency, 

or political subdivision of the Applicant that will be responsible for administering one or more 

programs. Please populate all fields in the Contracted Entity section before proceeding to click 

on ‘Create Contracted Entity’ button.

• Contracted Entity Type: [picklist of: existing, approved program of another jurisdiction, 

the District of Columbia, Tribal government, or territory; For-profit entity authorized or 

supervised by the state, the District of Columbia, Tribal government, or territory; Not-forprofit entity authorized or supervised by the state, the District of Columbia, Tribal 

government, or territory; Quasi-Public Agency authorized or supervised by the state, the 

District of Columbia, Tribal government, or territory; Other authorized agent of the state, the 

District of Columbia, Tribal government, or territory]

• Contracted Entity Name: [alphanumeric]

• Contracted POC First Name: [alphanumeric]

• Contracted POC Last Name: [alphanumeric]

• Contracted POC Email: [email format check]

• Contracted POC Phone: [3-3-4 numeric]

• Street Address 1: [alphanumeric field – reject P.O. Boxes]

• Street Address 2: [alphanumeric field – reject P.O. Boxes]

• City: [alpha field]

• State: [dropdown of eligible states & territories]

• Zip Code: [5-digit numeric field – reject if alpha or less than 5 digits]

SECTION 6: AWARDABLE AMOUNT

SECTION 6.1: APPLICANT AWARDABLE AMOUNT

Please populate the following information as it pertains to the awardable amount(s) for the 

Applicant.

• Have all legal actions been taken pursuant to applicable laws of the state, the 

District of Columbia, Tribal government, or territory that are necessary to enable 

the designated Implementing Entity named in Section 5.1 to implement the 

Applicant program(s) described herein? [Y/N]
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Statement on Legal Actions: Please upload a narrative describing the necessary legal actions 

(such as legislative authorization) that have been taken or that need to be taken to enable the 

designated Implementing Entity to implement the applicant’s programs, as required under 12 

U.S.C. 5703(b)(2). This narrative should confirm that (1) the entity is legally capable to bind the 

state, the District of Columbia, Tribal government or group of Tribal governments, or territory to 

obligations with the Federal Government; and (2) the legal mechanisms are in place for the state, 

the District of Columbia, Tribal government or group of Tribal governments, or territory to 

accept the transfer of SSBCI funds and Treasury to deliver funds to the Implementing Entity 

designated in Section 5.1. If any actions are still necessary to enable the entity to implement the 

applicant’s proposed program(s) (such as legislative approval, if applicable), indicate what the 

remaining actions are and when they will be complete. This application will not be approved 

until all legal actions necessary to enable the designated Implementing Entity to implement the 

proposed program(s) and participate in the SSBCI have been accomplished and the state, the 

District of Columbia, Tribal government, or territory has provided Treasury with description of 

such action. 

Under the statute, SSBCI is authorized to award multiple categories of funds. Preliminary 

allocations are listed below. As a reminder, all information associated with the Technical 

Assistance program will be collected in a separate application.

• Main capital amount: [dollar numeric field]

• Very Small Business (VSB) amount: [dollar numeric field]

• Socially & Economically Disadvantaged Individuals (SEDI) amount: [dollar numeric 

field]

• Initial eligible amount of Incentive funding: [dollar numeric field]

• Total Potential Funding Amount: [auto sum field of sub-allocations above]

Underserved Narrative: Please detail how you plan to use the federal contributions for your 

approved programs to help provide access to capital for small businesses in low- and moderateincome, minority, and other underserved communities, including women- and minority-owned 

small businesses. Treasury encourages states, territories, the District of Columbia, and Tribal 

governments to consider the following when including plans regarding “other underserved 

communities”: rural communities, communities undergoing the economic transitions, including 

communities impacted by the shift towards a net-zero economy or deindustrialization, and 

communities surrounding Minority-Serving Institutions, which include, but are not limited to, 

Historically Black Colleges and Universities (as defined in 20 U.S.C. § 1061(2)), HispanicServing Institutions (as defined in 20 U.S.C. § 1101a(a)(5)), Tribal Colleges and Universities (as 

defined in 20 U.S.C. § 1059c(b)(3)), and Asian American and Pacific Islander Serving 

Institutions (as defined in 20 U.S.C. § 1059g(b)(2)).

This narrative should describe efforts to reach underserved communities that are specific to each 

program; if similar measures are being deployed across two or more programs, please indicate 
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that. This narrative should contain information sufficient for Treasury to evaluate whether your 

plan to help provide access to capital for underserved communities is substantive and relevant to 

local market conditions. This narrative should describe how you will monitor performance with 

your plan, including relevant metrics, as you will be required to provide a description of any 

updates to your plan and your progress toward the metrics cited in your plan in your annual 

report.

This narrative can include details, if applicable, on how you intend to identify, develop, or 

expand existing programs to meet the needs of SEDI-owned businesses. States, territories, the 

District of Columbia, and Tribal governments are not required to establish a separate program for 

SEDI-owned businesses. However, any narrative that addresses meeting the needs of SEDIowned businesses must detail how these programs will focus on (1) businesses whose owners are 

SEDIs or (2) businesses located in, operated in, or whose owners reside in CDFI investment 

areas, which are geographies with SEDIs and SEDI-owned businesses that experience a 

substantial lack of access to capital and investment. 

This narrative that contains the jurisdiction’s underserved plan, as well as subsequent annual 

reporting on the plan, may be made public by Treasury. If Treasury makes this information

public, Treasury will withhold information that appears to be personally identifiable information 

(PII), sensitive information such as commercial or financial information about small businesses, 

or information that involves privacy, security, and proprietary business interests. Treasury will 

work with states to seek to protect the confidentiality of such information.

• Will all or part of the requested amount be used as collateral for a qualifying loan or 

swap funding facility? [dropdown of Yes, all; Yes, partial; No]

SECTION 6.1A: SWAP FACILITY

You have indicated that all or part of the requested amount will be used as collateral for 

qualifying loan or swap funding facility. If this is not correct, please revisit the prior question. If 

this is correct, please populate the following fields.

• Amount of Funding: [dollar numeric amount]

• Name(s) of the qualifying loan or swap funding facility(ies): [alphanumeric]

Swap Facility Commitment Letter or Narrative: Please upload a commitment letter from the 

source of financing. If a commitment letter is unavailable, please upload a narrative that 

describes the items and structure of the transaction. This description should not exceed one page.
16

SECTION 6.2: FINANCIAL INSTITUTION INFORMATION

Please provide the following information about the financial institution and bank account to 

which you want your SSBCI funds to be paid electronically, if approved. 

• Financial Institution Name: [alphanumeric field]

• Financial Institution Street Address 1: [alphanumeric field – reject P.O. Boxes]

• Financial Institution Street Address 2: [alphanumeric field – reject P.O. Boxes]

• Financial Institution City: [alpha field]

• Financial Institution State: [dropdown of eligible states & territories]

• Financial Institution Zip Code: [5-digit numeric field – reject if alpha or less than 5 digits]

• Financial Institution Zip Code +4: [4-digit numeric field] optional

• Financial Institution Phone: [10 digit numeric 3-3-4]

• Routing Transit Number: [9 digit numeric – reject if alpha characters or less than 9 digits]

• Confirm Routing Transit Number: [9 digit numeric – reject if alpha, less than 9 digits, or 

mismatch]

• Account Number: [numeric only – reject if alpha]

• Confirm Account Number: [numeric only – reject if alpha, or mismatch]

• Is this account Checking or Savings? [picklist of Checking or Savings]
17

SECTION 7: PROGRAM OVERVIEW

SECTION 7.1: PROGRAM OVERVIEW

Please enter the following information for each program to be administered. After you have 

entered the required information for one program, please select the “Create Program” button. 

The information entered for that program will be populated in the table below, and you will be 

able to proceed populating information for additional programs. Note that the sum of all program 

allocations entered below must match the total funding amount listed in Section 6.1 above.

• Program Type: [picklist of CAP; OCSP - Loan Participation Program; OCSP - Loan

Guarantee Program; OCSP - Collateral Support Program; OCSP – Equity Capital 

Program (Funds); OCSP – Equity Capital Program (Direct); OCSP – Other]

• Program Name: [alphanumeric]

• What is the amount of the applicant’s total funding that will be allocated to this 

program? [dollar numeric amount]

• Has this program operated in the past? [picklist of Yes or No]

SECTION 8: PROGRAM DETAILS

The table below shows the overview information you populated for each program in the previous 

page, Section 7: Program Overview. If you wish to modify this information or the number of 

programs for Treasury’s review, please return to the previous page, Section 7: Program

Overview, and make these edits. Once you have saved the updated information in the previous 

tab, the table below will update accordingly. To populate the required details for each program 

you must first select the program in the table below. 

[Insert screenshot of program overview table]

SECTION 8.1: ADMINISTERING ENTITIES

• Please select the entity(ies) that are administering this program (select all applicable 

entities): [multi-select picklist of implementing entity(ies) and contracted entity(ies) in 

Section 5.2]

SECTION 8.1A: CAPITAL ACCESS PROGRAM (CAP) CRITERIA

You have indicated that one of the programs to be administered is a CAP. If this is not correct, 

please revisit Section 7.1. If this is correct, please populate the following fields.

Confirm by checking the boxes below that the Applicant’s CAP satisfies each criteria. 

• Provides portfolio insurance for business loans based on a separate loan-loss reserve 

fund for each financial institution. [Checkbox]
18

• Requires insurance premiums to be paid by the participating financial institution 

lenders and by the business borrowers to the CAP-created reserve fund to have 

their loans enrolled in such reserve fund. [Checkbox]

• Provides for contributions to be made by the jurisdiction to the CAP-created 

reserve fund in amounts at least equal to the sum of the amount of the insurance 

premium borrower and the financial institution to the reserve fund for any newly 

enrolled loan. [Checkbox]

• Provides portfolio insurance solely for loans that meet both the following 

requirements: 

(a) the borrower has 500 employees* or less at the time the loan is enrolled in the 

CAP; and

(b) the loan amount does not exceed $5,000,000. 

*The definition at 12 CFR §121.106 should be used to calculate the number of 

employees. [Checkbox]

Enrolled Loan Data Table(s): Applicants establishing CAP programs that have not operated 

before will be required to provide detailed assumptions for their estimates of total enrolled loans, 

total loan amounts, and the estimated total Federal contributions over the lifespan of the 

program. Applicants with programs that have operated before should provide up to five (5) years 

of historical data for total enrolled loans, total loan amounts, and total public subsidies for these 

loans, and use this historical data as a reference to estimate total enrolled loans, total loan 

amounts, and the estimated total Federal contributions over the lifespan of the program. 

Applicants should download and populate the enrolled loan data template tables for each CAP 

program. Please note that all fields shaded in blue require data to be inputted, while those fields 

shaded in white are auto calculated. Please ensure you submit historical performance data, 

where applicable, to help support your enrolled loan projections.

• Download/Upload Function

Use the space below to articulate any assumptions or provide a brief narrative to support 

the data uploaded in the previous field.

[Text box for Enrolled Loan Data Narrative/Assumptions]

SECTION 8.1B: OTHER CREDIT SUPPORT PROGRAMS (OCSP) CRITERIA

You have indicated that at least one of the programs to be administered is an OCSP, which 

includes the following types of programs: collateral support program, loan participation program, 

loan guarantee program, equity capital program (funds), equity capital program (direct), and 

other. If this is not correct, please revisit Section 7.1. If this is correct, please complete the 

following for each OCSP.

OCSP Program Information: Please use the link here to download a template narrative 

describing the OCSP. Please complete the template and upload your narrative that addresses the 

information in the downloadable template, including:
19

1. A description of the background of the program, including historic performance of the 

program (for programs that have operated before) and expected performance.

2. A description summarizing the program guidelines. Include information on the 

credit/investment characteristics and the operating mechanics of the OCSP such as: 

a. qualifications or eligibility requirements for small business borrowers/investees and 

lenders/investors

b. minimum and maximum loan/investment amounts

c. standard loan types (e.g., term loans, lines of credit, etc.) and investments (e.g., 

equity, preferred equity, subordinated debt, etc.) and processes for reviewing nonstandard transactions

d. limitations on use of loan/investment proceeds

e. other standard terms required in loan, collateral support or guarantee provided, or 

investment agreement terms

f. sources for loan originations or investment opportunities in the program 

g. processes for negotiating and approving loan/credit support or investment terms

h. processes for determining and documenting the “cause and result” of private capital 

leverage related to the loan or investment

i. kinds of and rates for fees (e.g., application and origination fees, guarantee fees, 

management fees, etc.) that may be charged

j. processes for monitoring compliance and performance of outstanding 

loans/investments

k. processes for addressing loan defaults or investment write-offs

Also, provide the following information relevant to the type of OCSP as follows:

Loan Participation Program (LPP) – Describe how the program is structured, that is, 

explain whether the program purchases participation (the state, territory, the District of 

Columbia, or Tribal government purchases a portion of a loan originated by a lender), or 

originates companion loans (or co-lending participation or parallel loans in which a 

lender originates a senior loan and the state, territory, the District of Columbia, or Tribal 

government originates a second loan to the same borrower). Also, include the maximum 

percentage of the loan that the state, territory, the District of Columbia, or Tribal 

government can participate.

Collateral Support Program (CSP) – Include information on the maximum percentage of 

the loan amount that may be covered by the collateral, the form of collateral to be 

provided, and where the collateral will be held.

Loan Guarantee Program (LGP) – Include information on the maximum percentage of 

the loan that the guarantee will cover and describe how the reserve fund would work. 

Equity Capital Program (Funds) and Equity Capital Program (Direct) – Describe the 

structure of the Equity Capital Program and the capital deployment model. 

3. A description of the anticipated benefits of the state, territory, the District of Columbia, 

or Tribal government’s in-state and out-of-state loans and investments to the state, 

territory, the District of Columbia, or Tribal government, its businesses, and its residents 

including the extent to which the resulting small business lending and investing will 

expand economic opportunities. For example, climate transition investments may result 

in efficient energy use, sustainable jobs, or economic growth in sustainable 

manufacturing and industrial decarbonization, sustainable agriculture, bio-materials, and 
20

electric vehicles and changing infrastructure. Another example is that investments in 

areas such as small and mid-size enterprise (SME) manufacturing and supply chain 

resiliency may result in stronger economic growth, high-quality jobs, and innovation. 

Also, investments focused on innovation in supply chains of critical products such as 

semiconductors, critical minerals and materials, and advanced pharmaceuticals may 

provide long-term national and economic security benefits.

4. A description of how the OCSP will, at a minimum, “cause and result in” $1 of new 

private credit for every $1 of SSBCI funds used by the OCSP. For example, for OCSPs 

involving equity capital, applicants may specify such safeguards as limiting investments 

to anchor investments, prohibiting SSBCI participation after a fund’s initial close, or only 

permitting investments in funds for which private capital is likely to be catalyzed by 

SSBCI participation based on the funds' age, size, or experience. In addition, please 

complete the leverage ratio table for this OCSP program in Section 8.1C below.

5. A description of how the OSCP will ensure a meaningful amount of lender/investor 

capital is at risk. If the OCSP provides credit/equity support through a financial 

institution or non-financial institution lender or investor, such lender or investor must 

have a meaningful amount of capital resources at risk. The term “meaningful amount”

may vary for lenders and investors in different programs, as some will bear risk at the 

transaction level while others bear pooled risk. Capital at risk guidelines for OCSPs are 

contained in the SSBCI Capital Program Policy Guidelines.

6. A description of how the OCSP will provide credit support that meets all of the following 

requirements: 

a. targets an average borrower or investee size of 500 employees* or less; 

b. does not extend support to borrowers or investees that have more than 750 

employees; 

c. targets support towards loans or investments with an average principal amount of 

$5,000,000 or less; and 

d. does not extend credit support to loans or investments that exceed a principal amount 

of $20,000,000. 

*The definition at 12 CFR §121.106 should be used to calculate the number of 

employees.

Download/Upload Function

OCSP Additional Considerations: Please use the link here to download a template narrative 

describing the OCSP management team, operational capacity, and internal accounting and 

administrative controls systems. Please complete the template and upload your narrative that 

addresses the information in the downloadable template, including:

1. A description of the OCSP’s operational capacity, skills, and experience of the OCSP 

program management team. For example, address whether the OCSP has adequate 

organizational resources, infrastructure, systems, and standard operating policies and 

procedures to administer the OCSP.
21

2. A description of the ability of the OCSP to manage increases in the volume of its small 

business lending or investing. For example, describe the OCSP organizational 

infrastructure, resources, and the management team’s skills and experience to handle 

increases in small business lending or investing.

3. A description of the internal accounting and administrative controls systems of the OCSP 

and the extent to which such systems can provide reasonable assurance that the SSBCI 

funds will be safeguarded against waste, loss, unauthorized use, and misappropriation. 

For example, provide evidence of one or more of the following:

a. periodic internal audits

b. annual independent audits (including management letters)

c. program financial statements current within the past year

d. adequate accounting and financial management systems

4. A description of the soundness of the OCSP’s program design and implementation plan. 

For example, address whether research and market surveys have been conducted to 

determine program demand; whether successful programs that have operated before have 

been modified to meet SSBCI requirements; and whether the OCSP incorporates industry 

best practices.

• Download/Upload Function

OCSP Independent Financial Audit Upload: Please upload a copy of the most recent 

independent financial audit or financial statements for the OCSP if it has operated before. If no 

independent financial audit or program financial statements exist for the OCSP, then the 

applicant must attach a copy of the independent financial audit or program financial statements 

for the entity(ies) administering the program as identified in Section 7.1.

SECTION 8.1C: LEVERAGE DATA

Leverage Ratio Data Table(s): The SSBCI statute mandates that for OCSPs to be eligible for 

federal funding, jurisdictions must demonstrate, at the time of application, a “reasonable 

expectation” that, when considered with all other approved programs under SSBCI, such 

programs have the ability to use their federal contributions to generate small business lending or 

investing (“private leverage”) of at least 10 times the amount of the Federal contribution. To this 

end, you must use the application portal Leverage Tables for each applicable program to 

demonstrate the calculation and the assumptions underlying your leverage calculations, filling in 

the blue shaded fields as appropriate to enable auto calculation of leverage ratio projections. The 

chart below entitled “Leverage Table Input Guide” provides additional guidance on what inputs 
22

are required in the Leverage Tables. Please note this model calculates the leverage ratio under 

an assumed timeline of 10 years after each transaction that first uses SSBCI funds. To further 

assist the SSBCI Program in evaluating your leverage projections, please also submit historical 

performance data, if applicable, to support your assumptions.

• Download/Upload Function

Use the space below to articulate any assumptions or a brief narrative to support the data 

uploaded in the previous field.

[Text box for Leverage Ratio Narrative/Assumptions]

SECTION 8.2: PROGRAM OFFICIALS

Please enter the following information for the individual from the Administering Entity (i.e., 

either the Implementing Entity or Contracted Entity) to be contacted concerning this Program.

• Program POC First Name: [alphanumeric]

• Program POC Last Name: [alphanumeric]

• Program POC Title: [alphanumeric]

• Program POC Email: [email format check]

• Program POC Phone: [3-3-4 numeric]

SECTION 9: COMPLIANCE & OVERSIGHT

Please populate the information below on the compliance and oversight activities.

• Indicate how the Applicant plans to staff compliance and oversight activities (select 

all that apply) [picklist of Current Staff; New Staff; Contract Staff]

Staff Compliance and Oversight: Please upload a narrative describing what reporting 

mechanisms, audits, or other internal controls and compliance activities (a) the applicant has in 

place or (b) need to be implemented to enable the applicant to conduct oversight and meet annual 

and quarterly reporting requirements for the proposed program(s). Please include information for 

all proposed programs. In addition, explain the steps you will take to promote a fair, competitive, 

and open selection and contracting process. These steps could include application and 

enforcement of the jurisdiction’s existing procurement and ethics policies, as well as new 

measures that your jurisdiction chooses to implement specifically for the SSBCI program. 

Examples of such policies to include limitation or disclosure of political contributions to the 

jurisdiction’s officials with authority to select SSBCI contractors; reporting requirements for 

lobbying activity, including lobbying related to the SSBCI contractor selection process or 

program implementation; or request-for-proposal policies to govern the process for evaluating 

bids for SSBCI-related contracts. Documentation should not exceed 5 pages.
23

Assurances of Compliance with Civil Rights Requirements: If approved, SSBCI funding 

recipients will have to comply with legal requirements related to nondiscrimination and 

nondiscriminatory use of federal funds, where such laws are applicable to a recipient and any 

contracted entity operating SSBCI programs on the recipient’s behalf. To confirm that you will 

comply with these legal requirements if approved for SSBCI funding, please download, review,

and have an authorized official sign the assurances of compliance with civil rights requirements 

form and upload the signed form here. 

At this time, Tribal governments do not need to submit these assurances. Treasury will notify Tribal 

governments if subsequent assurances are required. All other jurisdictions must submit these 

Assurances of Compliance with Civil Rights Requirements in order to complete the application.

• Download/Upload Function

SECTION 10: APPLICATION CERTIFICATION

SECTION 10.1: AUTHORIZED OFFICIAL CERTIFICATION

An Authorized Official in Section 5.2 or official with delegated authority in Section 5.2A must 

sign your application using a DocuSign electronic signature.

By electronically signing and submitting this application, the Implementing Entity, any 

associated entities listed in this application, and the identified Authorized Official or official with 

delegated authority certify under penalty of perjury that:

1. all the information provided in this application is true and correct;

2. the Implementing Entity has and shall retain documentation and records to support the 

information provided in this application;

3. the Authorized Official or official with delegated authority will distribute and notify all 

applicants, entities, and organizations listed in this application of the status and 

documentation associated with this application, if applicable; and

4. the Implementing Entity shall make such supporting documents and records available 

upon request. 

After you click the button SUBMIT APPLICATION FOR AUTHORIZED SIGNATURE below, 

an email will be sent to the Authorized Official in Section 5.2 or official with delegated authority 

in Section 5.2A with your completed application and a DocuSign link to electronically sign the 
24

application. Please ensure the email addressed submitted in Section 5.2 and 5.2A is active and 

correct.

WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject 

to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil 

penalties (18 U.S.C. §§ 287, 1001; 31 U.S.C. §§ 3729, 3802). Treasury may refer any 

allegations of fraud, waste, or abuse in connection with SSBCI to the Treasury Inspector 

General.

(Render the following on a new page after submitting for signature)

Thank you for submitting your application for signature. An email with a DocuSign link has 

been sent to your Authorized Official in Section 5.2 or official with delegated authority in 

Section 5.2A to electronically sign the application. 

Your application is not complete or official until Treasury receives the electronically signed 

application. Please make sure your Authorized Official in Section 5.2 or official with delegated 

authority in Section 5.2A retrieves and responds to the email with the DocuSign electronic 

signature link. 

[CERTIFY & SUBMIT APPLICATION]