OMB Control Number 1505-0227 

Expiration Date: 07/31/2025 

Please note that this document is not the SSBCI TA Grant Program Application. This 

document is intended to be used as a reference for planning purposes. An online 

application portal is forthcoming.

TECHNICAL ASSISTANCE GRANT PROGRAM 

OVERVIEW 

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 

(capital programs) and technical assistance (TA) for very small businesses (VSBs) and business 

enterprises owned and controlled by socially and economically disadvantaged individuals 

(SEDI-owned businesses) applying for SSBCI capital programs or other federal or jurisdiction 

programs that support small businesses. 

Treasury intends to award technical assistance funds to jurisdictions as federal grants (the 

TA Grant Program). The SSBCI TA Grant Program Assistance Listing No. 21.031 may be 

accessed at https://sam.gov/fal/3af6a8cf39e14276a1b74d9fe8a3c2ed/view. Jurisdictions that 

submit a complete SSBCI capital program application by the applicable deadline may apply for 

TA Grant Program funds. 

For more information on SSBCI, including the applicable application deadlines and the 

TA Grant Program Guidelines, visit https://home.treasury.gov/policy-issues/small-businessprograms/state-small-business-credit-initiative-ssbci. 

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 4 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. 

SECTION 1: USER INSTRUCTIONS 

Welcome to the U.S. Department of the Treasury’s application submission portal for the 

SSBCI TA Grant Program. Based on the submission of your SSBCI Capital Program Notice of 

Intent, you may enter the TA Grant Program application portal. However, you will not be able to 

submit a TA Grant Program application until you have submitted your SSBCI Capital Program 

application by the applicable deadline (as specified on Treasury’s website). For your application 

to be evaluated by Treasury, please follow the instructions below. 
2

Eligible recipients must be registered in the System for Award Management (SAM, at SAM.gov) 

before submitting their TA Grant Program application to Treasury and, pursuant to 2 C.F.R. 

§ 25.200(b), must maintain an active SAM registration at all times throughout the period of 

performance. 

The TA Grant Program application consists of eight sections: 

Section 1: User Instructions 

Section 2: Application Documents 

Section 3: Definitions 

Section 4: Technical Assistance Eligible Recipient and Subrecipient Information 

Section 5: Technical Assistance Plan 

Section 6: Budget and Narrative Justification 

Section 7: Assurances of Compliance with Civil Rights Requirements 

Section 8: Application Certification and Submission 

For a list of documents that you will need to download, fill out, and upload as part of your 

completed application, see Section 2: Application Documents. 

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 application in progress is saved, you may return to it 

later to amend or complete your application. 

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

Authorized Official (or the official who has been delegated authority to act on the TA 

Authorized Official’s behalf ) and the primary and secondary contacts identified in Sections 4.2 

and 4.3 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 be incomplete and cannot be processed. 

Documents with an asterisk (*) are required if applicable to the applicant. 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 include. Links 

to templates are provided below for download, as well as throughout the application in the 

sections in which the documents are required.
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 Delegation of Authority.* 

 Recipient Letter of Designation. 

 Joint Applicant Designation Documentation.* 

 Program Design. Click here to download template. 

 Performance Goals. Click here to download template. 

 Negotiated Indirect Cost Rate Agreement/Cost Allocation Plan.* 

 Narrative Justification of Budget. Click here to download template. 

 Assurances of Compliance with Civil Rights Requirements. Click here to download template. 

SECTION 3: DEFINITIONS 

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. 

Business enterprise owned and controlled by socially and economically disadvantaged 

individuals) (SEDI-owned business) means: 

 a business enterprise that certifies that it is owned and controlled by individuals who have 

had their access to credit on reasonable terms diminished compared to others in comparable 

economic circumstances, due to (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 English proficiency, (5) disability, (6) long-term residence in an environment 

isolated from the mainstream of American society, (7) membership of a Federally or staterecognized 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 an underserved community. (Underserved communities are populations 

sharing a particular characteristic, as well as geographic communities, that have been 

systematically denied a full opportunity to participate in aspects of economic, social, and 

civic life, as exemplified by the list in the definition of equity. Equity is consistent and 

systematic fair, just, and impartial treatment of all individuals, including individuals who 

belong to underserved communities that have been denied such treatment, such as Black, 

Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders 

and other persons of color; members of religious minorities; lesbian, gay, bisexual, 

transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in 

rural areas; and persons otherwise adversely affected by persistent poverty or inequality.); 

 a business enterprise that certifies that it is owned and controlled by individuals whose 

residences are in Community Development Financial Institution (CDFI) Investment Areas, 

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

 a business enterprise that certifies that it will build, open, or operate a location in a 

CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii); or 

 a business enterprise that certifies that it is located in a CDFI Investment Area, as defined in 

12 C.F.R. § 1805.201(b)(3)(ii). 
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Eligible beneficiary means any very small business (VSB) or SEDI-owned business that is 

applying for, preparing to apply for, or has previously applied for an SSBCI capital program or 

other federal or other jurisdiction small business program. 

Eligible recipient means a state, the District of Columbia, or a territory that submitted a 

complete SSBCI capital program application by February 11, 2022; and a Tribal government that 

submits a complete SSBCI capital program application by September 1, 2022. 

TA provider means an entity that provides TA services to eligible beneficiaries. 

Very small business (VSB) means a business with fewer than 10 employees and includes 

independent contractors and sole proprietors. 

SECTION 4: TECHNICAL ASSISTANCE 

ELIGIBLE RECIPIENT AND SUBRECIPIENT 

INFORMATION 

SECTION 4.1: ELIGIBLE RECIPIENT 

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

designated to apply for, receive, and administer the TA Grant Program award. The term 

“agency” includes government corporations and other entities authorized or supervised by the 

jurisdiction; this would include, for example, Alaska Native Corporations. 

 Eligible Recipient Name: [dropdown of eligible states, the District of Columbia, territories, 

Tribal governments] 

 Eligible Recipient Designee: [alphanumeric] 

 Eligible Recipient Designee unique entity identifier (UEI) number1: [12-digit numeric 

field – reject if alpha or less than 12 digits] 

 Eligible Recipient Designee taxpayer identification number (TIN) or employer 

identification number (EIN): [9-digit numeric field – reject if alpha or less than 9 digits] 

 Does the Eligible Recipient designee 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 states & territories] 

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

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

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

1

 Please note that as of April 4, 2022, the unique entity identifier used across the Federal Government changed from 

the DUNS Number to the Unique Entity ID (UEI), which is generated by SAM.gov. For more information see 

https://sam.gov/content/duns-uei. 
5

<Section 4.1A will only be visible if joint application [Y] is selected in Section 4.1>

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 provide the following information for each Tribal government on behalf of which you are 

submitting this application. In Section 4.2, you will be asked to provide the contact information 

for the TA Authorized Official responsible for making decisions on behalf of multiple Tribal 

governments regarding this joint application. 

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

 What is the Unique Identifier (ID) associated with the Co-Applicant’s submitted NOI?2

[Lookup field for Co-Applicant to enter ID] 

 Co-Applicant UEI: [12-digit numeric field – reject if alpha or less than 12 digits] 

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

After you have provided the requested information, select “Enter Another Entity” button to save 

information for the current entity and provide information for additional entities. 

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 entity named in Section 4.1 and that such entity has the 

authority to do the following on behalf of all Co-Applicants: 

 Submit the TA Grant Program Application 

 Sign the TA grant agreement 

 Receive and disburse SSBCI TA Grant Program funds, if approved. 

The Designation Documentation must include Tribal resolutions or official documentation of 

other actions taken by each participating Tribal government to delegate such authority to the 

entity named in Section 4.1. 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. 

Please upload the Designation Documentation. 

<Section 4.1B will only be visible if joint application [N] is selected in Section 4.1> 

SECTION 4.1B: RECIPIENT LETTER OF DESIGNATION 

The eligible recipient will be required to submit a designation letter on official letterhead signed 

by the governor of the state or mayor of the District of Columbia, or governing official of the 

2

 The Unique ID associated with the Co-Applicant’s NOI will be a six-character ID similar to: NOI-XXX. If you 

have trouble locating your NOI, please contact your Outreach Manager or the SSBCI Questions mailbox at 

ssbci_information@treasury.gov. 
6

territory or Tribal government (or their delegates) stating that they have designated the specific 

entity named in Section 4.1 to do the following on behalf of the eligible recipient: 

 Submit the TA Grant Program Application 

 Sign the TA grant agreement 

 Receive and disburse SSBCI TA Grant Program funds, if approved 

This letter should include the title of the TA Authorized Official listed in Section 4.2. 

Please upload the Recipient Letter of Designation. 

SECTION 4.2: TA AUTHORIZED OFFICIAL 

Please enter the information for the official who is authorized to sign and make decisions on 

behalf of the eligible recipient regarding this application (TA Authorized Official). This 

individual will be asked to authorize the application using a DocuSign electronic signature at the 

completion of this application in Section 8. 

 First Name: [alphanumeric] 

 Last Name: [alphanumeric] 

 Title: [alphanumeric] 

 Email: [alphanumeric email format check]

 Phone: [3-3-4 numeric]

 Organization: [alphanumeric] 

 Street Address 1: [alphanumeric, reject P.O. boxes] 

 Street Address 2: [alphanumeric, reject P.O. boxes] 

 City: [alphanumeric] 

 State: [dropdown of eligible states, the District of Columbia, territories] 

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

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

 Is the TA Authorized Official delegating to another official the authority to certify and 

electronically sign the TA Grant application on their behalf? [Y/N] 

<Section 4.2A will only be visible if TA Authorized Official is delegating authority [Y] is 

selected> 

SECTION 4.2A: TA AUTHORIZED OFFICIAL DELEGATION OF AUTHORITY 

If the TA Authorized Official named in the section above has delegated the authority to another 

official to certify and electronically sign the application on their behalf, documentation 

evidencing the delegation of authority must be submitted. The delegation of authority 

documentation must include: 

 The scope of the delegation, including any specific authority to execute and deliver 

documents. 

 The name, title, telephone number, and email address of each official who has been delegated 

authority. 
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 The effective date of the delegation and the end date, if any, for which the delegation is valid. 

 References to applicable laws of the state, the District of Columbia, Tribal government, or 

territory that permit the delegation. 

Please upload additional information on this delegation of authority. 

If this delegation is submitted, this individual will be asked to authorize the application using a 

DocuSign electronic signature at the completion of this application in Section 8. 

SECTION 4.3: PRIMARY AND SECONDARY 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. 

The TA Authorized Official and/or the official who has been delegated authority to act on the 

TA Authorized Official’s behalf as identified in Sections 4.2 and 4.2A may be listed as 

application contacts or different individuals may be listed as application contacts.

 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 4.3A: PERMISSION TO SHARE CONTACT INFORMATION 

 Do you permit Treasury to share your application’s primary and secondary contacts’ 

information in Section 4.3 with other states, the District of Columbia, Tribal 

governments, and territories for TA Grant Program collaboration purposes? [Y/N] 

SECTION 4.4: SUBRECIPIENTS 

 Does the eligible recipient intend to make a subaward for one or more subrecipients to 

carry out all or a portion of the TA Grant Program award? [Y/N]

o If Yes, next question will open. 

o If No, Section 4.4 will open. 

 At this time, does the eligible recipient know any details about their subrecipient(s)? 

[Y/N]

o If Yes, Section 4.4A will open. 
8

o If No, the below text will display and Section 4.5 will open. 

[Help Text]: Before disbursing any funds to a proposed subrecipient, the Recipient 

must identify the subrecipient and provide documentation that the subrecipient is an 

entity eligible to receive a subaward under the TA Grant Program consistent with 

Section III.c of the TA Grant Program Guidelines. In addition, the Recipient must 

provide Treasury with an itemized subrecipient budget with an appropriate 

justification via a budget narrative. If the eligible recipient has not identified the 

subrecipients that will carry out the TA Grant Program Award at the time of 

application submission but will do so later, the eligible recipient should email details 

about the proposed subrecipients to Treasury at ssbci_information@treasury.gov with 

the subject, “TA GRANT APPLICATION – Subrecipient Information.” 

SECTION 4.4A: SUBRECIPIENT INFORMATION 

Please populate the information below for each subrecipient that has been designated to carry out 

all or part of the TA Grant Program Award on behalf of the eligible recipient. Once created and 

saved, the subrecipient information will appear in the table below. Please populate all fields in 

the below before proceeding to click on ‘Add Another Subrecipient’ button. For more 

information regarding subrecipients, please see the TA Grant Program Guidelines, particularly 

Section III.c. 

 Subrecipient Type: [picklist of Entity of the eligible recipient; Nonprofit entity; For-profit 

entity] 

 Subrecipient Name: [alphanumeric] 

 Subrecipient UEI: [12-digit numeric field – reject if alpha or less than 12 digits] 

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

 Does the Subrecipient 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 4.5: FINANCIAL INSTITUTION INFORMATION 

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

which TA Grant Program funds will 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 
9

 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]

SECTION 5: TECHNICAL ASSISTANCE PLAN 

SECTION 5.1: PROGRAM DESIGN 

Eligible recipients are required to submit a TA plan as part of their application for TA Grant 

Program funding. 

Eligible recipients must describe each project for which they will use TA Grant Program funds. 

Specifically, eligible recipients must address the following: 

1. Data-driven assessment of the needs of eligible beneficiaries in the eligible recipient’s 

jurisdiction. Eligible recipients must provide information and data that they have used to 

design their TA projects in a way that effectively addresses eligible beneficiaries’ needs, 

particularly information and data on barriers to capital access. Information and data may 

include information from organizations and businesses associated with eligible 

beneficiaries; historical records and research reports on the need for small business legal, 

accounting, and financial advisory services in the jurisdiction; and statistical data on local 

economic conditions such as unemployment or job-creation numbers. 

2. The organizational capacity and ability of the TA providers. Eligible recipients must 

describe the proposed TA providers and, if applicable, the process for identifying future 

TA providers, such as eligible recipients’ procurement processes. Eligible recipients must 

discuss their capability to directly implement the TA project or to manage subrecipient or 

contractor implementation. Eligible recipients must also discuss any subrecipient’s or 

contractor’s capability to implement the TA project or to manage the implementation of 

lower-tier subrecipients or contractors. Eligible recipients must discuss the process, 

sources, and tools used in identifying and determining the capability of the TA providers. 

Eligible recipients must address requirements set forth under “TA Provider Requirement: 

Connection to Economic Benefits’ in Section V.b and “TA Provider Requirement: 

Prioritization of SEDI-Owned Businesses as Providers” in Section V.c of the TA Grant 

Program Guidelines. 

3. The connection between the TA project and SSBCI or other program that supports small 

businesses. Eligible beneficiaries are VSBs and SEDI-owned businesses that are applying 

for, preparing to apply for, or previously applied for an SSBCI capital program or other 

federal or other jurisdiction small business program. Accordingly, eligible recipients must 

describe how the project is connected to the relevant small business programs. For 

example, where an eligible recipient’s capital program is focused on capital access for 

small manufacturing enterprises (SMEs), the eligible recipient’s TA Grant Program 

application should include information connecting TA projects to the needs of SMEs that 
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are SEDI-owned businesses and VSBs applying for an SSBCI program or other federal or 

other jurisdiction small business program. This could include information on how the 

planned TA services are expected to help SME eligible beneficiaries to, for example, 

implement new technologies, build relationships with local distributors, or reduce energy 

costs.

4. The strategy and efforts to reach SEDI-owned businesses and VSBs that are eligible 

beneficiaries. Eligible recipients should describe their strategy and efforts to reach 

eligible beneficiaries, such as regular internal organization meetings to assess TA project 

implementation and planned outreach efforts (e.g., publicity, email campaigns, 

neighborhood canvassing). 

Please download the template here and upload the completed document. 

SECTION 5.1A: PERFORMANCE GOALS 

Eligible recipients must describe their performance goals and benchmarks for their TA Grant 

Program award. Treasury expects the duration of the period of performance for TA Grant 

Program awards will be up to five years. The performance measures must be tied to addressing 

the needs of eligible beneficiaries and explain the approach to addressing those needs. Eligible 

recipients must explain the output measures they will use to measure performance and the 

benchmarks for all identified short-, medium-, or long-term goals. Examples of output measures 

may include the number of newly established business organizations or the number of successful 

small business program applications submitted by eligible beneficiaries. 

Please download the template here and upload the completed document. 

SECTION 6: BUDGETAND NARRATIVE 

JUSTIFICATION

SECTION 6.1: PROPOSED BUDGET 

Enter the requested amounts in the fields below. The amounts entered below must correspond to 

the amounts in the detailed budget and narrative justification template you upload in Section 6.2. 

Direct Costs by Budget Category 

 Personnel: [dollar numeric field to two decimal points] 

[Help Text]: This refers to salaries and wages paid to employees of the eligible recipient 

who are directly involved in TA Grant Program award implementation. The budget narrative 

must identify the personnel category type by full-time equivalent employees (FTEs), 
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including FTE equivalents for part-time employees, number of personnel proposed for each 

personnel category, and the estimated funding amounts. The budget narrative should identify 

positions by title and function, include a brief description of duties, and state the rate of 

compensation and the amount of time to be allocated for each position. This line item does 

not include personnel of subrecipients; those costs are included in the “Contractual” line item 

below. See also 2 C.F.R. § 200.430 (Compensation – personal services). 

 Fringe Benefits: [dollar numeric field to two decimal points] 

[Help Text]: This refers to the allowances and services the eligible recipient provides to its 

employees as compensation in addition to regular salaries and wages. Fringe benefits include, 

but are not limited to, the costs of leave (vacation, family-related, sick, or military), 

employee insurance, pensions, and unemployment benefit plans. The budget narrative must 

provide a basis for the eligible recipient’s fringe benefit amount. See also 2 C.F.R. § 200.431 

(Compensation – fringe benefits).

 Travel: [dollar numeric field to two decimal points] 

[Help Text]: This refers to the expenses for transportation, lodging, subsistence, and related 

items incurred by employees who are in travel status on official business of the eligible 

recipient. Such costs may be charged on an actual cost basis, on a per diem or mileage basis in 

lieu of actual costs incurred, or on a combination of the two, provided the method used is 

applied to an entire trip and not to selected days of the trip, and results in charges consistent 

with those normally allowed in like circumstances in the eligible recipient’s non-federally 

funded activities and in accordance with the recipient’s written travel reimbursement policies. 

The budget narrative must provide an estimated number of trips, points of origin and 

destination, and purpose of travel. It should also show how each trip (or type of trip) is needed 

to achieve the goals and objectives of the eligible recipient’s proposed projects. This line item 

does not include a subrecipient’s travel expenses; those costs are included in the “Contractual” 

line item. See also 2 C.F.R. § 200.472 (Travel costs).

 Equipment: [dollar numeric field to two decimal points] 

[Help Text]: This refers to tangible personal property (including information technology 

systems) having a useful life of more than one year and a per-unit acquisition cost that equals 

or exceeds the lesser of the capitalization level established by the eligible recipient for 

financial statement purposes or $5,000. The budget narrative must include an itemized listing 

of any proposed equipment to be purchased under the grant agreement. For each item to be 

purchased, provide an estimated unit cost, estimated useful life, basis for the estimated useful 

life, and justification for items of equipment to be purchased. Include a lease versus purchase 

analysis for each item of equipment. See the definition of “equipment” at 2 C.F.R. § 200.1.

 Supplies: [dollar numeric field to two decimal points] 

[Help Text]: This refers to all tangible personal property other than equipment to be 

purchased under the grant agreement. For example, a computing device is a supply if the 

acquisition cost is less than the lesser of the capitalization level established by the eligible 

recipient for financial statement purposes or $5,000, regardless of the length of its useful life. 

The budget narrative must include a brief description of and justification for the supplies 

required to perform the work. These costs should be listed by major supply categories 

(e.g., office supplies, computer supplies), and include the estimated costs by category. See 

the definition of “supplies” at 2 C.F.R. § 200.1.

 Contractual: [dollar numeric field to two decimal points] 
12

[Help Text]: This refers to purchases of property or services needed to carry out the project 

under the grant agreement. It is not specific to the legal instrument used, so this line item 

must include proposed subawards and contracts. The budget narrative should clearly identify 

the amount of funds the eligible recipient intends to award via contract or subaward, as well 

as the purpose of amounts to be awarded via contract or subaward.3 Before disbursing funds 

to any proposed subrecipient, the recipient must identify the subrecipient and provide 

Treasury with an itemized subrecipient budget using the same line items as specified here, 

with appropriate justification in a budget narrative. 

 Other: [dollar numeric field to two decimal points] 

[Help Text]: This refers to direct costs that do not fit any of the above categories, such as 

rent for buildings used to conduct award activities, utilities, or leased equipment, and costs 

for recipient personnel training. The budget narrative should list and describe other items by 

major type, provide a cost estimate or budget for each item, and describe the basis for the 

cost estimates or budget computations. 

Total Program Costs 

 Total Direct Costs: [sum of Direct Costs by Budget Category amounts above; dollar 

numeric field to two decimal points] 

 Total Indirect Costs: [dollar numeric field to two decimal points]

 [Help Text]: In accordance with 2 C.F.R. § 200.1, indirect costs are defined as those costs 

incurred for a common or joint purpose benefitting more than one cost objective 

(i.e., program, function, activity, award, organizational subdivision, contract, or work unit), 

and not readily assignable to the cost objectives specifically benefitted, without effort 

disproportionate to the results achieved. Indirect costs must be supported by either a current 

federally approved Negotiated Indirect Cost Rate Agreement (NICRA) or, if the recipient 

does not have a current NICRA and receives less than $35 million in direct federal funding 

per year, the eligible recipient may elect to use the de minimis indirect cost rate, 10 percent of 

modified total direct costs (MTDC), as defined at 2 C.F.R. § 200.1.4 Eligible recipients 

electing to use the de minimis rate should specify in the budget narrative that the recipient 

does not have a current NICRA and are electing to take the 10 percent de minimis rate. 

 Total Project Costs: [sum of Total Direct Costs and Total Indirect Costs above; dollar 

numeric field to two decimal points]

 Does the applicant have a current NICRA? [Y/N]

o If Yes, next question will open. 

3

 The eligible recipient may provide the overall amount the eligible recipient intends to award via contract or 

subaward. If known, the eligible recipient may also identify each proposed contract and specify its purpose and 

estimated cost. Treasury expects the eligible recipient to make reasonable efforts to carry out its TA plan as 

proposed in the plan, in particular TA providers’ connection to economic benefits as explained in Section V.b above, 

but Treasury recognizes that a plan regarding proposed TA providers may change over time. Post-award changes in 

the set of proposed TA providers are permitted subject to the restrictions on moving funds among direct cost 

categories described below in this Section V.d, the requirements for TA providers in Section III.c, and the 

requirements of the Uniform Guidance (2 C.F.R. Part 200), including requirements applicable to subawards and 

procurements. 

4

 In accordance with 2 C.F.R § 200.414(f), a recipient or subrecipient that does not have a current NICRA with the 

federal government and receives less than $35 million in direct federal funding per year may elect to use a de 

minimis rate of 10 percent of MTDC. 
13

o If No, Section 6.2 will open. 

 Program Income: [dollar numeric field to two decimal points] 

Enter the estimated amount of income, if any, expected to be generated from this TA Grant 

Program. Do not add or subtract this amount from the Total Program Costs. 

[Help Text]: If the eligible recipient anticipates generating any program income, the eligible 

recipient must detail the activities that are anticipated to generate such program income and 

must clearly explain those amounts in the budget narrative. For purposes of the TA Grant 

Program, program income is defined in 2 C.F.R. § 200.1 as gross income earned by a 

recipient or subrecipient that is directly generated by a supported activity or earned as a result 

of the TA Grant Program award during the period of performance and includes, but is not 

limited to, fees for services performed. In accordance with 2 C.F.R. § 200.307(e)(2), any 

program income must be added to the TA Grant Program award and used for the purposes 

and under the conditions of the award. Program income must be reported on in accordance 

with TA Grant Program reporting guidance. 

Use the space below to provide a narrative statement on the nature and source of the 

program income and articulate any assumptions on the amount of program income. 

[Text box for program income narrative statement]

SECTION 6.2: NARRATIVE JUSTIFICATION 

Please use the link here to download the template for the detailed narrative justification to 

support the amounts entered for each budget category above. 

The eligible recipient must provide a budget narrative that identifies and explains how funds in 

each line item of the budget will be used to support the proposed TA projects. The budget 

narrative must provide specific justification for all budget categories that apply, including 

eligible direct cost categories (i.e., personnel, fringe benefits, travel, equipment, supplies, 

contractual, and other), eligible indirect costs, and program income. The budget narrative must 

include an explanation of the necessity, allowability, reasonableness, and allocability of proposed 

costs. Eligible costs must be determined in accordance with 2 C.F.R. Part 200, Subpart E and the 

SSBCI TA Grant Program Guidelines and other SSBCI guidance. Each cost category should be 

treated consistently in like circumstances as direct or indirect costs, and eligible recipients must 

not double-count any costs as both direct and indirect costs. The narrative should not repeat 

information provided in the TA plan but should provide additional detail needed to understand 

the amounts allocated to each budget line item. Any resources and funding dedicated to the 

proposed projects from other funding sources must be clearly identified in the narrative. 

If applicable, the eligible recipient must clearly describe the proposed pre-award costs in the 

budget narrative and provide a compelling justification as to why Treasury should approve them. 

If the eligible recipient submits a cost allocation plan, the recipient must provide the relevant 

Certificate of Cost Allocation Plan required under 2 C.F.R. § 200.415(b)(1). 

Please download the template here and upload the completed document. 
14

SECTION 7: ASSURANCES OF COMPLIANCE 

WITH CIVIL RIGHTS REQUIREMENTS 

If approved, TA Grant Program funding recipients must comply with legal requirements related 

to nondiscrimination and nondiscriminatory use of federal funds, where such laws are applicable 

to a recipient and any subrecipient or contracted entity operating SSBCI programs on the 

recipient’s behalf. To confirm that you will comply with these legal requirements if approved for 

TA Grant Program funding, download, review, and have the TA 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.

Please download the template here and upload the completed document. 

SECTION 8: APPLICATION CERTIFICATION 

AND SUBMISSION 

The TA Authorized Official specified in Section 4.2 or official with delegated authority 

specified in Section 4.2A must sign your application using a DocuSign electronic signature. 

By electronically signing and submitting this application, the entities listed in this application 

and the identified TA Authorized Official or official with delegated authority certify under 

penalty of perjury that: 

1. all the information provided in this application and in email and other forms of 

communication to Treasury about this application is true and correct; 

2. the eligible recipient’s designee has and shall retain documentation and records to support 

the information provided in this application; 

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

all Co-Applicants (if applicable), entities, and organizations listed in this application of 

the status and documentation associated with this application, if applicable; and 

4. the eligible recipient’s designee shall make such supporting documents and records 

available upon request. 
15

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

an email will be sent to the TA Authorized Official in Section 4.2 or official with delegated 

authority in Section 4.2A with your completed application and a DocuSign link to electronically 

sign the application. Please ensure the email addresses provided in Sections 4.2 and 4.2A are 

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. 

[SUBMIT APPLICATION FOR AUTHORIZED SIGNATURE] 

(Render the following on a new page after submission) 

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

signature link has been sent to your Authorized Official in Section 4.2 or the official who has 

been delegated authority in Section 4.2A to electronically sign the application on the TA 

Authorized Official’s behalf. 

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

application. Please make sure your TA Authorized Official in Section 4.2 or official with 

delegated authority specified in Section 4.2A receives and responds to the email with the 

DocuSign electronic signature link. 
16

APPENDIX A: APPLICATION SIGNED AND 

SUBMITTED 

Subject: Your SSBCI Technical Assistance Grant Program application has been 

successfully certified and submitted 

Body: 

Thank you for successfully submitting your application for the SSBCI Technical 

Assistance Grant Program. Your application number is XXXXXXXX. 

Please continue to check Salesforce regarding the status of your application. 

For more information regarding the State Small Business Credit Initiative (SSBCI) 

program, please visit our web page: http://www.treasury.gov/ssbci. 

Signoff: 

Thank you, 

U.S. Department of the Treasury 

State Small Business Credit Initiative 

Ssbci_information@treasury.gov 

Confidentiality Notice: The information in this e-mail and any attachments is confidential 

and solely for the intended addressee(s). Do not share or use them without Treasury’s 

approval. If received in error, contact the sender, and immediately delete this email along 

with any attachments.