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Small business lending sample form

Download English and bilingual versions of the small business lending rule sample form.

The CFPB is providing lenders with a sample data collection form to assist them in collecting protected demographic data from applicants. The form has been translated into eight languages and is presented in a side-by-side format along with English. Although the contents of the sample form reflect certain legal requirements that financial institutions must follow, their use of the sample form is not itself required under the final rule. Rather, it is an available resource to financial institutions.

Print and source code versions of the form are provided on the CFPB’s Small Business Lending GitHub page.

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Appendix E: Sample Data Collection Form for Collecting Certain Applicant Provided Data
(§ 1002.107(a)(18) and (19))  

English

Spanish-English

Arabic-English

Chinese-English

Haitian Creole-English

Korean-English

Russian-English

Tagalog-English

Vietnamese-English