SBIR/STTR Information
OMB Number: 4040-0001
Expiration date: 06/30/2011
Program Type (select only one)*
SBIR
SBIR
STTR
STTR
Both
Both
(See agency-specific instructions to determine whether a particular agency allows a single submission for both SBIR and STTR)
SBIR/STTR Type (select only one)*
Phase I
Phase I
Phase II
Phase II
Fast-Track
Fast-Track
(See agency-specific instructions to determine whether a particular agency participates in Fast-Track)
Questions 1-7 must be completed by all SBIR and STTR Applicants:
1a. Do you certify that at the time of award your organization will meet the eligibility criteria for a small business as defined in the funding opportunity announcement?*
Y: Yes
Yes
N: No
No
1b. Anticipated Number of personnel to be employed at your organization at the time of award.*
2. Does this application include subcontracts with Federal laboratories or any other Federal Government agencies?*
Y: Yes
Yes
N: No
No
If yes, insert the names of the Federal laboratories/agencies:*
3. Are you located in a HUBZone? To find out if your business is in a HUBZone, use the mapping utility provided by the Small Business Administration at its web site: http://www.sba.gov *
Y: Yes
Yes
N: No
No
4. Will all research and development on the project be performed in its entirety in the United States?*
Y: Yes
Yes
N: No
No
If no, provide an explanation in an attached file.
Explanation:*
5. Has the applicant and/or Program Director/Principal Investigator submitted proposals for essentially equivalent work under other Federal program solicitations or received other Federal awards for essentially equivalent work?*
Y: Yes
Yes
N: No
No
If yes, insert the names of the other Federal agencies:*
6. Disclosure Permission Statement: If this application does not result in an award, is the Government permitted to disclose the title of your proposed project, and the name, address, telephone number and e-mail address of the official signing for the applicant organization, to organizations that may be interested in contacting you for further information (e.g., possible collaborations, investment)?*
Y: Yes
Yes
N: No
No
7. Commercialization Plan: If you are submitting a Phase II or Phase I/Phase II Fast-Track Application, include a Commercialization Plan in accordance with the agency announcement and/or agency-specific instructions.*
Attach File:*
SBIR/STTR Information
OMB Number: 4040-0001
Expiration date: 06/30/2011
SBIR-Specific Questions:
Questions 8 and 9 apply only to SBIR applications. If you are submitting ONLY an STTR application, leave questions 8 and 9 blank and proceed to question 10.
8. Have you received SBIR Phase II awards from the Federal Government? If yes, provide a company commercialization history in accordance with agency-specific instructions using this attachment.*
Y: Yes
Yes
N: No
No
Attach File:*
9. Will the Project Director/Principal Investigator have his/her primary employment with the small business at the time of award?*
Y: Yes
Yes
N: No
No
STTR-Specific Questions:
Questions 10 and 11 apply only to STTR applications. If you are submitting ONLY an SBIR application, leave questions 10 and 11 blank.
10. Please indicate whether the answer to BOTH of the following questions is TRUE:*
(1) Does the Project Director/Principal Investigator have a formal appointment or commitment either with the small business directly (as an employee or a contractor) OR as an employee of the Research Institution, which in turn has made a commitment to the small business through the STTR application process; AND
(2) Will the Project Director/Principal Investigator devote at least 10% effort to the proposed project?
Y: Yes
Yes
N: No
No
11. In the joint research and development proposed in this project, does the small business perform at least 40% of the work and the research institution named in the application perform at least 30% of the work?*
Y: Yes
Yes
N: No
No
(Mime-type: )
Y: Yes
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❍
Yes
✔
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