Instructions for Quarterly Supplemental Report for Banks and Savings Associations 1

Treasury Department Form: TD F 102.4A (05/03/2013) v6 OMB Number: 1505-0228

GENERAL INSTRUCTIONS 

The sections below constitute the Quarterly Supplemental Report. 

Quarter-End Adjusted Baseline Calculation

Quarter-End Qualified Small Business Lending

Change in Qualified Small Business Lending Calculation

WHO MUST REPORT ON WHICH FORMS 

Every bank and savings association participating in the Small Business Lending Fund (SBLF) is required to submit a Quarterly

Supplemental Report no more than 30 calendar days after the quarter in which SBLF funding is received and in each of the following 

quarters until all SBLF securities have been redeemed.

DEFINITIONS AND RULES OF PRACTICE

Unless otherwise stated, the Quarterly Supplemental Report and the Instructions for the Quarterly Supplemental Report incorporate 

the definitions and general rules of practice embodied in the Consolidated Reports of Condition and Income (Call Report), as well as

the instructions pertaining thereto.

ORGANIZATION OF THE INSTRUCTION BOOK

This instruction book is divided into two sections: 

(1) The General Instructions describing overall reporting requirements. 

(2) The Line Item Instructions for each section of the Quarterly Supplemental Report.

PREPARATION OF THE REPORT

Banks and savings associations are required to prepare and file the Quarterly Supplemental Report in accordance with these 

instructions. All reports shall be prepared in a consistent manner. 

The financial records of the bank or savings association shall be maintained in such a manner and scope so as to ensure that the

Quarterly Supplemental Report can be prepared and filed in accordance with these instructions and will reflect a fair presentation of 

the institution’s small business lending.

If you have general questions regarding this form, please contact the information line for the Small Business Lending Fund at

888-832-1147 (Monday-Friday, 9:00 AM-5:00 PM ET).

SIGNATURES 

The cover (signature) page of the Quarterly Supplemental Report shall be used to complete the signature and attestation 

requirement. The bank or savings association may use digital or handwritten signatures; however, the choice will impact how the 

form is submitted. For details, see SUBMISSION OF THE REPORT instructions below.

Chief Executive Officer and Chief Financial Officer Declarations

Both the Chief Executive Officer (CEO) and the Chief Financial Officer (CFO) of the bank or savings association (or the individuals performing 

equivalent functions) shall sign the respective declarations on the cover (signature) page attesting to the correctness of the Quarterly 

Supplemental Report that the bank or savings association has filed with the Treasury and the appropriate supervisory agency.

U.S. Department of the Treasury 

INSTRUCTIONS for the Quarterly Supplemental Report for Banks and 

Savings Associations Participating in the Small Business Lending Fund
Instructions for Quarterly Supplemental Report for Banks and Savings Associations 2

Treasury Department Form: TD F 102.4A (05/03/2013) v6 OMB Number: 1505-0228

Director Attestation 

National banks, state member banks, and savings associations – The correctness of the Quarterly Supplemental Reportshall be attested to 

by no fewer than three (3) directors of the reporting bank or savings association, other than the officerssigning the CEO or CFO

declarations, as indicated on the cover (signature) page. 

State nonmember banks – The correctness of the Quarterly Supplemental Reportshall be attested to by no fewer than two (2) directors of 

the reporting bank, other than the officerssigning the CEO or CFO declarations, as indicated on the cover (signature) page. 

SUBMISSION OF THE REPORT

Each bank and savings association must file its Quarterly Supplemental Report no more than 30 calendar days after the quarter by 

electronically entering the report data directly into the Report and emailing the completed copy, along with the cover (signature) page, 

to Treasury at SBLFSuppRpt@treasury.gov.

For banks and savings associations using digital signatures, the completed electronic report is submitted as a single document. For 

banks and savings associations using handwritten signatures, both the completed electronic report and a scanned copy of the entire 

report, including signature page, must be submitted.

One additional copy should be sent to the bank’s or savings association’s primary federal regulator using the following addresses, as 

appropriate:

• FDIC: State nonmember institutions should submit supplemental reports to their appropriate regional office or 

electronically through FDICconnect.

• Federal Reserve: Applicants should provide supplemental reports to the appropriate regional Federal Reserve Bank using 

existing procedures for filing report-related documentation. 

• OCC: National banks and savings associations should submit supplemental reports electronically via OCC secure mail. 

Please contact your OCC District Office for instructions on how to securely submit the supplemental reports. 

• State-chartered institutions must also provide a copy of the Quarterly Supplemental Report to their state regulator.

Submission Date 

Completed Quarterly Supplemental Report must be filed with the federal bank supervisory authorities and Treasury no later than 

30 calendar days after the end of the quarter, which is the same date the Call Report used to pull the data is due. For example, the 

report pertaining to the quarter ending March 31, 2012 must be filed by the following April 30, 2012. 

RETENTION OF REPORTS 

In general, a bank or savings association should maintain in its files a signed and attested record of its completed Quarterly 

Supplemental Report, including any amended reports, for five (5) years after the report date, unless any applicable state requirements 

mandate a longer retention period.

MISCELLANEOUS GENERAL INSTRUCTIONS 

Rounding 

Dollar amounts must be reported in thousands with the figures rounded to the nearest thousand. Items less than $500 must be reported 

as zero. 

Verification

All fields must be completed. All addition and subtraction should be double-checked before reports are submitted. Totals and 

subtotals in supporting materials should be cross-checked to corresponding items elsewhere in the reports. Before a report is 

submitted, all amounts should be compared with the corresponding amounts in the previous report. If there are any unusual 

changes from the previous report, a brief explanation of the changes should be attached to the submitted report.

RELEASE OF INDIVIDUAL BANK AND SAVINGS ASSOCIATION REPORTS 

All sections of the Quarterly Supplemental Report submitted by each reporting bank or savings association may be made available to 

the public by the federal bank supervisory agencies or Treasury.
Instructions for Quarterly Supplemental Report for Banks and Savings Associations 3

Treasury Department Form: TD F 102.4A (05/03/2013) v6 OMB Number: 1505-0228

LINE ITEM INSTRUCTIONS

Please note that some lines on the Supplemental Report are automatically calculated for ease of use. These lines are pre-populated with 

zeros and will not accept manual entry.

Quarter-End Adjusted Baseline Calculation

This section is used to adjust an institution’s Small Business Lending Baseline for increases in qualified loan balances resulting from 

mergers, acquisitions, and/or purchases of such loans. If the bank or savings association has gained qualifying loans by merger, 

acquisition, and/or purchase since 7/1/2010 through the report date, the amount must be added to the baseline. 

Item No. Caption and Instructions

1 Initial Small Business Lending Baseline (line 12 of the Initial Supplemental Report)

2 Prior quarter cumulative reported qualified small business lending increases resulting from an acquisition of, or merger 

with, another institution, and/or purchases of such loans as were reported on line 12 of the prior quarter’s submitted 

Quarterly Supplemental Report

3 Balance increases in commercial and industrial loans resulting from an acquisition of, or merger with, another institution, 

and/or purchases of such loans in the quarter being reported

4 Balance increases in loans secured by owner-occupied nonfarm, nonresidential properties resulting from an acquisition 

of, or merger with, another institution, and/or purchases of such loans in the quarter being reported

5 Balance increases in loans to finance agricultural production and other loans to farmers resulting from an acquisition of, 

or merger with, another institution, and/or purchases of such loans in the quarter being reported

6 Balance increases in loans secured by farmland resulting from an acquisition of, or merger with, another institution, 

and/or purchases of such loans in the quarter being reported

7 Subtotal (sum lines 3, 4, 5, and 6)

8 Dollar portion of any such loan or group of such loans to the same borrower and its affiliates with an original principal or 

commitment amount greater than $10 million 

9 Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 8

Include loans made to a business with more than $50 million in revenues during the most recent fiscal year ended as 

of the date of the loan origination. If the recipient’s revenues for that fiscal year are unknown, use available annual 

revenue information reasonably proximate to that fiscal year.

10 Dollar portion of line 7 guaranteed by the U.S. government, unless included in lines 8 or 9

Include only the portion of the loan which is guaranteed by the U.S. government.

11 Dollar portion of line 7 where a third party has assumed an interest, unless included in lines 8, 9, or 10

Include only the portion where a third party has assumed an interest.

12 Total cumulative reported qualified business lending increases resulting from an acquisition of, or merger with, another 

institution, and/or purchases of such loans (line 12 equals line 2 plus line 7 minus lines 8, 9, 10, and 11)

13 Quarter-End Adjusted Small Business Lending Baseline (line 13 equals line 1 plus line 12)

Quarter-End Qualified Small Business Lending

Item No. Caption and Instructions

14 Balances of commercial and industrial loans (as reflected on Call Report Schedule RC-C, Part I, item 4)

15 Balances of loans secured by owner-occupied nonfarm, nonresidential properties (as reflected on Call Report Schedule RC- C, Part I, item 1.e.(1))

16 Balances of loans to finance agricultural production and other loans to farmers (on Call Report RC-C, Part I, item 3)

17 Balances of loans secured by farmland (on Call Report Schedule RC-C, Part I, item 1.b)

18 Subtotal (sum lines 14, 15, 16, and 17)

19 Dollar portion of any such loan or group of such loans to the same borrower and its affiliates with an original principal or 

commitment amount greater than $10 million
Instructions for Quarterly Supplemental Report for Banks and Savings Associations 4

Treasury Department Form: TD F 102.4A (05/03/2013) v6 OMB Number: 1505-0228

Item No. Caption and Instructions

20 Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 19

Include loans made to a business with more than $50 million in revenues during the most recent fiscal year ended as 

of the date of the loan origination. If the recipient’s revenues for that fiscal year are unknown, use available annual 

revenue information reasonably proximate to that fiscal year.

21 Dollar portion of line 18 guaranteed by the U.S. government, unless included in lines 19 or 20

Include only the portion of the loan which is guaranteed by the U.S. government.

22 Dollar portion of line 18 where a third party has assumed an interest, unless included in lines 19, 20, or 21

Include only the portion where a third party has assumed an interest.

23 Total quarter-end qualified small business loans (line 23 equals line 18 minus lines 19, 20, 21, and 22)

Net Charge-Off Adjustments

For lines 24 – 34: if net charge-offs are negative (i.e., recoveries exceed charge-offs), type a minus symbol (-) in the “Neg (-)” column 

that corresponds with that line.

Item No. Caption and Instructions

24 Cumulative net charge-offs before last quarter (line 34 from prior quarter’s report)

25 Net charge-offs on commercial and industrial loans

26 Net charge-offs on loans secured by owner-occupied nonfarm, nonresidential properties

27 Net charge-offs on loans to finance agricultural production and other loans to farmers

28 Net charge-offs on loans secured by farmland

29 Subtotal (sum lines 24, 25, 26, 27, and 28)

30 Dollar portion of net charge-offs on any such loans or group of loans (from lines 25, 26, 27, and 28) to the same borrower 

and its affiliates with an original principal or commitment amount greater than $10 million

31 Dollar portion of net charge-offs on such loans (from lines 25, 26, 27, and 28) to businesses with more than $50 million 

in revenues, unless included in line 30

32 Dollar portion of net charge-offs on loans (from lines 25, 26, 27, and 28) guaranteed by the U.S. government, unless 

included in lines 30 and 31

33 Dollar portion of net charge-offs on loans (from lines 25, 26, 27, and 28) where a third party has assumed an interest, unless 

included in lines 30, 31, and 32

34 Total cumulative net charge-offs (line 34 equals line 29 minus lines 30, 31, 32, and 33)

35 Quarter-End Adjusted Qualified Small Business Lending (line 35 equals line 23 plus line 34)

Change in Qualified Small Business Lending Calculation

Item No. Caption and Instructions

36 Dollar value of current balances with the Small Business Lending Fund

37 Dollar value of Quarter-End Adjusted Small Business Lending Baseline (line 13)

38 Dollar value of Quarter-End Adjusted Qualified Small Business Lending (line 35)

39 Dollar value of increase in Qualified Small Business Lending from baseline (line 39 equals line 38 minus line 37)

40 Percent increase in Qualified Small Business Lending (line 40 equals line 39 divided by line 37; must be calculated to two 

decimal points; if line 39 is 0, enter 0 on line 40)