8(a) Applicant - Preliminary Questionnaire

The Randall Group 8(a) Questionnaire

Questions to be answered by Majority Owner(s) of 51% or more. Please also list all owners who have ownership in the company.
The Randall Group takes your privacy very serious. Please read our privacy policy below and check the "I understand" box to continue.
I understand.
Owner Information
YesNo
If yes, please indicate day/month/year of submission as well as what decision was rendered by SBA and/or if the 8(a) application was withdrawn.
Legally Registered Company Name*
Doing Busines As (DBA) Name, if Applicable
Legally Registered Business Address:*
Indicate if your firm is operating as a Broker, Non-Profit or Business owned by another firm. If not, please indicate "NONE". FYI, if you are any of the above, your firm does not quality for 8(a) certification.*
Business Phone Number:*

Area CodePhone Number
Business Fax Number:

Area CodePhone Number
Company E-mail Address:*
Majority Owner's E-mail Address*
example@example.com
Majority Owner's Spouse Email Address:*
example@example.com
Company Type*
Number of years in business as evidenced by federal tax returns:*
Total Number of full-time employees over last 12 months
Total Number of part-time employees over last 12 months
Current Number of Owners & how business was acquired*
How did the Principal Owner(s) acquire the applicant firm, i.e. start-up, ownership purchase, etc.*
List individual names and positions held in the Applicant Firm for all owners.*
YesNo
If yes, please indicate which owners and where they were born:
YesNo
If No, please explain which owner(s) are not US Citizens:
YesNo
If No, please explain:
Hours Devoted to the Management of Firm:*
YesNo
If Yes, please explain:
YesNo
If Yes, please explain - social disadvantage status can only be claimed once:
1st Owner Name*

First NameLast Name
51% or more owner in the company*
Percentage of Ownership
2nd Owner Name*

First NameLast Name
% of Ownership in the company*
3rd Owner Name*

First NameLast Name
% of Ownership in the company*
YesNo
If Yes, please provide all loan details including current balance:
Do you have any loan agreements that are commercial or non-commercial bank loans? If yes, you will be required to provide copies of "ALL" loan agreements, which includes any loans from factoring companies and officer’s, shareholder’s, or member’s loans. The agreements should identify the complete terms of the loan (loan sources, amounts, purposes of money loaned, name(s) of any persons/firms securing the loan and the name(s) of those guaranteeing the loan)*

YesNo
Background Information
YesNo
Indicate which owner, date parole or probation is to expire.*
If Yes, please provide all loan details:
YesNo
Disclose all arrests and charges for all owners below.*
YesNo
Indicate which owner(s) the above applies to and explain conviction.*
YesNo
List all owners who are currently paying on student loans.
YesNo
If No, please explain:
YesNo
If Yes, please indicate which owner and explain current status of bankruptcy
Tax Debts
Personal Tax Liability

Please Note: You will not be able to apply for 8(a) certification until tax debt is paid and/or a IRS repayment arrangement is established along with proof of all payments made to-date.
YesNo
If Yes, please explain:
YesNo
Business Tax Liability

Please Note: You will not be able to apply for 8(a) certification until tax debt is paid and/or a IRS repayment arrangement is established along with proof of all payments made to-date.
YesNo
If Yes, please explain:
YesNo
8(a) Affiliation Information
Does the business concern have any ownership interest in, or an affiliation with (see definition below), any other business concern? You will be required to upload supporting documentation into the appropriate folder in our share file system. Definition: Affiliate or Affiliation may be present when there iscommon management, ownership, or control between the applicant business concernand another business concern or when there are contractual relationships, priorrelationships, familial ties, common investments or economic dependence onanother business concern. For more information on affiliation, see 13 C.F.R.121.103 *

YesNo
Please discribe, in detail, the affiliation.
YesNo
Please discribe, in detail, the affiliation.
YesNo
If Yes, please explain:
How many of the owners have participated in or have relatives that have participated in the 8(a) Program?*
Name of Owner

First NameLast Name
Name of Relative

First NameLast Name
Relationship to Owner
8(a) Company Name
8(a) Entry Date

MonthDayYear
8(a) Exit Date

MonthDayYear
Name of 2nd Owner

First NameLast Name
Name of Relative (2nd Owner)

First NameLast Name
Relationship to 2nd Owner
2nd 8(a) Company Name
8(a) Entry Date (2nd Co.)

MonthDayYear
8(a) Exit Date (2nd Co.)

MonthDayYear
Name of 3rd Owner

First NameLast Name
Name of Relative (3rd Owner)

First NameLast Name
Relationship to 3rd Owner
3rd 8(a) Company Name
8(a) Entry Date (3rd Co.)

MonthDayYear
8(a) Exit Date (3rd Co.)

MonthDayYear
YesNo
If Yes, please explain:
Please upload a brief statement listing the addional owners name, name of relative, relationship to owner, 8(a) company name, 8(a) company entry date and 8(a) company exit date.
Additional 8(a) Affiliation Information

Upload a File

Cancelof
Personal Assets
YesNo
If sold, list the name of the owner and state asset and evidence of acquisition/disposition.
YesNo
If No, you will not be able to apply for 8(a) Certification because your Personal Net Worth, minus above exclusions can't exceed $750,000.
YesNo
If Yes, please explain:
SBA will require you to provide statements for these accounts.
SBA Form 413
FOR FYI, ONLY PURPOSES:

Each 10% or more owner(s) as well as any officers within the firm must complete SBA Form 413, Personal Financial Statement. Be sure and divide all jointly held assets and liabilities in ½. Only place half on your form and remainig ½ on your spouses form. Spouses will need to complete a separate Personal Financial Statement, 413 form.

DO NOT COMPLETE THESE FORMS UNTIL ALL OTHER REQUIRED INFORMATION IS SUBMITTED TO THE RANDALL GROUP AND UPLOADED INTO OUR SHAREFILE SYSTEM. THESE FORMS ARE COMPLETED LAST AND PART OF STAGE 4 OF THE PROCESS.

Link to form 413 - ONLY GOOD FOR 30 DAYS COMPLETE LAST

https://www.sba.gov/sites/default/files/forms/SBA%20Form%20413%20(8a).pdf

ALSO COMPLETE LAST:

Link to form: SBA Form 912 - ONLY GOOD FOR 90 DAYS

https://www.sba.gov/document/sba-form-912-statement-personal-history

Do not date or sign either form until ready to submit to SBA. The Randall Group will inform you when its time to complete the above 2 forms. At this time, we are ONLY informing you of these two requirements so you are aware.
BrokersNonprofit OrganizationFranchiseNone of the Above
-A broker is a concern that adds no material value to an item being supplied to procuring activity or which does not take ownership or possession of or handle the item being procured with its own equipment or facilities
-Nonprofit organizations are ineligible
-Franchises may be allowed contingent upon SBA review of the franchise agreement.
NAICS Codes
What is your primary NAICS Code?*
YesNo
The percentage of the firm's revenues earned in the primary NAICS code*
YesNo
If less than 2 years of sales, please explain and a 2 year in business waiver may need to be requested:
YesNo
If No, please explain:
YesNo
If Yes, please explain:
YesNo
List all the secondary NAICS Codes your company operates under.*
YesNo
Please enter your DUNS Number:*
Please enter your Tax ID Number:*
YesNo
SAM.GOV - As part of the 8(a) Application submission, your firm must have an updated and active SAM and SBA DSBS profile.

SAM.GOV Link: https://sam.gov/SAM/

SBA DSBS Profile Link: https://web.sba.gov/pro-net/search/dsp_dsbs.cfm
Owner Compensation

Personal Income: MUST not exceed an average of $350,000 over the previous three years. Total Assets: MUST not exceed $6 million, which includes the equity in the business.
YesNo
If No, please explain why:
The president may elect to take a lower salary than a non-disadvantaged individual if it is demonstrated to be in the best interest of the applicant firm. This could potentially be a reason for denial.
Owner Experience: Majority owner(s) on whom eligibility is based must have experience and possess the ability to operate the applicant firm on a daily basis. Below, please list such experience. Your personal resume will be included in the application.*
Online Application Questions
YesNo
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If no and have outside employment, please explain because outside employment is not permitted:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
YesNo
If yes, please explain why:
Hubzone Program
YesNo
If you would like to know if your company resides within a HUBZone, click the link:

http://map.sba.gov/hubzone/maps/
Confirmation Email Address*
How did the Principal Owner(s) acquire the applicant firm, i.e. start-up, ownership purchase, etc.*
Should be Empty:

The Randall Group 8(a) Questionnaire

Owner Information

Background Information

Tax Debts

8(a) Affiliation Information

Personal Assets

SBA Form 413

NAICS Codes

Owner Compensation

Online Application Questions

Hubzone Program