When starting a small business, there are many important forms to fill out and file with the government. One of these is the SBA Form 5C. This form is used to apply for small business loans and assistance from the Small Business Administration (SBA). The SBA is a government agency that provides support and resources to small businesses. The form can be intimidating to complete, but with this guide you will be able to complete it easily.
The listing features details about the sba form 5c. You can find out its size, the average time to prepare the form, the fields you will have to fill in, and so forth.
Question | Answer |
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Form Name | Sba Form 5C |
Form Length | 6 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min 30 sec |
Other names | sba form 5c pdf, sba disaster home loan application, sba 5c business, sba disaster loan forms |
U. S. SMALL BUSINESS ADMINISTRATION DISASTER HOME / SOLEPROPRIETOR LOAN APPLICATION
OMB No. :
Expiration: 07/31/2021
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SBA Internal Use Only: |
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Date Received |
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Location |
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By |
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SBA Application Number: |
FEMA Registration Number: |
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Filing Deadline: |
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Declaration Number: |
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ARE YOU APPLYING FOR: |
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Primary Residence |
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Sole Proprietor - Physical Damage |
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Sole Proprietor - Economic Injury |
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INFORMATION ABOUT THE APPLICANT(S) |
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Primary Applicant |
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Joint Applicant |
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First Name |
Middle Name |
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First Name |
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Middle Name |
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Last Name |
Suffix |
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Last Name |
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Suffix |
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Social SecurityNumber |
Date of Birth |
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Social SecurityNumber |
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Date of Birth |
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Household Size |
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Marital Status |
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Married |
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Not Married |
Marital Status |
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Married |
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Not Married |
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Are you a U.S. Citizen? |
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Are you a U.S. Citizen? |
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Yes |
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No |
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Yes |
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No |
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AreyouanSBA Employee? |
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Yes |
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No |
AreyouanSBA Employee? |
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Yes |
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No |
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CONTACT INFORMATION
Checkyourpreferredmethodofcontact:
CellPhone
HomePhone
Work Phone
Check your preferred method of contact:
Cell Phone
Home Phone
Work Phone
ClosestRelativeNot |
Name: |
Phone Number: |
Living WithYou: |
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DAMAGED PROPERTY ADDRESS additional damaged properties added in "additional comments" section
Address |
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City |
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County |
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State |
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Zip |
Type of Damage: |
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Real Estate |
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Personal Property |
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Automobile |
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MAILING ADDRESS |
ifdifferentthanthedamagedpropertyaddress. |
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Address |
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City |
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County |
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State |
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Zip |
DAMAGED PROPERTY INFORMATION
Do you own or rent |
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Own |
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Rent |
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this property? |
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Isthis propertyyour |
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Yes |
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No |
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Primary Residence? |
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If No, please select from the list below: Vacation/secondary home
I own the property but a family member/friend lives in the property
Rental/Business Property
INCOME INFORMATION
Primary Applicant |
Joint Applicant |
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Employed |
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Unemployed |
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SelfEmployed |
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Retired |
Total Annual Income (before deductions) |
$ |
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EmployerName
Employer PhoneNumber
Note: Includeallreoccurringincomefromallsourcessuchasemployment,
Do not include
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Employed |
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Unemployed |
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SelfEmployed |
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Retired |
Total Annual Income (before deductions) |
$ |
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Employer Name
Employer Phone Number
Note: Includeallreoccurringincomefromallsourcessuchasemployment,
Do not include
SBA Form 5C |
Page 1 of 6 |
DEBTS |
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I have no debts |
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Mortgage Holder or Landlord's Name (Primary Residence) |
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MonthlyPayment/Rent |
Current Balance |
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Name |
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$ |
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$ |
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2nd MortgageHolderName(ifapplicable) |
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MonthlyPayment/Rent |
Current Balance |
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Name |
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$ |
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$ |
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Note: Please complete the section below if the amounts are NOT included in your mortgage payment: |
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RealEstateTaxes |
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Homeowner's Insurance |
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per year |
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$ |
per year |
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$ |
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per year |
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OtherDebtincludingautopayments,creditcards,installmentloans,studentloans,etc. |
Note: Only include debts that will last longer than 10 months. |
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Nameof Creditor |
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Monthly Payment |
Current Balance |
$ $ $ $ $ $
$ $ $ $ $ $
INSURANCE INFORMATION
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Pleasecheckallinsuranceinforceforthedamagedproperty: |
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(describe) |
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Homeowner's |
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Flood |
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Automobile |
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Renter's |
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NoInsurance |
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Other: |
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PolicyType |
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Insurance Company Name |
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PolicyNumber |
PhoneNumber |
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Amount Received |
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$ |
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$ |
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$ |
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OTHER DISASTER ASSISTANCE |
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Other than FEMA, have you received any grant award (i.e. city grants, county grants, state grants, etc.): |
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Yes |
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No |
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ASSETS
Cash, Bank Accounts and Marketable Securities (e.g. Stock & Bonds, CDs, etc.) (Not including retirement accounts) . . . . . . . . . . . . . . . . . . . ... . . .. . $ Retirement Accounts (e.g. IRAs, Keogh, TSP or other similar accounts). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . .$ Personal Property (furniture, appliances, vehicles, RVs, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
Primary Residence |
$ |
All Other Real Estate (describe) |
$ |
DISCLOSURES
The responses below apply to the Applicant and Joint Applicant, if any. Please explain any "Yes" responses on the last page.
1. |
. . . . . .. .Are you delinquent on any Federal taxes, Federal loans, Federal grants, or 60 days past due on any child support obligation? |
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Yes |
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No |
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2. |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Are you currently a defendant in any lawsuits or have pending judgements against you? |
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Yes |
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No |
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3. |
....................AreyoucurrentlysuspendedordebarredfromcontractingwithFederalgovernmentorreceivingFederalgrantsorloans? |
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Yes |
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No |
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4. |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..Do you have federal loans, federally guaranteed loans, or previous SBA loans? |
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Yes |
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No |
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5. Are you engaged in the productionor distribution of any product that has been determined to be obscene by a court of competent |
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Yes |
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No |
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jurisdiction? |
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. |
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6. |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .In the past year, have you been convicted of a felony committed in connection with a riot or civil disorder? |
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Yes |
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No |
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7. |
Areyoupresently, a)subject toan indictment,criminal information, arraignment, orothermeans by whichformalcriminal charges arebrought inany |
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Yes |
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No |
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. . . . . . . . . . . . .parole or probation (including probation before judgment)? |
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SBA Form 5C |
Page 2 of 6 |
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REPRESENTATIVE INFORMATION
If you have paid a representative (packager, attorney, accountant, etc.) to assist you in completing the application, please complete the section below:
NameandAddressofRepresentative: |
Fee charged or agreed upon |
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$ |
CONSENT
I authorize my insurance company, bank, financial institution, or other creditors to release to SBA all records and financial information necessary to process this application.
SBA has my permission, as required by the Privacy Act, to release any information collected in connection with this application to Federal, state, local, tribal or nonprofit organizations (e.g.RedCross,SalvationArmy, MennoniteDisasterServices,SBAResource Partners)forthepurposeof assistingme withmySBA application, evaluatingmyeligibilityforadditional disaster assistance, or notifying me of the availability of such assistance.
If my loan is approved, I may be eligible for additional funds to safeguard my property from damages similar to those caused by this disaster. Although it is not necessary for me to provide with my application, a description and cost estimate will be required prior to SBA approval of the mitigation measure.
I have received and read a copy of the "STATEMENTS REQUIRED BY LAWS AND EXECUTIVE ORDERS" which was attached to this application.
CERTIFICATIONASTOTRUTHFULINFORMATION:Bysigningthisapplication,youcertifythatallinformationin yourapplicationandsubmitted with yourapplicationistrueandcorrectto the best of your knowledge, and that you will submit truthful information in the future.
WARNING: Whoever wrongfully misapplies the proceeds of an SBA disaster loan shall be civilly liable to the Administrator in an amount equal to
Signature of Applicant |
Date |
Signature of Joint Applicant |
Date |
ADDITIONAL COMMENTS
SBA Form 5C
Page 3 of 6
U.S. Small Business Administration
DISASTER HOME LOAN APPLICATION
If you have questions about this application or problems providing the required information, please contact our Customer Service Center at
SBA will contact you by phone or Email to discuss your loan request.
FILING REQUIREMENTS
REQUIRED FOR ALL LOAN APPLICATIONS:
■Complete and sign this application form (SBA Form 5C)
■Complete and sign the Tax Information Authorization (IRS Form 4506T) enclosed with this application. This income information, obtained from the IRS, will help us determine your repayment ability. U.S. Territories that have their own taxing authority outside of the IRS may require additional form(s) in order to obtain copies of their transcripts. The exact form(s) required will be determined at the onset of the declared disaster. All other filing requirements remain the same.
WHILE NOT NECESSARY TO ACCEPT YOUR APPLICATION, YOU MAY BE REQUIRED TO SUPPLY THE FOLLOWING INFORMATION TO PROCESS THE APPLICATION. IF REQUESTED, PLEASE PROVIDE WITHIN 7 DAYS OF THE INFORMATION REQUEST:
■If any applicant has changed employment within the past two years, provide a copy of a current (within 1 month of the application date) pay stub for all applicants
■If we need additional income information, you may be asked to provide copies of your
Federal income tax returns, including all schedules
IF SBA APPROVES YOUR LOAN, WE MAY REQUIRE THE FOLLOWING ITEMS BEFORE LOAN CLOSING. WE WILL ADVISE YOU, IN WRITING, OF THE DOCUMENTS WE NEED.
■If you own your residence, a COMPLETE legible copy of the deed, including the legal description of the property
■If the damaged property is your primary residence, proof of residency at the damaged address
■If you had damage to a manufactured home, a copy of the title. If you own the lot where the home is located, a COMPLETE legible copy of the deed, including the legal description of the property
■If you have damage to an automobile or other vehicle, proof of ownership (a copy of the registration, title, bill of sale, etc.)
SBA Form 5C
Page 4 of 6
NOTE: PLEASE READ, DETACH AND KEEP FOR YOUR RECORDS
STATEMENTS REQUIRED BY LAWS AND EXECUTIVE ORDERS
TocomplywithlegislationpassedbytheCongressandExecutiveOrdersissuedbythePresident,Federalexecutiveagencies, includingtheSmallBusinessAdministration(SBA),mustnotifyyouofcertaininformation.Youcanfindtheregulationsandpolicies implementing these laws and Executive Orders in Title 13, Code of Federal Regulations (CFR), Chapter 1, or our Standard Operating Procedures(SOPs).Inordertoprovidetherequirednotices,thefollowingisabriefsummaryofthevariouslawsandExecutive Orders that affect SBA's Disaster Loan Programs. A glossary of terms can be found at Disasterloan.SBA.GOV
FREEDOM OF INFORMATION ACT (5 U.S.C. 552)
This law provides, with some exceptions, that we must make records or portions of records contained in our files available to persons requesting them. This generally includes aggregate statistical information on our disaster loan programs and other information suchasnames of borrowers (andtheirofficers,directors,stockholders orpartners),loanamounts at maturity,the collateral pledged, and the general purpose of loans.Wedo not routinely make available to third parties your proprietary data withoutfirstnotifyingyou,asrequiredbyExecutiveOrder#12600,orinformationthatwouldcausecompetitive harmorconstitute a clearly unwarranted invasion of personal privacy.
FreedomofInformationAct(FOIA)requestsmustdescribethespecificrecordsyouwant.ForinformationabouttheFOIA,contact the Chief, FOI/PA Office, 4093rd Street, SW, Suite 5900,Washington, DC 20416, or by
PRIVACY ACT (5 U.S.C. § 552a)
Anyonecanrequestto seeor getcopies of anypersonal informationthat wehavein your file.Anypersonal informationinyourfile that is retrieved by individual identifiers, such asname or social security number is protected bythe Privacy Act, which means requests for information about you may be denied unless we have your written permission to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act. The Agreements and Certifications section of this form contains written permission for us to disclose the information resulting from this collection to state, local or private disaster relief services.
ThePrivacyActauthorizesSBAtomakecertain"routineuses"ofinformationprotectedbythatAct.OnesuchroutineuseforSBA's loan system of records is that when this information indicates a violation or potential violation of law, whether civil, criminal, or administrative in nature, SBA may refer it to the appropriate agency, whether Federal, State, local or foreign, charged with responsibilityfororotherwiseinvolvedininvestigation,prosecution,enforcementorpreventionofsuchviolations.Anotherroutine use of personal information isto assist in obtaining credit bureau reports, on the Disaster Loan Applicants and guarantors for purposesoforiginating,servicing,andliquidatingDisasterloans.See,69F.R.58598,58617(andasamendedfromtimetotime)for additional background and other routine uses.
UndertheprovisionsofthePrivacyAct,youarenotrequiredtoprovidesocialsecuritynumbers.(Butseetheinformationunder DebtCollectionActbelow)Weusesocialsecuritynumberstodistinguish betweenpeoplewithasimilarorthesamenamefor credit decisions andfor debt collection purposes. Failure toprovide this number may not affectanyright, benefit or privilege to which you are entitled bylaw, but having the number makes it easier for us to more accurately identify to whom adverse credit information applies and to keep accurate loan records.
Note: Any person concerned with the collection, use and disclosure of information, under the Privacy Act may contact the Chief, FOI/PA Office, 409 3rd Street, SW, Suite 5900, Washington, DC 20416 or by
for information about the Agency's procedures relating to the Privacy Act and the Freedom of Information Act.
SBA Form 5C
Page 5 of 6
DEBT COLLECTION ACT OF 1982; DEFICIT REDUCTION ACT OF 1984; DEBT COLLECTION IMPROVEMENT ACT OF 1996 & other titles (31 U.S.C. 3701 et seq.)
These laws require us to aggressively collect any delinquent loan payments and to require you to give your taxpayer identification number to us when you apply for a loan. If you receive a loan and do not make payments when theybecome due, we may take one or more of the following actions (this list may not be exhaustive):
*Report the delinquency to credit reporting bureaus.
*Offset your income tax refunds or other amounts due to you from the Federal Government.
*Refer the account to a private collection agency or other agency operating a debt collection center. *Suspend or debar you from doing business with the Federal Government.
*Refer your loan to the Department of Justice.
*Foreclose on collateral or take other actions permitted in the loan instruments. *Garnish wages.
*Sell the debt.
*Litigate or foreclose.
RIGHT TO FINANCIAL PRIVACY ACT OF 1978 (12 U.S.C. § 3401 et seq.)
Thisnotifiesyou,asrequiredbytheRighttoFinancialPrivacyActof1978(Act),ofourrighttoaccessfinancialrecords heldbyfinancialinstitutionsthatwereoraredoingbusinesswithyouoryourbusiness.Thisincludesfinancialinstitutions participating in loans or loan guarantees.
ThelawprovidesthatwemayaccessyourfinancialrecordswhenconsideringoradministeringGovernmentloanorloan guarantyassistancetoyou.Wemustgiveafinancial institutionacertificate of ourcompliancewiththeActwhenwefirst requestaccesstoyourfinancialrecords.Noothercertificationisrequiredforlateraccess.Ouraccessrightscontinuefor the term of any approved loan or loan guaranty. We do not have to give you any additional notice of our access rights during the term of the loan or loan guaranty.
We may transfer to another Government authority any financial records included in a loan application or about an approvedloanorloanguarantyasnecessarytoprocess,service,liquidate,orforeclosealoanorloanguaranty.Wewill notpermitanytransferof your financial recordstoanother Governmentauthorityexceptasrequiredorpermitted bylaw.
CONSUMER CREDIT PROTECTION ACT (15 U.S.C. 1601 et seq.)
This legislation gives an applicant who is refused creditbecause of adverse information about the applicant's credit, reputation,characterormode oflivinganopportunitytorefuteorchallengetheaccuracyofsuchreports.Therefore,ifwe decline your loan in whole or in part because of adverse information in a credit report, you will be given the name and address of the reporting agency so you can seek to have that agency correct its report, if inaccurate. If we decline your loaninwholeorinpart becauseof adverseinformationreceivedfromasourceother thana creditreportingagency, you will be given information but not the source of the report.
Within3daysaftertheconsummation of thetransaction,anyrecipientof anSBAloanwhichissecuredinwholeorinpart byalienontherecipient'sresidenceorhouseholdcontentsmayrescindsuchaloaninaccordancewith"RegulationZ"of the Federal Reserve Board.
PLEASE NOTE: The estimated burden for completing this form is 1.25 hours. Your responses to the requested information are required in order to obtain a benefit under our Disaster Home Loan Program. However, you are not required to respondtoanycollectionofinformation unlessitdisplaysacurrentlyvalidOMBapprovalnumber.Ifyouhavequestions or comments concerning any aspects of this information collection, please contact the U.S. Small Business Administration InformationBranch,4093rdStreet,SW,Washington,DC20416andDeskOfficerforSBA,OfficeofManagementand Budget, Office ofInformation and Regulatory Affairs, 725 17th Street,NW,Washington, DC20503.
SBA Form 5C |
Page 6 of 6 |