Your Business Name*

Federal Program*

Federal Agency*

Application:

Application Instructions

All applicants must complete the SBIR/STTR Outreach Program Application and attach only those additional sections for the components to which the applicant is applying.

Before filling out this application form, please read all applicable sections of the Iowa Code and Iowa Administrative Code (rules). https://www.legis.iowa.gov/law

Only typed or computer-generated applications will be accepted and reviewed. Any material change to the format, questions, or wording of questions presented in this application will render the application invalid and it will not be accepted.

Complete the applicable sections of the application fully. If questions are left unanswered are not submitted, an explanation must be included.

Use clear and concise language.

Any inaccurate information of a significant nature may disqualify the application from consideration.

Public Records Policy

Funding for the SBIR/STTR Outreach Program is provided by an appropriation to the Iowa Economic Development Authority. Any funds awarded will be subject to Public Record Policies as outlined below.

During the application process, the information submitted by you to BCI is exempt from disclosure under the “industrial prospects” exemption found in Section 22.7(8). However, once you receive an award, the industrial prospects exemption no longer applies and all information submitted and generated during the application and negotiation process become public records under Iowa’s Open Records Law (Iowa Code, Chapter 22), unless

The information belongs to one of the classes of records automatically treated as confidential; or
You have applied for and received written notice that your information will be treated as confidential.

Automatically Confidential Records

BCI automatically treats the following records as confidential and will withhold them from public inspection even without a request for confidential treatment:

Tax Records and Tax Liability Information
Quarterly Iowa Employer’s Contribution and Payroll Report prepared for the Iowa Workforce Development Department
Payroll Registers
Business Financial Statements and Projections (unless those statements are already publicly available elsewhere, e.g., 10-K filings)
Personal Financial Statements

Exemptions to the Open Records Law

If you wish to have additional information treated as confidential, you must fill out the confidential treatment request form. This form is available on request after consultation with IEDA legal counsel. Under the Open Records Law, BCI may lawfully treat certain information as confidential if that information falls within an exemption to the Open Records Law. The following exemptions represent records which may lawfully be treated as confidential under the Open Records law and which are most often applicable to the information submitted to BCI:

Release of information would give an unfair advantage to competitors – Iowa Code Sec. 15.118
Trade secrets – See Iowa Code section 22.7(3), see also Iowa Code Ch. 550
Information on an industrial prospect with which the IEDA is currently negotiating – See Iowa Code section 22.7(8)
Communications not required by law, rule or regulation made to IEDA by persons outside the government to the extent that IEDA could reasonably believe that those persons would be discouraged from making them to IEDA if they were made available for general public examination – Iowa Code section 22.7(18)

Additional Information Available

Copies of and IEDA's administrative rules relating to public records are available from the BCI upon request.

The Iowa Economic Development Authority (IEDA) has delegated to BioConnect Iowa (BCI) the administration of the SBIR/STTR Outreach Program. The purpose of the Small Business Innovation Research and Technology Transfer (SBIR/STTR) Outreach Program is to increase the rate of successful grant applications for Iowa's innovative businesses seeking federal grants through the Small Business Administration's SBIR/STTR Phase I & II programs and provide additional financial assistance to businesses that receive these federal grants.

You will be prompted prior to submitting your application to complete the attachment required based on your choice below:

Third-party Proposal Assistance: Professional proposal assistance services from an BCI-approved third-party vendor for SBIR/STTR Phase I and II applications.

Technical assistance is 100% paid for by BioConnect Iowa.
Additional application requirement: Attachment A – Third-party Proposal Assistance
Financial Assistance: Financial assistance is available for Phase I SBIR/STTR award recipients and for those that advance to Phase II proposal submission.

This component provides $50,000 to businesses that receive a Phase I award and an additional $25,000 to Phase I award winners that progress to submission of a Phase II application.
Final determination of whether this Financial Assistance will be approved, denied, or deferred will be made by the IEDA.
Additional application requirement: Attachment B – Financial Assistance

Please indicate which technical assistance services you are applying for:*

Third-party Proposal Assistance:

Financial Assistance

Both

Applicant Information:

Business Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person:*

First Last

Title:*

Email*

Federal ID Number:*

Does the Business file a consolidated tax return under a different tax ID number?*

Yes

No

Please provide tax ID number:

Is the contact person listed above authorized to obligate the Business?*

Yes

No

Name the company officer authorized to obligate the Business:

Are you working with your local economic development or business development organization?*

No

Yes

Which organization are you working with?*

Business Overview

Business Structure:*

State of Incorporation:*

Total Number of Years in Business*

Current Number of Employees*

Provide name of organization:*

Key Management Personnel:*

Add each person and then click the + sign to add another person. Up to 10 can be added via this form

Full Name

Job Title

Describe the business, its history and products/services currently offered:*

(Keep under 1000 words)

Description of technology area:*

(Keep under 1000 words)

SBIR/STTR Previous Experience

Applicants must provide the following information about any previous SBIR/STTR experience:

Number of Phase I Applications Submitted:*

Number of Phase I Applications Awarded:*

Awarding Agencies (if applicable):

Number of Phase II Applications Submitted:*

Number of Phase II Applications Awarded:*

Awarding Agencies (if applicable):

Number of other SBIR/STTR applications (FastTrack, etc) submitted:*

Number of other SBIR/STTR awards (FastTrack, etc) received:*

Awarding Agencies (if applicable):

All Applicants

Federal Agency*

Solicitation number:*

Proposal Due Date:*

Proposal Title:*

Estimate of federal grant dollars to be requested:*

Briefly describe the product, process or service that will be developed as an outcome of SBIR/STTR funding:*

Attachments

Attachment A: Third-Party Proposal Assistance

This component of the program provides technical assistance from BCI-approved third-party services for preparation of SBIR/STTR Phase I and II proposals. The program does not provide funding to reimburse applicant's employees (payroll or contract) for time spent preparing SBIR/STTR Phase I and II proposals. Additional program information:

Funding is only available for SBIR/STTR PROPOSALS NOT YET SUBMITTED. The program does not provide reimbursement for SBIR/STTR proposals submitted prior to approval of this application.
Technical assistance costs are 100% covered by BCI.
Applicant, if approved, will enter into a Technical Assistance Agreement with BCI.
Technical assistance for Phase II applications will only be provided to companies that utilized BCI-provided assistance for the corresponding Phase I application.

Level of SBIR/STTR proposal Assistance Assistance Requested:

Full Proposal Assistance

Full support in proposal preparation and submission
Requires application submission at least 10 weeks before deadline.

Partial Proposal Assistance

Typically consists in a proposal review and potentially assistance submitting
Availability dependent on consultant capacity
Requires application submission at least 6 weeks before proposal deadline.

Assistance Requested*

Full Proposal Assistance

Partial Proposal Assistance

Attachment B: Financial Assistance

This component of the program provides additional financial assistance to businesses that are awarded SBIR/STTR grants. The application should be submitted in support of a Phase I SBIR/STTR proposal.

Additional program information:

Funding is only available for SBIR/STTR PROPOSALS NOT YET SUBMITTED. This program does not provide financial assistance for SBIR/STTR proposals submitted prior to this application approval or previous awards without BioConnect Iowa support or resources.
Maximum commitment is a total of $75,000 across Phase I and Phase II.
Program awards are in the form of a grant.
The final determination of whether this financial assistance will be approved, denied or deferred, will be made by the IEDA.
Allowable costs are those related directly to achieving the SBIR/STTR proposal objectives, such as direct costs for conducting additional technology development work, purchase of necessary equipment, validation of product prototype or technology, market research, and development of a commercialization plan.
Companies approved for financial assistance will enter into an agreement with BCI regarding use of the matching funds.

$50,000 upon receipt of an Official Notification of Phase I Award from the Federal funding agency.
Phase I award recipients are eligible for an additional $25,000 award upon submission of a Phase II proposal.

Please provide a brief statement regarding the proposed use of the $50,000 state award covered by this application:*

Certification & Release of Information

Judgements*

Are there any judgments or court actions completed or pending against the applicant entity, or any current or prospective officer, principal, director, or owner?

Convictions*

Has any current or prospective officer, principal, director, or owner been accused or convicted of any wrongdoing or crime, other than a simple misdemeanor?

Bankruptcies*

Have there been any current or past bankruptcies on the part of the applicant entity (or predecessor entities), or on the part of any current (or prospective) officer, principal, owner or in any business dealings of current (or prospective) officers, principals, or owners of the applicant entity?

Investigations*

In the last five years have there been, or are there currently any investigations of potential violations of public health, safety (including workplace safety) or environmental laws by the applicant entity, or any current or prospective officer, principal, director, or owner?

Anti-trust*

In the last five years have there been, or are there currently any violations of antitrust laws by the applicant entity, or any current or prospective officer, principal, director, or owner?

Regarding your "yes" to the above questions:

Please provide additional details below:

I hereby give permission to BioConnect Iowa (BCI) to research the Business’ history, make credit checks, contact the Business’ financial institutions, insurance carriers, and perform other related activities necessary for reasonable evaluation of this application. I also hereby authorize the Iowa Department of Revenue to provide to IEDA state tax information pertinent to the Business' state income tax, sales and use tax, and state tax credits claimed.

I understand that all information submitted to the BCI related to this application is subject to Iowa’s Open Record Law (Iowa Code, Chapter 22), unless specifically marked as confidential section.

I understand that BCI reserves the right to negotiate the financial assistance.

I understand this application is subject to final approval by BCI and that the BCI-supported application process may not be initiated until final approval is secured. Furthermore, I am aware that technical support will not be provided until a contract has been executed and the appropriate terms have been met.

I hereby certify that all representations, warranties, or statements made or furnished to IEDA in connection with this application are true and correct in all material respect. I understand that it is a criminal violation under Iowa law to engage in deception and knowingly make, or cause to be made, directly or indirectly, a false statement in writing for procuring economic development assistance from a state agency or subdivision.

Signature*

Name*

First Last

Today's Date*

Title*

BCI will not provide assistance in situations where it is determined that any representation, warranty, or statement made in connection with this application is incorrect, false, misleading or erroneous in any material respect. If assistance has already been provided prior to discovery of the incorrect, false, or misleading representation, BCI may initiate legal action to recover incentives and assistance awarded to the Business.

SBIR/STTR Outreach Application

Application Instructions

Resources to Review:

SBIR/STTR Outreach Program FY2024 Application

Application:

Application Instructions

Public Records Policy

Automatically Confidential Records

Exemptions to the Open Records Law

Additional Information Available

Applicant Information:

Business Overview

SBIR/STTR Previous Experience

All Applicants

Attachments

Attachment A: Third-Party Proposal Assistance

Level of SBIR/STTR proposal Assistance Assistance Requested:

Attachment B: Financial Assistance

Certification & Release of Information