Form 1993 Federal Agency Comment Form

OMB Control # 3245-0313

Exp. date

Federal Agency Comment Form

8/31/2025

Case #:

Small Business Administration – Office of the National Ombudsman

Instructions

PURPOSE: Small business owners may use this form to submit comments on Federal enforcement/compliance actions
that they consider excessive or unfair. The National Ombudsman will use the information when it contacts the
applicable Federal agency for a review of the action. Completion of this form is voluntary; however, failure to submit
the requested information could impact whether SBA’s Office of the National Ombudsman is able to provide you with
assistance.

1. Complete, sign, and date this form. A signature is not required for web submissions.
2. Provide a brief statement on the specific enforcement action / compliance assistance / communication to
your small entity by a federal agency.
3. Submit substantiating documentation (for example: the correspondence, notice, or fine). If this is
provided separately by email, fax, or mail, please reference the name of your small entity.
4. If your comment concerns the IRS, you must also submit a completed IRS Tax Information
Authorization (Form 8821). This is available at IRS.gov/forms.
5. Email this form and relevant documentation to Ombudsman@SBA.gov

Type of Small Entity: Small Business: Manufacturing
List the bank (if applicable):

Was your small entity debanked? No
Reason: Other Lawful Business Activities

Company / Organization Name:
Address:
City
Phone:

State

Zip

E-Mail:

Contact Name:

Title:

Relevant Federal Agency:
Applicable Regulation (if known):
Confidentiality/Disclosure:
Per the Small Business Regulatory Enforcement Fairness Act, the Office of the National Ombudsman (ONO) will keep
confidential the identities of small entities filing Federal Agency Comments (“Comments”). Commenters may authorize
ONO to share their identity with the relevant SBA office(s) and / or federal agency(ies) to provide a resolution.
I authorize ONO to share my identity with the relevant SBA office(s) and/or federal agency(ies) in response to this comment.
I request my identity be kept confidential.

Signature:

Date:

Your signature authorizes the SBA Ombudsman to proceed on your behalf.
Reviews are confidential and do not waive the right to pursue administrative appeals or any other legal action.

SBA FORM 1993 (8-25) Previous Editions Obsolete
PLEASE NOTE: The estimated burden for completing this form is 45 minutes. You are not required to respond to this information collection if a valid OMB approval
number is not displayed. If you have any questions or comments concerning this estimate or other aspects of this information collection, please contact the U. S. Small
Business Administration, Director, Records Management Division, 409 Third Street, SW, Washington, D.C., 20416 and/or Office of Management and Budget, SBA Desk
Officer, New Executive Office Building, Rm. 10202, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB, as this will delay action on your request for
assistance.

Type or (print) your comments below: