Fillable Printable Sba Form 1790
Fillable Printable Sba Form 1790
Sba Form 1790
SBA Form 1790 (11-15) Previous Edition Obsolete
OMB Approval No.: 3245-0270
Expiration Date: 01/31/2019
SEMI-ANNUALREPOR T ON REPRESENTATIVES USED AND COMPENSATION PAID
FOR SERVICES IN CONNECTIONWITHOBTAINING FEDERAL CONTRACTS
FOR THE PERIOD ____________________ TO_____________________.
As required by 15 USC 637(a)(20) (a) and 13 CFR Parts 124.601and 124.112, all 8(a) Par ticipants ar e required to semiannually report to
SBA information on compensation provided to any Agents or Representatives (hereafter referred to as “Representatives”), including
attorneys,accounta nts, and consultants, for assisting the Participants to o btain a Federal contra c t.The information includes the amount
of compensation provided to the Representative and a description of the services performed in return for such compensation.The
information is used to ensure that Participants do not engage in any improper or illegal activity in connection with ob ta ining a contract.
The 1790 is to be submitted at thetime of the firm’s ann ual review and six months thereafterto their s ervicing Bus ines s Opportunity
Specialist (B OS). Failure to pro vide this information is good cause for SBA to initiate proceedings to terminate yo ur 8(a) Program
participation.
Representative’s Name:
Address:City:
State:ZIP Code:
Fees, Commissions or Compensat ion:
Amount P aid (If any)$
Amount Due (If any)
$
Total A mount of Compensation
$
Description of Services Provided:
Representative’s Name:
Address:City:
State:ZIP Code:
Fees, Commissions or Compensat ions:
Amount P aid (If any)
$
Amount Due (If any)
$
Total A mount of Compensation
$
SBA Form 1790 (11-15) Previous Edition Obsolete
Description of Services Provided:
Theundersignedhereby certi fies thattheinformationforthesix-monthperiodbeginning ________________________ and ending
_____________________________, asprovided aboveisaccurate and complete. ( I f n ecessary, the statement of services may be con tinuedon a
separate page).
Name of 8(a) Participant Firm: _____________________________________________________________________________
Principals’Printed Name:__________________ 8(a) Case #___________________
Principals’Printed Title:__________________________________________________________________________________
Principals’Signature:_____Date:_______________________
The total estimated time to respond to this form, including time to read instructions, and compile t he information needed to respond, is
15 minutes. You arenot required to respond to this or any collection of i nformation unless it displays a currently valid OMB approval
number and expiration date. Comments on the burden should be sent to: U.S. Small Business Administration, Chief, AIB, 409 Third
St., S .W., Washington, D C 20 416 andDesk Officer for the U.S. Small Business Administration, Office of Management and Budget,
New Executive Office Building, Room 10202, Washington, DC 20503
PLEASE DO NOT SEND FORMS TO OMB.
