Appendix E-Quarterly Reporting Template SSBCI New York 2026 TA.xlsx
XLSX spreadsheet 321 KB Posted
- Solicitation number
- 2139616
- Issued by
- New York
About this file
Summary
This is a quarterly reporting template for the New York State Small Business Credit Initiative (SSBCI) Technical Assistance Grant program for the fiscal year ending March 31, 2026. The template is designed for Technical Assistance (TA) Providers administering funds to deliver legal, accounting, and financial advisory services to Eligible Beneficiaries through Round 2 of SSBCI TA funding. TA Providers must report comprehensive data on their organization type, SEDI-owned business certification status, services provided, and budget allocations. The program targets very small businesses (VSBs) with fewer than 10 full-time equivalent employees and businesses owned and controlled by socially and economically disadvantaged individuals (SEDI-owned businesses) that are applying for, preparing to apply for, or have previously applied for SSBCI capital programs or other federal and state small business programs.
The reporting template requires TA Providers to document all services delivered during the reporting period, including detailed information on each Eligible Beneficiary served, such as business location, industry classification using 2017 NAICS codes, ownership demographics, minority/women/veteran ownership status, and referrals made to small business programs and capital sources. TA Services must be categorized by type (legal, accounting, or financial advisory), delivery method (one-on-one, small-group, or cohort), and hours spent. The template also captures whether TA Providers or Eligible Beneficiaries self-certified as SEDI-owned businesses based on criteria including racial or ethnic prejudice, gender, veteran status, limited English proficiency, disability, rural residence, Community Development Financial Institution (CDFI) Investment Area location, or membership in underserved communities as defined by Executive Order 13985. The TA Grant funding supports qualifying providers in delivering services that build business capacity and facilitate access to capital and other small business resources for disadvantaged entrepreneurs.
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ToolTips
| Data Element | Tab Location | Data Requirement | Data Type | Description | Color Legend | |||
| TA Provider | Provider Data | Required | Alphanumeric | Enter the name of the TA Provider | Provider | Eligible Beneficiary | Referral | Service |
| Relationship to TA Grant | Provider Data | Required | Single-Select (Dropdown) | Indicate which category applies to the TA provider: |
- TA Grant recipient
- TA Grant subrecipient - entity of TA Grant recipient (including political subdivisions)
- TA Grant subrecipient - legal, accounting, or financial advisory firm
- TA Grant contractor - legal, accounting, or financial advisory firm
- Sister to the TA Grant Recipient TA Provider Type Provider Data Required Single-Select (Dropdown) Indicate what type of entity the TA provider is (if multiple types apply, choose the one that best describes the TA provider):
- State entity (including political subdivisions)
- Institution of higher education-affiliated entity, including community colleges
- For-profit entity
- Non-profit entity
- Other
| Other TA Provider Type | Provider Data | Conditional (Description of "Other") | String/Text | Provide a description if "Other" was selected for the data element "TA Provider Type" |
| Self-Certified SEDI-Owned Business TA Provider | Provider Data | Required | Multi-Select (Double click for menu) | Indicate whether the TA provider self-certified that it is a SEDI-owned business. Select all categories in groups (1) through (4) that apply, including all subcategories in group (1) that apply: |
- (1) TA provider self-certified it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to other in comparable economic circumstances, due to their:
- membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society
- gender
- veteran status
- limited English proficiency
- disability
- long-term residence in an environment isolated from the mainstream of American society
- membership of a Federally or state-recognized Indian Tribe
- residence in a U.S. territory
- residence in a community undergoing economic transitions (including communities impacted by the shift towards a net-zero economy or deindustrialization)
- membership of an "underserved community" as defined in Executive Order 13985 (see the definition of "SEDI-owned business"
- (2) TA provider self-certified it is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)
- (3) TA provider self-certified 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)
- (4) TA provider self-certified that it is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)
- (5) TA provider self-certified but did not select a demographic category
- The TA provider did not certify TA Services Provided Provider Data Required Multi-Select (Double click for menu) Indicate the types of TA services that the TA provider provides (if multiple types apply, select all that apply):
-Legal services: Assisting with business formation or adopting corporate governance documents -Legal services: Obtaining needed registrations, licenses, filings, and certifications -Legal services: Advising on, or preparing documents for, the business to enter into contracts -Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements -Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans
- Legal services: Other
- Accounting services: Digitizing financial records
- Accounting services: Preparing audits, financial statements, or business records
- Accounting services: Advisory services or training regrading accounting practices, recordkeeping, or accounting software
- Accounting services: Other
- Financial advisory services: Assisting with the establishment of banking relationships or other financial services
- Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses
- Financial advisory services: Identifying sources of credit, capital, grants and other financing
- Financial advisory services: Advising on factor that may impede access to business financing
- Financial advisory services: Advising on financial management
- Financial advisory services: Developing presentations to potential investors, financial models, and business plan
- Financial advisory services: Other
| Description of Other TA Services | Provider Data | Conditional (Description of "Other") | String/Text | Provide a description if "Legal Services: Other”, “Accounting services: Other", or "Financial advisory services: Other" was selected for the data element "TA Services Provided" |
| Amount of TA Grant Funds Budgeted | Provider Data | Required | Currency | Amount of TA Grant funds budgeted for the TA provider |
| TA Provider | Eligible Beneficiary Data | Required | Alphanumeric | Enter the name of the TA Provider |
| Eligible Beneficiary Identifier | Eligible Beneficiary Data | Required | Alphanumeric | Name of the business that is the eligible beneficiary. If the eligible beneficiary prefers not to be identified by name, enter an alphanumeric or numeric code that serves as an anonymous identifier for the eligible beneficiary. Do not provide a Social Security number as an identifier. |
| Eligible Beneficiary Street Address | Eligible Beneficiary Data | Required | Alphanumeric | Enter the street address of the eligible beneficiary. |
If the eligible beneficiary business does not provide an address or prefers not to respond, enter "None provided."
| Eligible Beneficiary City | Eligible Beneficiary Data | Required | String/Text | City of the eligible beneficiary. |
| Eligible Beneficiary State | Eligible Beneficiary Data | Required | Single-Select (Dropdown) | State of the eligible beneficiary. |
| Eligible Beneficiary Zip Code | Eligible Beneficiary Data | Required | Numeric | Zip code of the eligible beneficiary. |
| NAICS Code | Eligible Beneficiary Data | Required | Numeric | 2017 North American Industry Classification System |
(NAICS) code for the eligible beneficiary’s industry. Each industry sector is defined by the U.S. Census Bureau; see https://www.census.gov/programs-surveys/economic-census/year/2022/guidance/understanding-naics.html.
If multiple NAICS codes apply, choose the one that best describes the eligible beneficiary.
Full-Time Equivalent Employees Eligible Beneficiary Data Required Numeric The eligible beneficiary's full-time equivalent employees (FTEs), rounded to the nearest whole number, at the time TA services are provided. This is determined by adding the number of full-time employees and the number of part-time and seasonal employees as a fraction of a full-time employee.
For example, if a business has 100 employees working full-time (assume a full-time week of 40 hours) and 50 employees working 20 hours per week, the total number of FTEs would be 125. For seasonal employees, the FTE count is based on a 2,080-hour year, so that an employee who works 520 hours per year counts as 0.25 FTEs.
Volunteers (i.e., individuals who receive no compensation, including no in-kind compensation, for work performed) are not considered employees.
This data element can be used to assess whether a business qualifies as VSB VSB Eligible Beneficiary Data Required Single-Select (Dropdown) Indicate whether the eligible beneficiary's business is a VSB (Defined as fewer than 10 Full-Time Equivalent Employees).
- Yes -No
The TA Grant recipient may reasonably determine that a business is a VSB based on the FTE number provided by the business or a certification that the business meets the definition of VSB.
Self-Certified SEDI-Owned Business Status Eligible Beneficiary Data Required Multi-Select (Double click for menu) Indicate whether the eligible beneficiary self-certified that it is a SEDI-owned business. Select all categories in groups (1) through (4) that apply:
-(1) Eligible beneficiary self-certified it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to others in comparable economic circumstances, due to their:
-membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society -gender -veteran status -limited English proficiency -disability -long-term residence in an environment isolated from the mainstream of American society -membership of a Federally or state-recognized Indian Tribe -long-term residence in a rural community -residence in a U.S. territory -residence in a community undergoing economic transitions (including communities impacted by the shift towards a net zero economy or deindustrialization) -membership of an “underserved community” as defined in Executive Order 13985 (see the definition of “SEDI-owned business” in Section II above) -(2) Eligible beneficiary self-certified it is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii) -(3) Eligible beneficiary self-certified 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) -(4) Eligible beneficiary self-certified that it is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii) -(5) Eligible beneficiary self-certified but did not select a demographic category -Eligible beneficiary did not certify Minority-owned or Controlled Business Status Eligible Beneficiary Data Required Single-Select (Dropdown) Indicate whether the eligible beneficiary is a minority-owned or controlled business:
-Yes -No -Prefer not to respond -The business did not answer Women-Owned or Controlled Business Status Eligible Beneficiary Data Required Single-Select (Dropdown) Indicate whether the eligible beneficiary is a women-owned or controlled business:
-Yes -No -Prefer not to respond -The business did not answer Veteran-Owned or Controlled Business Status Eligible Beneficiary Data Required Single-Select (Dropdown) Indicate whether the eligible beneficiary is a veteran-owned or controlled business:
-Yes -No -Prefer not to respond -The business did not answer Race of Principal Owners Eligible Beneficiary Data Required Multi-Select (Double click for menu) dictate the race categories with which the principal owner or principal owners identify (check all that apply):
-American Indian or Alaska Native -Asian --Indian --Chinese --Filipino --Japanese --Korean --Vietnamese --Asian (Other) -Black or African American -Native Hawaiian or Other Pacific Islander --Guamanian or Chamorro --Native Hawaiian --Samoan --Pacific Islander (Other) -White -Prefer not to respond -The business did not answer Ethnicity of Principal Owners Eligible Beneficiary Data Required Multi-Select (Double click for menu) Indicate the following ethnicity categories with which the principal owner or principal owners identify (check all that apply):
-Hispanic or Latino/a -Not Hispanic or Latino/a -Prefer not to respond -The business did not answer Middle Eastern or North African Ancestry of Principal Owners Eligible Beneficiary Data Required Multi-Select (Double click for menu) Indicate the following ancestry categories with which the principal owner or principal owners identify (check all that apply):
-Middle Eastern or North African -Not Middle Eastern or North African -Prefer not to respond -The business did not answer Gender of Principal Owners Eligible Beneficiary Data Required Multi-Select (Double click for menu) Indicate the following gender categories with which the principal owner or principal owners identify (check all that apply):
-Female -Male -Nonbinary -Prefer to self-describe -Prefer not to respond -The business did not answer
| Gender of Principal Owners - Self-Identification | Eligible Beneficiary Data | Conditional (Description of "Prefer to self-describe") | String/Text | Provide a description if "Prefer to self-describe" was selected in the data element "Gender of Principal Owners" |
| Sexual Orientation of Principal Owners | Eligible Beneficiary Data | Required | Multi-Select (Double click for menu) | Indicate the following sexual orientation categories with which the principal owner or principal owners identify (check all that apply): |
-Gay or lesbian -Bisexual -Straight, that is, not gay, lesbian, or bisexual -Something else -Prefer not to respond -The business did not answer Veteran Status of Principal Owners Eligible Beneficiary Data Required Multi-Select (Double click for menu) Indicate the following categories with which the principal owner or principal owners identify (check all that apply):
-Veteran -Non-veteran -Prefer not to respond -The business did not answer Small Business Program Referral Eligible Beneficiary Data Required Multi-Select (Double click for menu) If the TA provider made a referral to a small business program with respect to the eligible beneficiary, check all that apply:
-SSBCI-supported lending program -SSBCI-supported equity/venture capital program -Other federal small business program -Other small business program -N/A
| Name of Small Business Program | Eligible Beneficiary Data | Conditional (If "N/A" was not selected) | Alphanumeric | If the TA provider made a referral to a small business program with respect to the eligible beneficiary, specify the name of each small business program to which the eligible beneficiary was referred. |
| Referral to Source of Capital | Eligible Beneficiary Data | Required (If applicable, otherwise skip) | Multi-Select (Double click for menu) | If the TA provider made a referral to a potential source of capital with respect to the eligible beneficiary, check all that apply: |
-CDFI bank, thrift, or depository institution holding company -Non-CDFI community bank -Other bank, thrift, or depository institution holding company -CDFI loan fund -Non-CDFI credit union -Nonbank lender or nonbank payment services provider -Non-CDFI debt or loan fund -Growth equity capital fund -Angel investor or angel fund -For-profit venture capital fund -Nonprofit venture capital fund or venture/entrepreneurial development organization -Corporate venture capital fund -CDFI venture capital fund -University/technology transfer office -Other
| Description of Other Lender or Other Investor | Eligible Beneficiary Data | Conditional (Description of "Other") | String/Text | Provide a description of the type of lender or investor if selected "Other" for the data element "Referral to Source of Capital". Note that the TA provider is not required to specify the name of the lender or investor. |
| TA Provider | TA Service Data | Required | Alphanumeric | Enter the name of the TA Provider |
| Eligible Beneficiary Identifier | TA Service Data | Required | Alphanumeric | Name of the business that is the eligible beneficiary. If the eligible beneficiary prefers not to be identified by name, enter an alphanumeric or numeric code that serves as an anonymous identifier for the eligible beneficiary. Do not provide a Social Security number as an identifier. |
| Primary Purpose - TA Service | TA Service Data | Required | Single-Select (Dropdown) | Indicate the primary purpose of TA service: |
-Legal services: Assisting with business formation or adopting corporate governance documents -Legal services: Obtaining needed registrations, licenses, filings, and certifications -Legal services: Advising on, or preparing documents for, the business to enter into contracts -Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements -Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans -Legal services: Other -Accounting services: Preparing audits, financial statements, or business records -Accounting services: Digitizing financial records -Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software -Accounting services: Other -Financial advisory services: Assisting with the establishment of banking relationships or other financial services -Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses -Financial advisory services: Identifying sources of credit, capital, grants, and other financing -Financial advisory services: Advising on factors that may impede access to business financing -Financial advisory services: Advising on financial management -Financial advisory services: Developing presentations to potential investors, financial models, and business plans -Financial advisory services: Other Primary Purpose of TA Service - Other TA Service Data Conditional (Description of "Other") String/Text Provide a description if “Legal Services: Other,” “Accounting services: Other,” or “Financial advisory services:
Other” was selected for the data element “Primary Purpose – TA Service.”
| TA Service - Brief Description | TA Service Data | Required | String/Text | Provide a brief, descriptive overview of TA service. |
| Style - TA Service | TA Service Data | Required | Single-Select (Dropdown) | Indicate how the TA provider provided TA service. |
-One-on-one (TA provider worked individually with eligible beneficiary) -Small-group (TA provider worked with a group to address specific small business issues (generally 2-10 people, but number may vary)) -Cohort (a group of eligible beneficiaries advanced through an educational program or curriculum) -Other
| Description of Other Style - TA Service | TA Service Data | Conditional (Description of "Other") | String/Text | Provide a description if "Other" was selected for the data element "Style - TA Service". |
| Hours - TA Service | TA Service Data | Required | Numeric | Number of hours spent providing TA Service to the eligible beneficiary. |
| Classroom-Style TA Service Event - Primary Purpose | Classroom-Style TA Services | Conditional (If Classroom-Style TA Services are provided) | Single-Select (Dropdown) | Indicate the primary purpose of the classroom-style TA service event: |
-Legal services: Assisting with business formation or adopting corporate governance documents -Legal services: Obtaining needed registrations, licenses, filings, and certifications -Legal services: Advising on, or preparing documents for, the business to enter into contracts -Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements -Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans -Legal services: Other -Accounting services: Preparing audits, financial statements, or business records -Accounting services: Digitizing financial records -Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software -Accounting services: Other -Financial advisory services: Assisting with the establishment of banking relationships or other financial services -Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses -Financial advisory services: Identifying sources of credit, capital, grants, and other financing -Financial advisory services: Advising on factors that may impede access to business financing -Financial advisory services: Advising on financial management -Financial advisory services: Developing presentations to potential investors, financial models, and business plans -Financial advisory services: Other
| Primary Purpose of Classroom-Style TA Service Event - Other | Classroom-Style TA Services | Conditional (Description of "Other") | String/Text | Provide a description if "Legal Services: Other", "Accounting services: Other", or "Financial advisory services: Other" was selected for the data element "Classroom-Style TA Service Event - Primary" |
| Classroom-Style TA Service Event - Brief Description | Classroom-Style TA Services | Conditional (If Classroom-Style TA Services are provided) | String/Text | Provide a brief, descriptive overview of the classroom-style TA service event, including how the TA provider specifically targeted the event towards eligible beneficiaries. |
| Classroom-Style TA Service Event - Attendees | Classroom-Style TA Services | Conditional (If Classroom-Style TA Services are provided) | Numeric | Provide the number of attendees that attended the classroom-style TA service event. |
| Classroom-Style TA Service Event - Date | Classroom-Style TA Services | Conditional (If Classroom-Style TA Services are provided) | Date (MM/DD/YYYY) | Provide the date of the classroom-style TA service event. |
Cover Page
| The cells on this Cover Page contain prepopulated and/or calculated values and cannot be edited. | Current Status (basic validation checks): | |
| Data Validated | ||
| Reporting Period | 4/1/2025-3/31/2026 |
| Total Hours of TA | 0.00 | Cause of failure(s): |
| Total Number of Business Serviced | 0 | |
| Small Business Referrals Made | 0 | |
| Total TA Grant Funds Budgeted | $ - 0 |
| SEDI Businesses Serviced | 0 |
| VSB Businesses Serviced | 0 |
| SSBCI Privacy Notice | |
| Information from this collection will be shared with the U.S. Department of the Treasury |
(Treasury). Treasury will maintain a Privacy and Civil Liberties Impact Assessment that describes what Treasury will do with the information your business provides in connection with the SSBCI TA Grant program. It can be found on the Treasury website. If you have any questions about this document, please email Privacy@Treasury.gov.
| Paperwork Reduction Act Notice |
| OMB Control Number 1505-0227: 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. |
Run Preliminary Validations
Provider Data
| TA Provider | |
| Administrator: Enter the name of the TA provider. | Relationship to TA Grant |
| Administrator: Indicate which category applies to the TA provider. | TA Provider Type |
| Administrator: Indicate what type of entity the TA provider is (if multiple types apply, choose the one that best describes the TA provider). | Other TA Provider Type |
| Administrator: Provide a description if "Other" was selected for the data element "TA Provider Type" | Self-Certified SEDI-Owned Business TA Provider |
Administrator: Indicate whether the TA provider self-certified that it is a SEDI-owned business.
| Select all categories in groups (1) through (5) that apply, including all subcategories in group (1) that apply. | TA Services Provided |
| Administrator: Indicate the types of TA services the TA provider provides (if multiple types apply, select all that apply). | Description of Other TA Services |
| Administrator: Provide a description if "Legal Services: Other”, “Accounting services: Other", or "Financial advisory services: Other" was selected for the data element "TA Services Provided" | Amount of TA Grant Funds Budgeted |
Administrator: Amount of TA Grant funds budgeted for the TA provider.
Eligible Beneficiary Data TA Provider Administrator: Enter the name of the TA provider.
Eligible Beneficiary Identifier Administrator: Name of the business that is the eligible beneficiary. If the eligible beneficiary prefers not to be identified by name, enter an alphanumeric or numeric code that serves as an anonymous identifier for the eligible beneficiary. Do not provide a Social Security number as an identifier.
Eligible Beneficiary Street Address Administrator: Enter the street address of the eligible beneficiary.
| If the eligible beneficiary business does not provide an address or prefers not to respond, enter “None provided.” | Eligible Beneficiary City |
| Administrator: City of the eligible beneficiary. | Eligible Beneficiary State |
| Administrator: State of the eligible beneficiary. | Eligible Beneficiary Zip Code |
| Administrator: Zip code of the eligible beneficiary. | NAICS Code |
Administrator: 2017 North American Industry Classification System (NAICS) code for the eligible beneficiary’s industry. Each industry sector is defined by the U.S. Census Bureau; see https://www.census.gov/programs-surveys/economic-census/year/2022/guidance/understanding-naics.html.
If multiple NAICS codes apply, choose the one that best describes the eligible beneficiary. Full-Time Equivalent Employees Administrator: The eligible beneficiary’s full-time equivalent employees (FTEs), rounded to the nearest whole number, at the time TA services are provided. This is determined by adding the number of full-time employees and the number of part-time and seasonal employees as a fraction of a full-time employee.
For example, if a business has 100 employees working full-time (assume a full-time week of 40 hours) and 50 employees working 20 hours per week, the total number of FTEs would be 125. For seasonal employees, the FTE count is based on a 2,080-hour year, so that an employee who works 520 hours per year counts as 0.25 FTEs.
Volunteers (i.e., individuals who receive no compensation, including no in-kind compensation, for work performed) are not considered employees.
This data element can be used to assess whether a business qualifies as a VSB. VSB Administrator: Indicate whether the eligible beneficiary’s business is a VSB (Defined as fewer than 10 Full-Time Equivalent Employees).
The TA Grant recipient may reasonably determine that a business is a VSB based on the FTE number provided by the business or a certification that the business meets the definition of VSB.
| Self-Certified SEDI-Owned Business Status | |
| Administrator: Indicate whether the eligible beneficiary self-certified that it is a SEDI-owned business. Select all categories in groups (1) through (5) that apply. | Minority-Owned or Controlled Business Status |
Administrator: Indicate whether the eligible beneficiary is a minority-owned or controlled business.
| Women-Owned or Controlled Business Status | |
| Administrator: Indicate whether the eligible beneficiary is a women-owned or controlled business. | Veteran-Owned or Controlled Business Status |
Administrator: Indicate whether the eligible beneficiary is a veteran-owned or controlled business. Race of Principal Owners Administrator: Indicate the race categories with which the principal owner or principal owners identify.
Check all that apply. Ethnicity of Principal Owners Administrator: Indicate the following ethnicity categories with which the principal owner or principal owners identify.
Check all that apply.
Middle Eastern or North African Ancestry of Principal Owners Administrator: Indicate the following ancestry categories with which the principal owner or principal owners identify.
Check all that apply.
Gender of Principal Owners Administrator: Indicate the following gender categories with which the principal owner or principal owners identify.
| Check all that apply. | Gender or Principal Owners - Self-Identification |
| Administrator: Provide a description if "Prefer to self-describe" was selected in the data element "Gender of Principal Owners" | Sexual Orientation of Principal Owners |
Administrator: Indicate the following sexual orientation categories with which the principal owner or principal owners identify.
Check all that apply. Veteran Status of Principal Owners Administrator: Indicate the following categories with which the principal owner or principal owners identify.
| Check all that apply. | Small Business Program Referral |
| Administrator: If the TA provider made a referral to a small business program with respect to the eligible beneficiary, check all that apply. | Name of Small Business Program |
| Administrator: If the TA provider made a referral to a small business program with respect to the eligible beneficiary, specify the name of each small business program to which the eligible beneficiary was referred. | Referral to Source of Capital |
| Administrator: If the TA provider made a referral to a potential source of capital with respect to the eligible beneficiary, check all that apply. | Description of Other Lender or Other Investor |
Administrator: Provide a description of the type of lender or investor if selected "Other" for the data element "Referral to Source of Capital". Note that the TA provider is not required to specify the name of the lender or investor.
TA Service Data TA Provider Administrator: Enter the name of the TA provider.
Eligible Beneficiary Identifier Administrator: Name of the business that is the eligible beneficiary. If the eligible beneficiary prefers not to be identified by name, enter an alphanumeric or numeric code that serves as an anonymous identifier for the eligible beneficiary. Do not provide a Social Security number as an identifier.
| Primary Purpose - TA Service | |
| Administrator: Indicate the primary purpose of TA service. | Primary Purpose of TA Service - Other |
Administrator: Provide a description if “Legal Services: Other,” “Accounting services: Other,” or “Financial advisory services:
| Other” was selected for the data element “Primary Purpose – TA Service.” | TA Service - Brief Description |
| Administrator: Provide a brief, descriptive overview of TA service. | Style - TA Service |
| Administrator: Indicate how the TA provider provided TA service. | Description of Other Style - TA Service |
| Administrator: Provide a description if "Other" was selected for the data element "Style - TA Service". | Hours - TA Service |
Administrator: Number of hours spent providing TA Service to the eligible beneficiary.
Classroom-Style TA Services
| Classroom-Style TA Service Event - Primary Purpose | |
| Administrator: Indicate the primary purpose of the classroom-style TA service event. | Primary Purpose of Classroom-Style TA Service Event - Other |
| Administrator: Provide a brief, descriptive overview of the classroom-style TA service event, including how the TA provider specifically targeted the event towards eligible beneficiaries. | Classroom-Style TA Service Event - Brief Description |
| Administrator: Provide a brief, descriptive overview of the classroom-style TA service event, including how the TA provider specifically targeted the event towards eligible beneficiaries. | Classroom-Style Service Event - Attendees |
| Administrator: Provide the number of attendees that attended the classroom-style TA service event. | Classroom-Style Service Event - Date |
Administrator: Provide the date of the classroom-style TA service event.
Single Select DV
| Relationship to TA Grant | TA Provider Type | States | VSB | Minority-owned or Controlled Business Status | Women-Owned or Controlled Business Status | Veteran-Owned or Controlled Business Status | Primary Purpose - TA Service | Style - TA Service | Primary Purpose - TA Service 2 | Style - TA Service 2 | Primary Purpose - TA Service 3 | Style - TA Service 3 | Primary Purpose - TA Service 4 | Style - TA Service 4 | Classroom-Style TA Service Event - Primary Purpose |
| TA Grant recipient | State entity (including political subdivisions) | AL | Yes | Yes | Yes | Yes | Legal services: Assisting with business formation or adopting corporate governance documents | One-on-one (TA provider worked individually with eligible beneficiary) | Legal services: Assisting with business formation or adopting corporate governance documents | One-on-one (TA provider worked individually with eligible beneficiary) | Legal services: Assisting with business formation or adopting corporate governance documents | One-on-one (TA provider worked individually with eligible beneficiary) | Legal services: Assisting with business formation or adopting corporate governance documents | One-on-one (TA provider worked individually with eligible beneficiary) | Legal services: Assisting with business formation or adopting corporate governance documents |
| TA Grant subrecipient – entity of TA Grant recipient (including political subdivisions) | Institution of higher education-affiliated entity, including community colleges | AK | No | No | No | No | Legal services: Obtaining needed registrations, licenses, filings, and certifications | Small-group (TA provider worked with a group to address specific small business issues (generally 2-10 people, but number may vary)) | Legal services: Obtaining needed registrations, licenses, filings, and certifications | Small-group (TA provider worked with a group to address specific small business issues (generally 2-10 people, but number may vary)) | Legal services: Obtaining needed registrations, licenses, filings, and certifications | Small-group (TA provider worked with a group to address specific small business issues (generally 2-10 people, but number may vary)) | Legal services: Obtaining needed registrations, licenses, filings, and certifications | Small-group (TA provider worked with a group to address specific small business issues (generally 2-10 people, but number may vary)) | Legal services: Obtaining needed registrations, licenses, filings, and certifications |
| TA Grant subrecipient – legal, accounting, or financial advisory firm | For-profit entity | AZ | Prefer not to respond | Prefer not to respond | Prefer not to respond | Legal services: Advising on, or preparing documents for, the business to enter into contracts | Cohort (a group of eligible beneficiaries advanced through an educational program or curriculum) | Legal services: Advising on, or preparing documents for, the business to enter into contracts | Cohort (a group of eligible beneficiaries advanced through an educational program or curriculum) | Legal services: Advising on, or preparing documents for, the business to enter into contracts | Cohort (a group of eligible beneficiaries advanced through an educational program or curriculum) | Legal services: Advising on, or preparing documents for, the business to enter into contracts | Cohort (a group of eligible beneficiaries advanced through an educational program or curriculum) | Legal services: Advising on, or preparing documents for, the business to enter into contracts | |
| TA Grant contractor – legal, accounting, or financial advisory firm | Non-profit entity | AR | The business did not answer | The business did not answer | The business did not answer | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | Other | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | Other | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | Other | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | Other | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | |
| Other | CA | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | |||||||||
| CO | Legal services: Other | Legal services: Other | Legal services: Other | Legal services: Other | Legal services: Other | ||||||||||
| CT | Accounting services: Preparing audits, financial statements, or business records | Accounting services: Preparing audits, financial statements, or business records | Accounting services: Preparing audits, financial statements, or business records | Accounting services: Preparing audits, financial statements, or business records | Accounting services: Preparing audits, financial statements, or business records | ||||||||||
| DE | Accounting services: Digitizing financial records | Accounting services: Digitizing financial records | Accounting services: Digitizing financial records | Accounting services: Digitizing financial records | Accounting services: Digitizing financial records | ||||||||||
| DC | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software. | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software. | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software. | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software | ||||||||||
| FL | Accounting services: Other | Accounting services: Other | Accounting services: Other | Accounting services: Other | Accounting services: Other | ||||||||||
| GA | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | ||||||||||
| HI | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | ||||||||||
| ID | financial advisory services: Identifying sources of credit, capital, grants, and Other financing | financial advisory services: Identifying sources of credit, capital, grants, and Other financing | financial advisory services: Identifying sources of credit, capital, grants, and Other financing | financial advisory services: Identifying sources of credit, capital, grants, and Other financing | Financial advisory services: Identifying sources of credit, capital, grants, and other financing | ||||||||||
| IL | Financial advisory services: Advising on factors that may impede access to business financing | Financial advisory services: Advising on factors that may impede access to business financing | Financial advisory services: Advising on factors that may impede access to business financing | Financial advisory services: Advising on factors that may impede access to business financing | Financial advisory services: Advising on factors that may impede access to business financing | ||||||||||
| IN | Financial advisory services: Advising on financial management | Financial advisory services: Advising on financial management | Financial advisory services: Advising on financial management | Financial advisory services: Advising on financial management | Financial advisory services: Advising on financial management | ||||||||||
| IA | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | ||||||||||
| KS | Financial advisory services: Other | Financial advisory services: Other | Financial advisory services: Other | Financial advisory services: Other | Financial advisory services: Other | ||||||||||
| KY | |||||||||||||||
| LA | |||||||||||||||
| ME | |||||||||||||||
| MD | |||||||||||||||
| MA | |||||||||||||||
| MI | |||||||||||||||
| MN | |||||||||||||||
| MS | |||||||||||||||
| MO | |||||||||||||||
| MT | |||||||||||||||
| NE | |||||||||||||||
| NV | |||||||||||||||
| NH | |||||||||||||||
| NJ | |||||||||||||||
| NM | |||||||||||||||
| NY | |||||||||||||||
| NC | |||||||||||||||
| ND | |||||||||||||||
| OH | |||||||||||||||
| OK | |||||||||||||||
| OR | |||||||||||||||
| PA | |||||||||||||||
| RI | |||||||||||||||
| SC | |||||||||||||||
| SD | |||||||||||||||
| TN | |||||||||||||||
| TX | |||||||||||||||
| UT | |||||||||||||||
| VT | |||||||||||||||
| VA | |||||||||||||||
| WA | |||||||||||||||
| WV | |||||||||||||||
| WI | |||||||||||||||
| WY | |||||||||||||||
| AS | |||||||||||||||
| VI | |||||||||||||||
| GU | |||||||||||||||
| MP | |||||||||||||||
| PR |
Multi-Select DV
| Self-Certified SEDI-Owned Business TA Provider | TA Services Provided | Self-Certified SEDI-Owned Business Status | Race of Principal Owners | Ethnicity of Principal Owners | Middle Eastern or North African Ancestry of Principal Owners | Gender of Principal Owners | Sexual Orientation of Principal Owners | Veteran Status of Principal Owners | Small Business Program Referral | Referral to Source of Capital |
| (1) TA provider self-certified it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to others in comparable economic circumstances, due to their: | Legal services: Assisting with business formation or adopting corporate governance documents | (1) Eligible beneficiary self-certified it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to others in comparable economic circumstances, due to their: | American Indian or Alaska Native | Hispanic or Latino/a | Middle Eastern or North African | Female | Gay or lesbian | Veteran | SSBCI-supported lending program | CDFI bank, thrift, or depository institution holding company |
| membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society | Legal services: Obtaining needed registrations, licenses, filings, and certifications | membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society | Asian-Indian | Not Hispanic or Latino/a | Not Middle Eastern or North African | Male | Bisexual | Non-veteran | SSBCI-supported equity/venture capital program | Non-CDFI community bank |
| gender | Legal services: Advising on, or preparing documents for, the business to enter into contracts | gender | Asian-Chinese | Prefer not to respond | Prefer not to respond | Nonbinary | Straight, that is, not gay, lesbian, or bisexual | Prefer not to respond | Other federal small business program | Other bank, thrift, or depository institution holding company |
| veteran status | Legal services: Legal services related to the business obtaining capital from investors, such as the development of financial instruments, investment term sheets, purchase agreements, and shareholder rights agreements | veteran status | Asian-Filipino | The business did not answer | The business did not answer | Prefer to self-describe | Something else | The business did not answer | Other small business program | CDFI loan fund |
| limited English proficiency | Legal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans | limited English proficiency | Asian-Japanese | Prefer not to respond | Prefer not to respond | N/A | Non-CDFI credit union | |||
| disability | Legal services: Other | disability | Asian-Korean | The business did not answer | The business did not answer | Nonbank lender or nonbank payment services provider | ||||
| long-term residence in an environment isolated from the mainstream of American society | Accounting services: Preparing audits, financial statements, or business records | long-term residence in an environment isolated from the mainstream of American society | Asian-Vietnamese | Non-CDFI debt or loan fund | ||||||
| membership of a Federally or state-recognized Indian Tribe | Accounting services: Digitizing financial records | membership of a Federally or state-recognized Indian Tribe | Asian (Other) | Growth equity capital fund | ||||||
| long-term residence in a rural community | Accounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting software | long-term residence in a rural community | Black or African American | Angel investor or angel fund | ||||||
| residence in a U.S. territory | Accounting services: Other | residence in a U.S. territory | Native Hawaiian or Other Pacific Islander | For-profit venture capital fund | ||||||
| residence in a community undergoing economic transitions (including communities impacted by the shift towards a net-zero economy or deindustrialization) | Financial advisory services: Assisting with the establishment of banking relationships or other financial services | residence in a community undergoing economic transitions (including communities impacted by the shift towards a net-zero economy or deindustrialization) | Native Hawaiian or Other Pacific Islander - Guamanian or Chamorro | Nonprofit venture capital fund or venture/entrepreneurial development organization | ||||||
| membership of an “underserved community” as defined in Executive Order 13985 (see the definition of “SEDI-owned business” in Section II above) | Financial advisory services: Assisting with applications for government small business programs, including preparing financial analyses | membership of an “underserved community” as defined in Executive Order 13985 (see the definition of “SEDI-owned business” in Section II above) | Native Hawaiian or Other Pacific Islander - Native Hawaiian | Corporate venture capital fund | ||||||
| (2) TA provider self-certified it is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii) | Financial advisory services: Identifying sources of credit, capital, grants, and other financing | (2) Eligible beneficiary self-certified it is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii) | Native Hawaiian or Other Pacific Islander - Samoan | CDFI venture capital fund | ||||||
| (3) TA provider self-certified 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) | Financial advisory services: Advising on factors that may impede access to business financing | (3) Eligible beneficiary self-certified 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) | Native Hawaiian or Other Pacific Islander - Pacific Islander (Other) | University/technology transfer office | ||||||
| (4) TA provider self-certified that it is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b) (3)(ii) | Financial advisory services: Advising on financial management | (4) Eligible beneficiary self-certified that it is located in a CDFI Investment Area, as defined in 12 C.F.R. §1805.201(b)(3)(ii) | White | Other | ||||||
| (5) TA provider self-certified but did not select a demographic category | Financial advisory services: Developing presentations to potential investors, financial models, and business plans | (5) Eligible beneficiary self-certified but did not select a demographic category | Prefer not to respond | |||||||
| The TA provider did not certify | Financial advisory services: Other | Eligible beneficiary did not certify | The business did not answer |
PV
0 ERROR:#REF!
EB
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