Personal Financial Statement Form
Exec utive O rders -- Floodplain Management and Wetland Protection (42 F.R. 26951 and 42 F.R. 26961) – SBA
disco ura ges settlement in or d e velop ment of a flood plain or a wetland. This state ment is to no tif y all SBA loan applicants
that such actions are hazardous to both life and property and should be avoided. The additional cost of flood preventive
construction must be considered in addition to the possible loss of all assets and investments due to a future flood.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) -- T his legislation authorizes the Occupational Safety and
Health Administra tion in the Dep a r tment of Labor to r e quire businesses to modif y faciliti es and proced ures to protect
employees or pay penalty fees. B usinesses can be forced to cease oper ations or be prevented from starting operations i n a
new facility. T herefore, SBA may requ ire additional information from a n applicant to deter mine whet her the business will
be in compliance with OSHA r e gulat ions and allowed to o perate its facility after the loan is app r oved and disbursed.
Signing t his form as an appl icant i s c e rtification that the OSHA requireme nts t hat a pply to the applicant b usiness have
been determined and that the applicant, to the best of its knowledge, is in co mpliance. Further more, applicant certifies that
it will remai n in compliance during the life of the loan.
Civil Rights Legislation -- All businesses receiving SBA financial assistance must agree not to discrimi nate in any
business pr actice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R.,
Parts 112, 113, and 117 of SBA Regul ations. This inc ludes maki ng thei r go od s and s ervi ces available to ha ndicapped
client s o r customer s. A ll business borrowers will be required to display the "Equal Employment Opportunity Poste r"
prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) -- The Federal Equal Credit Opportunity Act prohibits cr e ditors from
discr iminating against credit applicants on the b a sis o f rac e , color, religion, national or igin, sex, marital status or age
(provided the applicant has the capacity to e nter into a bindi ng contract); because all or part of the applicant's inco me
derives fro m any public assistance progra m, or because the app licant has in good faith e xe r cised any right u nder the
Consumer Credit Pro te c tion Act.
Exec utive O rder 11 7 38 -- Environmental Protection (38 F.R. 251621) -- The Executive Order charges SBA wit h
administering its loan programs in a manner that will result in effective enforceme nt of the Clean Air Act, the Federal
Water Poll utio n Act and o ther environment p rotection legisla tion.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) -- These laws
require SBA to col lec t aggressively an y l oan payments whi ch become delinquent. S BA m us t obtai n yo ur taxpayer
identi fication nu mber when you apply for a loan. If yo u receive a loan, and do not make payments as they come due, SBA
may take one or more of t he f ollowing actio ns: (1) report the statu s of your loan(s) to credit bureaus, (2) hire a collection
agency t o coll ect your loan, ( 3) offset your i ncome tax refund or other amounts due to you fro m the Federal Government,
(4) suspend or debar you or your company fro m doing business with the Federal Government, (5) refer your loan to the
Department of Justice or other a ttorne ys for litigation, or (6) foreclose on colla te r a l or take other a c tion permitted in the
loan instr uments.
Immigration Reform and Control Act of 1986 (Pub. L. 99-603) -- If yo u are an a l ien who was in this country illegally
since before January 1, 1982, you may have been granted lawful temporary resident status by the United States
Immigr ation and N a turalization Service pursuant to the Immigratio n Reform and Control Act of 1986. Fo r five year s fro m
the date you are granted such status, you are not eligible for financial assistance from the SBA in the form o f a loan
guarant y under S ection 7(a) of the Small B usines s Act u nless you are di s abled or a Cuban or Haitian ent rant. Whe n yo u
sign this document, you are making the certification that the I mmigration Reform and Control Act of 1986 does not apply
to yo u, or if it does apply, more than fi ve years have elapsed since you have been granted lawful temporar y resident status
pursuant t o such 1986 legislation.
Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4821 et seq.)
Borro wers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using lead-
based paint (as defined in SBA regulations) on all interior surfaces, whether accessible or not, and exterior surfaces, such
as stairs, decks, porches, railings, windo ws and doors, which are readily accessible to children under 7 years of age. A
"residential structure" is any home, apartment, hotel, motel, orphanage, boarding school, dormitory, day care center,
extended care facility, college or other school housing, hospital, group practice or commun ity facility and all other
residential o r institutional structure s where persons reside.
Exec utive Order 125 49 , Debarment and Suspens ion 2 CFR 2700
1. The borrower or contractor cer tifies, by sub mis sio n o f its application for an SBA loan or bond guarantee, that neithe r
it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from particip a tion in this transaction by any Federal department or agency.
2. Where the prospective lower tier participant is unable to cer tify to any of the statements in t his cer tification, such
prospective p a rticipants s hall attach an explanation to the applica tion.
SBA Form 413 (7a/504/SBG) (09-14) P r evi ous Edi tions Obsolete Page 5
Personal Financial Statement Form PDF
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