INFORMATION NOTICE OMB Approval No.:3245-0324

I request business counseling service from the Northern California Small Business Development Center (SBDC) Network, an SBA Resource Partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBDC services. I understand that any information disclosed will be held in strict confidence. (The SBDC will not provide my personal information to commercial entities.) I authorize the SBDC to furnish relevant information to the assigned Business Advisor(s). I further understand that the advisor(s) agree not to:

• recommend goods or services from sources in which he/she has an interest, and
• accept fees or commissions developing from this counseling relationship.

In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against SBA personnel, and that of its Resource Partners, host organizations, and SBDC Advisors arising from this assistance.

By accepting these terms, I give my consent to participate in surveys designed to evaluate the services and impact of the Northern California SBDC Network. Surveys are sent twice a year and responses are kept confidential. Responses typically take less than five minutes and ask about four key areas: business start-up, growth in sales, jobs created, and/or loans/grants.

Please note: You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.