Appendix E-Quarterly Reporting Template SSBCI New York 2026 TA.xlsx

XLSX spreadsheet 321 KB Posted

Attached to
SSBCI Technical Assistance to Capital Programs (Round 2)
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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Data ElementTab LocationData RequirementData TypeDescriptionColor Legend
TA ProviderProvider DataRequiredAlphanumericEnter the name of the TA ProviderProviderEligible BeneficiaryReferralService
Relationship to TA GrantProvider DataRequiredSingle-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 TypeProvider DataConditional (Description of "Other")String/TextProvide a description if "Other" was selected for the data element "TA Provider Type"
Self-Certified SEDI-Owned Business TA ProviderProvider DataRequiredMulti-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 ServicesProvider DataConditional (Description of "Other")String/TextProvide 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 BudgetedProvider DataRequiredCurrencyAmount of TA Grant funds budgeted for the TA provider
TA ProviderEligible Beneficiary DataRequiredAlphanumericEnter the name of the TA Provider
Eligible Beneficiary IdentifierEligible Beneficiary DataRequiredAlphanumericName 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 AddressEligible Beneficiary DataRequiredAlphanumericEnter 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 CityEligible Beneficiary DataRequiredString/TextCity of the eligible beneficiary.
Eligible Beneficiary StateEligible Beneficiary DataRequiredSingle-Select (Dropdown)State of the eligible beneficiary.
Eligible Beneficiary Zip CodeEligible Beneficiary DataRequiredNumericZip code of the eligible beneficiary.
NAICS CodeEligible Beneficiary DataRequiredNumeric2017 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-IdentificationEligible Beneficiary DataConditional (Description of "Prefer to self-describe")String/TextProvide a description if "Prefer to self-describe" was selected in the data element "Gender of Principal Owners"
Sexual Orientation of Principal OwnersEligible Beneficiary DataRequiredMulti-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 ProgramEligible Beneficiary DataConditional (If "N/A" was not selected)AlphanumericIf 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 CapitalEligible Beneficiary DataRequired (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 InvestorEligible Beneficiary DataConditional (Description of "Other")String/TextProvide 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 ProviderTA Service DataRequiredAlphanumericEnter the name of the TA Provider
Eligible Beneficiary IdentifierTA Service DataRequiredAlphanumericName 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 ServiceTA Service DataRequiredSingle-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 DescriptionTA Service DataRequiredString/TextProvide a brief, descriptive overview of TA service.
Style - TA ServiceTA Service DataRequiredSingle-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 ServiceTA Service DataConditional (Description of "Other")String/TextProvide a description if "Other" was selected for the data element "Style - TA Service".
Hours - TA ServiceTA Service DataRequiredNumericNumber of hours spent providing TA Service to the eligible beneficiary.
Classroom-Style TA Service Event - Primary PurposeClassroom-Style TA ServicesConditional (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 - OtherClassroom-Style TA ServicesConditional (Description of "Other")String/TextProvide 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 DescriptionClassroom-Style TA ServicesConditional (If Classroom-Style TA Services are provided)String/TextProvide 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 - AttendeesClassroom-Style TA ServicesConditional (If Classroom-Style TA Services are provided)NumericProvide the number of attendees that attended the classroom-style TA service event.
Classroom-Style TA Service Event - DateClassroom-Style TA ServicesConditional (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 Period4/1/2025-3/31/2026
Total Hours of TA0.00Cause of failure(s):
Total Number of Business Serviced0
Small Business Referrals Made0
Total TA Grant Funds Budgeted$ - 0
SEDI Businesses Serviced0
VSB Businesses Serviced0
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 GrantTA Provider TypeStatesVSBMinority-owned or Controlled Business StatusWomen-Owned or Controlled Business StatusVeteran-Owned or Controlled Business StatusPrimary Purpose - TA ServiceStyle - TA ServicePrimary Purpose - TA Service 2Style - TA Service 2Primary Purpose - TA Service 3Style - TA Service 3Primary Purpose - TA Service 4Style - TA Service 4Classroom-Style TA Service Event - Primary Purpose
TA Grant recipientState entity (including political subdivisions)ALYesYesYesYesLegal services: Assisting with business formation or adopting corporate governance documentsOne-on-one (TA provider worked individually with eligible beneficiary)Legal services: Assisting with business formation or adopting corporate governance documentsOne-on-one (TA provider worked individually with eligible beneficiary)Legal services: Assisting with business formation or adopting corporate governance documentsOne-on-one (TA provider worked individually with eligible beneficiary)Legal services: Assisting with business formation or adopting corporate governance documentsOne-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 collegesAKNoNoNoNoLegal services: Obtaining needed registrations, licenses, filings, and certificationsSmall-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 certificationsSmall-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 certificationsSmall-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 certificationsSmall-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 firmFor-profit entityAZPrefer not to respondPrefer not to respondPrefer not to respondLegal services: Advising on, or preparing documents for, the business to enter into contractsCohort (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 contractsCohort (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 contractsCohort (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 contractsCohort (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 firmNon-profit entityARThe business did not answerThe business did not answerThe business did not answerLegal 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 agreementsOtherLegal 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 agreementsOtherLegal 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 agreementsOtherLegal 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 agreementsOtherLegal 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
OtherCALegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plansLegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plansLegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plansLegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plansLegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership plans
COLegal services: OtherLegal services: OtherLegal services: OtherLegal services: OtherLegal services: Other
CTAccounting services: Preparing audits, financial statements, or business recordsAccounting services: Preparing audits, financial statements, or business recordsAccounting services: Preparing audits, financial statements, or business recordsAccounting services: Preparing audits, financial statements, or business recordsAccounting services: Preparing audits, financial statements, or business records
DEAccounting services: Digitizing financial recordsAccounting services: Digitizing financial recordsAccounting services: Digitizing financial recordsAccounting services: Digitizing financial recordsAccounting services: Digitizing financial records
DCAccounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting softwareAccounting 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
FLAccounting services: OtherAccounting services: OtherAccounting services: OtherAccounting services: OtherAccounting services: Other
GAFinancial advisory services: Assisting with the establishment of banking relationships or other financial servicesFinancial advisory services: Assisting with the establishment of banking relationships or other financial servicesFinancial advisory services: Assisting with the establishment of banking relationships or other financial servicesFinancial advisory services: Assisting with the establishment of banking relationships or other financial servicesFinancial advisory services: Assisting with the establishment of banking relationships or other financial services
HIFinancial advisory services: Assisting with applications for government small business programs, including preparing financial analysesFinancial advisory services: Assisting with applications for government small business programs, including preparing financial analysesFinancial advisory services: Assisting with applications for government small business programs, including preparing financial analysesFinancial advisory services: Assisting with applications for government small business programs, including preparing financial analysesFinancial advisory services: Assisting with applications for government small business programs, including preparing financial analyses
IDfinancial advisory services: Identifying sources of credit, capital, grants, and Other financingfinancial advisory services: Identifying sources of credit, capital, grants, and Other financingfinancial advisory services: Identifying sources of credit, capital, grants, and Other financingfinancial advisory services: Identifying sources of credit, capital, grants, and Other financingFinancial advisory services: Identifying sources of credit, capital, grants, and other financing
ILFinancial advisory services: Advising on factors that may impede access to business financingFinancial advisory services: Advising on factors that may impede access to business financingFinancial advisory services: Advising on factors that may impede access to business financingFinancial advisory services: Advising on factors that may impede access to business financingFinancial advisory services: Advising on factors that may impede access to business financing
INFinancial advisory services: Advising on financial managementFinancial advisory services: Advising on financial managementFinancial advisory services: Advising on financial managementFinancial advisory services: Advising on financial managementFinancial advisory services: Advising on financial management
IAFinancial advisory services: Developing presentations to potential investors, financial models, and business plansFinancial advisory services: Developing presentations to potential investors, financial models, and business plansFinancial advisory services: Developing presentations to potential investors, financial models, and business plansFinancial advisory services: Developing presentations to potential investors, financial models, and business plansFinancial advisory services: Developing presentations to potential investors, financial models, and business plans
KSFinancial advisory services: OtherFinancial advisory services: OtherFinancial advisory services: OtherFinancial advisory services: OtherFinancial 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 ProviderTA Services ProvidedSelf-Certified SEDI-Owned Business StatusRace of Principal OwnersEthnicity of Principal OwnersMiddle Eastern or North African Ancestry of Principal OwnersGender of Principal OwnersSexual Orientation of Principal OwnersVeteran Status of Principal OwnersSmall Business Program ReferralReferral 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 NativeHispanic or Latino/aMiddle Eastern or North AfricanFemaleGay or lesbianVeteranSSBCI-supported lending programCDFI 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 societyLegal services: Obtaining needed registrations, licenses, filings, and certificationsmembership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American societyAsian-IndianNot Hispanic or Latino/aNot Middle Eastern or North AfricanMaleBisexualNon-veteranSSBCI-supported equity/venture capital programNon-CDFI community bank
genderLegal services: Advising on, or preparing documents for, the business to enter into contractsgenderAsian-ChinesePrefer not to respondPrefer not to respondNonbinaryStraight, that is, not gay, lesbian, or bisexualPrefer not to respondOther federal small business programOther bank, thrift, or depository institution holding company
veteran statusLegal 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 agreementsveteran statusAsian-FilipinoThe business did not answerThe business did not answerPrefer to self-describeSomething elseThe business did not answerOther small business programCDFI loan fund
limited English proficiencyLegal services: Legal services related to a transfer of ownership interests in a business, including employee stock ownership planslimited English proficiencyAsian-JapanesePrefer not to respondPrefer not to respondN/ANon-CDFI credit union
disabilityLegal services: OtherdisabilityAsian-KoreanThe business did not answerThe business did not answerNonbank lender or nonbank payment services provider
long-term residence in an environment isolated from the mainstream of American societyAccounting services: Preparing audits, financial statements, or business recordslong-term residence in an environment isolated from the mainstream of American societyAsian-VietnameseNon-CDFI debt or loan fund
membership of a Federally or state-recognized Indian TribeAccounting services: Digitizing financial recordsmembership of a Federally or state-recognized Indian TribeAsian (Other)Growth equity capital fund
long-term residence in a rural communityAccounting services: Advisory services or training regarding accounting practices, recordkeeping, or accounting softwarelong-term residence in a rural communityBlack or African AmericanAngel investor or angel fund
residence in a U.S. territoryAccounting services: Otherresidence in a U.S. territoryNative Hawaiian or Other Pacific IslanderFor-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 servicesresidence 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 ChamorroNonprofit 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 analysesmembership 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 HawaiianCorporate 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 - SamoanCDFI 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)WhiteOther
(5) TA provider self-certified but did not select a demographic categoryFinancial advisory services: Developing presentations to potential investors, financial models, and business plans(5) Eligible beneficiary self-certified but did not select a demographic categoryPrefer not to respond
The TA provider did not certifyFinancial advisory services: OtherEligible beneficiary did not certifyThe business did not answer

PV

0 ERROR:#REF!

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