SBA Form 912 is the Statement of Personal History that the U.S. Small Business Administration (SBA) uses as one part of its assessment of program eligibility. An individual connected to a business that is applying for an SBA loan or other SBA assistance completes it with identifying details, residence history, three yes/no questions and a signed authorization for a criminal record check. On this page you can fill out the form online on FillingPDF and download or print the completed PDF. The original PDF is published by the SBA, and completed forms go to the address your SBA representative gives you.
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What is SBA Form 912?
SBA Form 912, Statement of Personal History, is the U.S. Small Business Administration form on which an individual gives personal identifying information, residence history and answers about certain criminal and child-support matters, so SBA can weigh character and credit eligibility for a loan or other assistance.
The form says SBA uses it as one part of its assessment of program eligibility. Its Privacy Act statement explains the purpose: SBA collects the information, including the Social Security number, to make a character and credit eligibility decision in connection with you or your company's application for a loan or other form of SBA assistance. In judging character, SBA considers a person's integrity, candor and disposition toward criminal actions.
The form asks for the applicant's business name and address, the individual's full name and former names, percentage of ownership, Social Security number, date and place of birth, citizenship, present and prior addresses, and three questions (lines 8 to 10). By signing, you authorize SBA to request criminal record information about you from criminal justice agencies, and the information may be checked against Federal Bureau of Investigation criminal history indices.
The form carries OMB Approval No. 3245-0178. SBA estimates 15 minutes to complete it. The printed edition is SBA Form 912 (12/2028), and the form states that the previous edition is obsolete.
Who needs to file SBA Form 912?
The form is completed by an individual whose information SBA needs for a loan or other SBA assistance connected with a business. Line 1a asks for the Applicant/Borrower/Assumptor (firm or business name and address), and line 2 asks for your percentage of ownership in the small business, if applicable. Line 1b is the "Personal Statement of" the person filling it in, so each person who is asked to submit the form completes his or her own.
The form does not list who must submit it. It tells you to reference SBA Regulations and Standard Operating Procedures for who must submit the form and where to submit it, and to check www.sba.gov. In practice, your SBA representative is the person to ask whether the form is required of you.
Line 6 asks whether you are a U.S. citizen. Noncitizens give an alien registration number, or mark that they do not have one. The form has no instructions for representatives signing for someone else; the signature block is for the person whose statement it is.
When to file SBA Form 912
The form prints no due date of its own. It is completed when SBA asks for it as part of an application for a loan or other SBA assistance, which is why the top of the form has spaces for the SBA Office and the Loan Number. Ask your SBA representative when SBA needs it.
Use the current edition, SBA Form 912 (12/2028); the form says the previous edition is obsolete. Answer the questions as of the day you sign. Line 8 and line 10 ask about your situation currently, line 9 covers the past year, and the prior address on line 7 is omitted if it was over 10 years ago.
Documents you need
- A separate sheet listing all former names and the dates each was used, only if the space on line 1b is not enough; the form says to use a separate sheet if necessary.
How to fill out SBA Form 912
Enter SBA office and loan number
At the top, write the SBA Office and the Loan Number if you have them. Your SBA representative can tell you which office is handling your application.
Complete line 1a business details
Enter the name and address of the Applicant/Borrower/Assumptor: firm or business name, street, city, state, ZIP code and email.
State your full name on line 1b
Write your name in full, enter NMN if you have no middle name, or an initial only where that is all you use. List all former names and the dates each was used, on a separate sheet if necessary.
Give ownership and Social Security number
Line 2: enter your percentage of ownership in the small business, if applicable. Line 3: enter your Social Security Number.
Enter birth information
Line 4: your date of birth with month, day and year. Line 5: your place of birth, as city and state or foreign country.
Answer the citizenship question
Line 6: mark Yes, I am a United States Citizen or No, I am not a United States Citizen. If no, give your alien registration number, or mark I do not have an alien registration number, and add your initials.
List present and prior addresses
Line 7: enter your present residence address with From and To dates, and your most recent prior address with its dates, omitting it if it was over 10 years ago. Add home and business telephone numbers with area codes.
Answer lines 8 and 9
Line 8: mark Yes or No on incarceration, sentence of imprisonment or indictment for a felony or a crime involving financial misconduct or a false statement. Line 9: mark Yes or No on a conviction in the past year tied to a riot, civil disorder or declared disaster. Initial each answer.
Answer the child support question
Line 10: mark Yes or No on whether you are currently more than 60 days late on paying any child support obligations, and add your initials.
Read the authorization and penalties
The form authorizes SBA to request criminal record information about you from criminal justice agencies. The caution box warns that knowingly making a false statement is a violation of federal law.
Sign, date and download the PDF
Enter your signature, title and date. Check every line and initial box, then download or print the completed PDF from FillingPDF and send it to the address your SBA representative gives you.
How to submit SBA Form 912
The form names no portal, fax number or mailing address for completed forms. It says to send the form to the address provided by your SBA representative, so contact that representative or the SBA office handling your application.
- Do not send it to OMB. The form warns that sending completed forms to the Office of Management and Budget will delay the processing of your application.
- Comments are separate. The Records Management Division and OMB addresses in the Paperwork Reduction Act notice are only for comments on the estimated completion time or other aspects of the information collection, not for completed forms.
- More information. The form points to www.sba.gov and to SBA Regulations and Standard Operating Procedures for where to submit it.
Sign and date the form before you send it. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Sending the completed form to OMB; the form says this delays processing and that forms go to the address provided by your SBA representative.
- Leaving out your initials where the form asks for them, after line 6 and after the answers to lines 8, 9 and 10.
- Not stating NMN when you have no middle name, or writing only an initial without indicating it is an initial on line 1b.
- Leaving off former names and the dates each was used on line 1b instead of adding a separate sheet.
- Answering No to line 6 without giving an alien registration number or marking that you do not have one.
- Listing a prior address on line 7 that is more than 10 years old; the form says to omit it.
- Signing without reading lines 8 to 10; knowingly making a false statement violates federal law and can lead to prosecution, civil penalties and denial of a loan, surety bond or other participation.
- Submitting the form unsigned or without the date and title next to the signature.
- Using an older edition after the form says the previous edition is obsolete.
Frequently asked questions
What is SBA Form 912 used for?
SBA Form 912 is the Statement of Personal History. SBA uses it as one part of its assessment of program eligibility, to make a character and credit eligibility decision when you or your company applies for a loan or other form of SBA assistance.
Where do I send SBA Form 912?
Send it to the address provided by your SBA representative. The form prints no address of its own and says not to send completed forms to OMB, because that delays processing of your application. Check www.sba.gov or ask your SBA office if you are unsure.
Who has to complete SBA Form 912?
The form does not say. It tells you to check SBA Regulations and Standard Operating Procedures for who must submit it. It asks for your percentage of ownership in the small business, if applicable, so ask your SBA representative whether you must complete one.
Is my Social Security number required on Form 912?
The Privacy Act statement calls providing the information voluntary, but says that without the information SBA cannot make a final decision on your application. It asks for the Social Security number to distinguish you from people with similar names or birth dates.
What happens if I give false information on SBA Form 912?
Knowingly making a false statement violates federal law and can lead to criminal prosecution, significant civil penalties and denial of your loan, surety bond or other program participation. The form cites 18 USC 1001 and 3571 and 15 USC 645.
Can I fill out SBA Form 912 online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to the SBA, and it does not submit the form; you send it to the address your SBA representative provides.
How long does SBA Form 912 take to complete?
SBA estimates 15 minutes, including reviewing instructions, gathering information and reviewing your responses. That estimate appears in the Paperwork Reduction Act notice under OMB Approval No. 3245-0178.
Does Form 912 authorize a criminal background check?
Yes. The authorization above the signature lets SBA request criminal record information about you from criminal justice agencies to determine eligibility for programs under the Small Business Act and Small Business Investment Act. The information may be checked against FBI criminal history indices.
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