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Researchers at Wake Forest School of Medicine have shown that a targeted therapy using where to buy cheap cipro non-thermal radio waves is safe to use in the treatment of hepatocellular carcinoma (HCC), the most common type of liver cancer. The therapy also showed a benefit in overall survival.The study findings appear online in 4Open, a journal published by EDP Sciences."HCC accounts for nearly 90% of all liver cancers, and current survival rates are between six and 20 months," said Boris Pasche, M.D., Ph.D., chair of cancer biology and director of Wake Forest Baptist's Comprehensive Cancer Center. "Currently, there are limited treatment options for patients with this advanced liver cancer."For the study researchers used a device called TheraBionic P1, invented by Pasche and Alexandre Barbault of TheraBionic GmbH in Ettlingen, Germany, where to buy cheap cipro that works by delivering cancer-specific, amplitude-modulated radiofrequency electromagnetic fields (AM RF EMF) programmed specifically for HCC.The frequencies used are specific to the patient's type of cancer as identified through tumor biopsies or blood work, Pasche said.Pasche and Barbault discovered radio frequencies for 15 different types of cancer, as previously reported in a study published in 2009 in the Journal of Experimental &. Clinical Cancer Research. advertisement TheraBionic P1 is a hand-held device that emits radio frequencies via a spoon-shaped antenna, which is placed on the patient's tongue during treatment and is administered three times a day for one hour to deliver low levels of radiofrequency electromagnetic fields throughout the patient's body.In previous studies, the device, which received breakthrough designation from the FDA in 2019, was shown where to buy cheap cipro to block the growth of liver cancer cells in the body without damaging healthy cells.For the current study, 18 patients with advanced HCC participated and received treatment with the device.

Researchers also analyzed previously published data on 41 patients from a phase II study and historical controls from earlier clinical trials."Our findings show an improvement in overall survival of more than 30% in patients with well-preserved liver function and also in those with more severe disease," Pasche said.Researchers also tracked side effects, and no patients stopped TheraBionic P1 treatment because of adverse reactions. advertisement "We're encouraged by these initial where to buy cheap cipro findings," Pasche said. "Our study shows a benefit in overall survival, and the treatment isn't associated with any significant side effects."Support for this study was provided by TheraBionic Inc. And funds from Wake Forest Baptist's Comprehensive Cancer Center.Pasche noted that the study does have several limitations because of the small sample size and "selection bias inherent in the use of historical control data."However, two additional clinical trials are underway and are being led by William Blackstock, M.D., chair of where to buy cheap cipro radiation oncology at Wake Forest Baptist's Comprehensive Cancer Center. One is a single-center study to assess the safety and effectiveness of the TheraBionic device in combination with Regorafenib, a chemotherapy drug, as a second-line treatment.

Another multicenter, double-blind, randomized study comparing TheraBionic with placebo will assess the where to buy cheap cipro safety and effectiveness of the device as a third-line therapy in the treatment of advanced HCC.Pasche holds stock in TheraBionic Inc. And TheraBionic GmbH. He is where to buy cheap cipro chairman of the board and CEO of TheraBionic Inc. And co-CEO of TheraBionic GmbH. He is also a senior editorial board member of Life Sciences-Medicine where to buy cheap cipro of 4Open by EDP Sciences.

These relationships are being managed per institutional policy by Wake Forest School of Medicine's Conflict of Interest Review Committee.Green manufacturing is becoming an increasingly critical process across industries, propelled by a growing awareness of the negative environmental and health impacts associated with traditional practices. In the biomaterials industry, electrospinning is a universal fabrication method used around the world to produce nano- where to buy cheap cipro to microscale fibrous meshes that closely resemble native tissue architecture. The process, however, has traditionally used solvents that not only are environmentally hazardous but also pose a significant barrier to industrial scale-up, clinical translation, and, ultimately, widespread use.Researchers at Columbia Engineering report that they have developed a "green electrospinning" process that addresses many of the challenges to scaling up this fabrication method, from managing the environmental risks of volatile solvent storage and disposal at large volumes to meeting health and safety standards during both fabrication and implementation. The team's new study, published June 28, 2021, by Biofabrication, details how they have modernized the nanofiber fabrication of where to buy cheap cipro widely utilized biological and synthetic polymers (e.g. Poly-α-hydroxyesters, collagen), polymer blends, and polymer-ceramic composites.The study also underscores the superiority of green manufacturing.

The group's "green" fibers exhibited exceptional mechanical properties and preserved growth factor bioactivity relative to traditional fiber counterparts, which is essential for drug delivery and tissue where to buy cheap cipro engineering applications.Regenerative medicine is a $156 billion global industry, one that is growing exponentially. The team of researchers, led by Helen H. Lu, Percy where to buy cheap cipro K. And Vida L.W. Hudson Professor of Biomedical Engineering, wanted to address the challenge of establishing scalable green manufacturing practices for biomimetic biomaterials and scaffolds used in regenerative medicine."We think this is a paradigm shift in biofabrication, and will accelerate the translation of scalable biomaterials and biomimetic scaffolds for tissue engineering and regenerative medicine," said Lu, a leader in research on tissue interfaces, particularly the design of biomaterials and therapeutic strategies where to buy cheap cipro for recreating the body's natural synchrony between tissues.

"Green electrospinning not only preserves the composition, chemistry, architecture, and biocompatibility of traditionally electrospun fibers, but it also improves their mechanical properties by doubling the ductility of traditional fibers without compromising yield or ultimate tensile strength. Our work provides both a more biocompatible and sustainable solution for scalable nanomaterial fabrication."The team, which included several BME doctoral students from Lu's group, Christopher Mosher PhD'20 and Philip Brudnicki, as well as Theanne Schiros, an expert in eco-conscious textile synthesis who is also a research scientist at Columbia MRSEC and assistant professor at FIT, applied sustainability principles to biomaterial production, and developed a green electrospinning process by systematically testing what the FDA considers as biologically benign solvents (Q3C Class 3).They identified acetic acid as a green solvent that exhibits low ecological impact (Sustainable Minds® where to buy cheap cipro Life Cycle Assessment) and supports a stable electrospinning jet under routine fabrication conditions. By tuning electrospinning parameters, such as needle-plate distance and flow rate, the researchers were able to ameliorate the fabrication of research and industry-standard biomedical polymers, cutting the detrimental manufacturing impacts of the electrospinning process by three to six times.Green electrospun materials can be used in a broad range of applications. Lu's team is currently working on further innovating these materials for orthopaedic and dental applications, and expanding this eco-conscious fabrication process for scalable production of regenerative materials."Biofabrication has been referred to as the 'fourth industrial revolution' following steam engines, electrical power, and the digital age where to buy cheap cipro for automating mass production," noted Mosher, the study's first author. "This work is an important step towards developing sustainable practices in the next generation of biomaterials manufacturing, which has become paramount amidst the global climate crisis."Symptoms for early buy antibiotics differ among age groups and between men and women, new research has found.

These differences are most notable between younger age groups (16 to 59 years) compared to older age groups (60 to 80 years and over), and men have different symptoms compared to women in the early stages of buy antibiotics .The paper, published today in The Lancet Digital Health, and led by researchers from King's College London where to buy cheap cipro analyses data from the ZOE buy antibiotics Symptom Study app between April 20th to 15th October 2020. App contributors are invited to get tested as soon as they report any new symptoms, thanks to a joint initiative with the Department of Health and Social Care. The researchers modelled the early signs of buy antibiotics and successfully detected 80% of cases when using three days of where to buy cheap cipro self-reported symptoms.Researchers compared the ability to predict early signs of buy antibiotics using current National Health Service UK diagnostic criteria and a Hierarchical Gaussian Process model, a type of machine learning.This machine learning model was able to incorporate some characteristics about the person affected, such as age, sex, and health conditions, and showed that symptoms of early buy antibiotics are different among various groups.18 symptoms were examined, which had different relevance for early detection in different groups. The most important symptoms for earliest detection of buy antibiotics overall included loss of smell, chest pain, persistent cough, abdominal pain, blisters on the feet, eye soreness and unusual muscle pain. However, loss of smell where to buy cheap cipro lost significance in people over 60 years of age and was not relevant for subjects over 80.

Other early symptoms such as diarrhoea were key in older age groups (60-79 and >80). Fever, while a known symptom of disease, was not an early feature of the disease in any age group.Men were more likely to report where to buy cheap cipro shortness of breath, fatigue, chills and shivers, whereas women were more likely to report loss of smell, chest pain and a persistent cough.While these models were generated in the buy antibiotics Symptom study app, models were replicated across time suggesting they would also apply to non-app contributors. Although the models were used on the first strain of the cipro and Alpha variants, the key findings suggest the symptoms of the Delta variant and subsequent variants will also differ across population groups.Lead author, Claire Steves, Reader at King's College London said. "Its important people know the earliest symptoms are wide-ranging and may look different for each where to buy cheap cipro member of a family or household. Testing guidance could be updated to enable cases to be picked up earlier, especially in the face of new variants which are highly transmissible.

This could include using widely available lateral flow tests for people with any of these non-core symptoms."Dr Liane dos Santos Canas, first author from King's College London, said. "Currently, in the UK, only a few symptoms are used to recommend self-isolation and where to buy cheap cipro further testing. Using a larger number of symptoms and only after a few days of being unwell, using AI, we can better detect buy antibiotics positive cases. We hope such a method is used to encourage more people to get tested as early as possible where to buy cheap cipro to minimise the risk of spread."Dr Marc Modat, Senior Lecturer at King's College London, said. "As part of our study, we have been able to identify that the profile of symptoms due to buy antibiotics differs from one group to another.

This suggests that the criteria to encourage people to get tested where to buy cheap cipro should be personalised using individuals' information such as age. Alternatively, a larger set of symptoms could be considered, so the different manifestations of the disease across different groups are taken into account." Story Source. Materials provided by King's College London where to buy cheap cipro. Note. Content may be edited for style and length.The mutations that give rise to melanoma result from a chemical conversion in DNA fueled by sunlight -- not just where to buy cheap cipro a DNA copying error as previously believed, reports a study by Van Andel Institute scientists published today in Science Advances.The findings upend long-held beliefs about the mechanisms underlying the disease, reinforce the importance of prevention efforts and offer a path forward for investigating the origins of other cancer types."Cancers result from DNA mutations that allow defective cells to survive and invade other tissues.

However, in most cases, the source of these mutations is not clear, which complicates development of therapies and prevention methods," said Gerd Pfeifer, Ph.D., a VAI professor and the study's corresponding author. "In melanoma, we've now shown that damage from sunlight primes the DNA by creating 'premutations' that then give way to full where to buy cheap cipro mutations during DNA replication."Melanoma is a serious type of skin cancer that begins in pigment-producing skin cells. Although less common than other types of skin cancer, melanoma is more likely to spread and invade other tissues, which significantly reduces patient survival. Previous large-scale sequencing studies have shown that where to buy cheap cipro melanoma has the most DNA mutations of any cancer. Like other skin cancers, melanoma is linked to sun exposure, specifically a type of radiation called UVB.

Exposure to UVB damages skin cells where to buy cheap cipro as well as the DNA within cells.Most cancers are thought to begin when DNA damage directly causes a mutation that is then copied into subsequent generations of cells during normal cellular replication. In the case of melanoma, however, Pfeifer and his team found a different mechanism that produces disease-causing mutations -- the introduction of a chemical base not normally found in DNA that makes it prone to mutation.DNA comprises four chemical bases that exist in pairs -- adenine (A) and thymine (T), and cytosine (C) and guanine (G). Different sequences of these pairs encode all of the instructions for where to buy cheap cipro life. In melanoma, the problem occurs when UVB radiation from the sun hits certain sequences of bases -- CC, TT, TC and CT -- causing them to chemically link together and become unstable. The resulting instability causes where to buy cheap cipro a chemical change to cytosine that transforms it into uracil, a chemical base found in the messenger molecule RNA but not in DNA.

This change, called a "premutation," primes the DNA to mutate during normal cell replication, thereby causing alterations that underlie melanoma.These mutations may not cause disease right away. Instead, they may lay where to buy cheap cipro dormant for years. They also can accumulate as time goes on and a person's lifetime exposure to sunlight increases, resulting in a tough-to-treat cancer that evades many therapeutic options."Safe sun practices are very important. In our where to buy cheap cipro study, 10-15 minutes of exposure to UVB light was equivalent to what a person would experience at high noon, and was sufficient to cause premutations," Pfeifer said. "While our cells have built-in safeguards to repair DNA damage, this process occasionally lets something slip by.

Protecting the skin is generally the where to buy cheap cipro best bet when it comes to melanoma prevention."The findings were made possible using a method developed by Pfeifer's lab called Circle Damage Sequencing, which allows scientists to "break" DNA at each point where damage occurs. They then coax the DNA into circles, which are replicated thousands of times using a technology called PCR. Once they have enough DNA, they use next-generation sequencing to identify which DNA bases are present at the breaks where to buy cheap cipro. Going forward, Pfeifer and colleagues plan to use this powerful technique to investigate other types of DNA damage in different kinds of cancer.Other authors include Seung-Gi Jin, Ph.D., Dean Pettinga, Jennifer Johnson and Peipei Li, Ph.D., of VAI. Story Source where to buy cheap cipro.

Materials provided by Van Andel Research Institute. Note. Content may be edited for style and length.UT Southwestern faculty have discovered what appears to be an Achilles' heel in ovarian cancers, as well as new biomarkers that could point to which patients are the best candidates for possible new treatments.The finding, published in the journal Cell, was made in part using a research tool invented in a UT Southwestern lab in the Cecil H. And Ida Green Center for Reproductive Biology Sciences.The research was led by W. Lee Kraus, Ph.D., Professor of Obstetrics and Gynecology and Pharmacology and a member of the Harold C.

Simmons Comprehensive Cancer Center."Many researchers are trying to find dependencies in cancers by asking why a cancer cell amplifies a gene, increases the levels of a protein, or upregulates a critical cellular pathway. These changes give that cancer a selective advantage, but at the same time they can become an Achilles' heel -- something that, if the alteration was blocked, would kill the cancer or stop its growth," he said.Dr. Kraus and his team, including lead author Sridevi Challa, Ph.D., a postdoctoral researcher in the lab, found that ovarian cancers massively amplify an enzyme, NMNAT-2, that makes NAD+. NAD+ is the substrate for a family of enzymes called PARPs, which chemically modify proteins with ADP-ribose from NAD+. In this study, the team found that one PARP family member, PARP-16, uses NAD+ to modify ribosomes, the protein synthesizing machines of the cell.A challenge for this work was that a single ADP-ribose group attached to a protein is difficult to detect.

Dr. Kraus and his team overcame this problem by developing a synthetic mono(ADP-ribose) detection reagent made up of natural protein domains fused together, which can be used to detect ADP-ribosylated proteins in cells and patient samples. advertisement In collaboration with UT Southwestern clinicians, led by Jayanthi Lea, M.D., Professor of Obstetrics and Gynecology and member of the Simmons Cancer Center, Dr. Kraus and his team screened human ovarian cancer patient samples using the mono(ADP-ribose) detection reagent to identify those with low or high levels of mono(ADP-ribose)."We were able to show that when ribosomes are mono(ADP-ribosyl)ated in ovarian cancer cells, the modification changes the way they translate mRNAs into proteins," Dr. Kraus said.

"The ovarian cancers amplify NMNAT-2 to increase the levels of NAD+ available for PARP-16 to mono(ADP-ribosyl)ate ribosomes, giving them a selective advantage by allowing them to fine-tune the levels of translation and prevent toxic protein aggregation. But that selective advantage also becomes their Achilles' heel. They're addicted to NMNAT-2, so inhibition or reduction of NMNAT-2 inhibits the growth of the cancer cells."This study identified mono(ADP-ribose) and NMNAT-2 as potential biomarkers for ovarian cancers, which may allow clinicians to determine which ovarian cancer patients may respond well and which will not. Even more ovarian cancer patients might do well if an inhibitor is developed for PARP-16, which blocks ribosome mono(ADP-ribosyl)ation.Dr. Kraus, an expert in PARPs, said medical science has had great success in developing FDA-approved PARP-1 inhibitors, and an inhibitor for PARP-16 is likely."No PARP-16 inhibitors are currently in clinical trials, but labs in academia and the pharmaceutical industry are developing specific and potent inhibitors of PARP-16.

Such a drug could be an effective therapeutic for treating ovarian cancers," he said. advertisement Dr. Kraus is a founder and consultant for Ribon Therapeutics Inc., and ARase Therapeutics Inc. He is also co-holder of U.S. Patent 9,599,606 covering the mono(ADP-ribose) detection reagent, which has been licensed to and is sold by EMD Millipore."Dr.

Kraus' research is not just a great advance in basic science. It has real promise for clinician investigators and cancer care practitioners because it shows a biomarker and a pathway a future drug could target. The fact that technology developed in his laboratory helped make these findings shows how our faculty builds on their findings to break new ground," said Carlos L. Arteaga, M.D., Director of the Simmons Cancer Center.Other researchers who contributed to this study include Beman R. Khulpateea, Tulip Nandu, Cristel V.

Camacho, Keun W. Ryu, Hao Chen, and Yan Peng.The research work was supported by a grant from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK069710) as well as funds from the Cecil H. And Ida Green Center for Reproductive Biology Sciences Endowment to Kraus, and a postdoctoral fellowship from the Ovarian Cancer Research Alliance (GAA202103-0003) to Challa.Dr. Arteaga holds the The Lisa K. Simmons Distinguished Chair in Comprehensive Oncology.

Kraus holds the Cecil H. And Ida Green Distinguished Chair in Reproductive Biology Sciences. Dr. Lea holds the Patricia Duniven Fletcher Distinguished Professorship in Gynecological Oncology.In May, Vincent Keenan traveled from Chicago to Charlottesville, Virginia, for a wedding — his first trip out of town since the start of the cipro. €œHi there!.

€ he called out to customers at a gas station where he’d stopped on his way to the airport. €œHow’s your day going?. € he said he asked the Transportation Security Administration agent who checked his ID. €œIsn’t this wonderful?. € he exclaimed to guests at the wedding, most of whom were strangers.

€œI was striking up conversations with people I didn’t know everywhere I went,” said Keenan, 65, who retired in December as chief executive officer of the Illinois Academy of Family Physicians. €œEven if they just grunted at me, it was a great day.” It wasn’t only close friends Keenan missed seeing during 15 months of staying home and trying to avoid buy antibiotics. It was also dozens of casual acquaintances and people he ran into at social events, restaurants, church and other venues. These relationships with people we hardly know or know only superficially are called “weak ties” — a broad and amorphous group that can include anyone from your neighbors or your pharmacist to members of your book group or fellow volunteers at a school. Like Keenan, who admitted he’s an unabashed extrovert, many older adults are renewing these connections with pleasure after losing touch during the cipro.

Casual relationships have several benefits, according to researchers who’ve studied them. These ties can cultivate a sense of belonging, provide bursts of positive energy, motivate us to engage in activities, and expose us to new information and opportunities — all without the emotional challenges that often attend close relationships with family and friends. Multiple studies have found that older adults with a broad array of “weak” as well as “close” ties enjoy better physical and psychological well-being and live longer than people with narrower, less diverse social networks. Also, older adults with broad, diverse social networks have more opportunities to develop new relationships when cherished friends or family members move away or die. €œFeeling connected to other people, not just the people who are closest to you, turns out to be incredibly important,” said Gillian Sandstrom, a senior lecturer in the department of psychology at the University of Essex in England.

Sandstrom’s research has found that people who talk to more acquaintances daily tend to be happier than people who have fewer of these interactions. Even talking to strangers makes people feel less lonely and more trusting, she has discovered. Claire Lomax, 76, of Oakland, California, who’s unmarried, has made a practice of chatting with strangers all her life. Among her greatest pleasures in recent years was volunteering at the Oakland Police Department, where she would ask patrol officers about their families or what was happening at the station. €œI never wanted a man of my own, but I like to be around them,” she explained.

€œSo, I got to have my guy buzz without any complications, and I felt recognized and appreciated,” Lomax told me. Since becoming fully vaccinated, she’s volunteering in person at the police stations again — a deep source of satisfaction. Even people who describe themselves as introverts enjoy the positivity that casual interactions can engender. €œIn fact, people are more likely to have purely positive experiences with weak ties” because emotional complications are absent, said Katherine Fiori, a prominent researcher and chair of the psychology department at Adelphi University in Garden City, New York. Lynn Eggers, 75, a retired psychologist in Minneapolis, loved going to coffee shops and the gym before buy antibiotics hit.

€œIn both places, you can be in a group and alone,” she told me. €œYou can choose to talk to someone or not. But you feel you’re part of the community.” At a light-rail station, Eggers would strike up conversations with strangers. Two police officers who told her about growing up in Somalia, a working-class Texan whose daughter won a scholarship to Harvard, a young Vietnamese woman whose parents worried she was abandoning her culture. When Eggers stopped taking public transportation for fear of buy antibiotics, she missed “getting these glimpses into other ways of seeing the world.” Instead, she started chatting with neighbors in daily walks around her neighborhood — another way to feel connected.

Many people may have found that neighbors, mail carriers and delivery people became more important during the cipro — simply because they were around when others were not, said Karen Fingerman, a professor of human ecology at the University of Texas-Austin. As cipro restrictions lift, “the key is to get out in daily life again” and reengage with a variety of people and activities, she recommended. Helen Bartos, 69, a retired clinical psychologist, lives in a condominium community in Rochester, New York. €œWith buy antibiotics, a whole group of us started getting together outside,” she told me. €œWe’d bring out chairs and drinks, wear masks, and sit around and talk.

It was very bonding. All of these people are neighbors. Now I would call some of them friends.” Ellie Mixter-Keller, 66, of Milwaukee, turned to social gatherings sponsored by the activity group Meetup six years ago after a divorce disrupted her life. €œIt was my salvation. It exposed me to a bunch of new people who I didn’t have to date or have to dinner,” she said.

Now that she’s fully vaccinated, she’s busy almost every night of the week attending Meetup events and informal get-togethers arranged by people she’s met. In some cases, varying views of buy antibiotics treatments have made casual interactions more difficult. Patty Beemer, 61, of Hermosa Beach, California, used to go swing-dancing two or three times a week before the cipro. €œIt’d be 20 seconds of chitchat and just dance” before all those events were canceled, she said. In the past several months, however, the swing-dance community in and around Los Angeles has split, with some events requiring proof of vaccination and others open to everyone.

€œBefore, everyone danced with everyone, without really thinking about it. Now, I don’t know if it’s going to be like that. I’m not sure how much mixing is going to happen,” Beemer said. €œAnd that sense of shared humanity, which is so meaningful to all of us, may be harder to find.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Judith Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story Tip.

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Start Further early signs of cipro toxicity Info William N. Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information early signs of cipro toxicity can be found in each collection's supporting statement and associated materials (see ADDRESSES). CMS-10241 Survey of Retail Prices CMS-10545 Outcome and Assessment Information Set (OASIS) OASIS-D Under the PRA (44 U.S.C.

3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection early signs of cipro toxicity of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is early signs of cipro toxicity publishing this notice.

Information Collection 1. Type of Information Collection Request. Revision of early signs of cipro toxicity a currently approved collection. Title of Information Collection. Survey of Retail Prices.

Use. This information collection request provides for a survey of the average acquisition costs of all covered outpatient drugs purchased by retail community pharmacies. CMS may contract with a vendor to conduct monthly surveys of retail prices for covered outpatient drugs. Such prices represent a nationwide average of consumer purchase prices, net of discounts and rebates. The contractor shall provide notification when a drug product becomes generally available and that the contract include such terms and conditions as the Secretary shall specify, including a requirement that the vendor monitor the marketplace.

CMS has developed a National Average Drug Acquisition Cost (NADAC) for states to consider when developing reimbursement methodology. The NADAC is a pricing benchmark that is based on the national average costs that pharmacies pay to acquire Medicaid covered outpatient drugs. This pricing benchmark is based on drug acquisition costs collected directly from pharmacies through a nationwide survey process. This survey is conducted on a monthly basis to ensure that the NADAC reference file remains current and up-to-date. Form Number.

CMS-10241 (OMB control number 0938-1041). Frequency. Monthly. Affected Public. Private sector (Business or other for-profits).

Number of Respondents. 72,000. Total Annual Responses. 72,000. Total Annual Hours.

36,000. (For policy questions regarding this collection contact. Lisa Shochet at 410-786-5445.) 2. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Outcome and Assessment Information Set (OASIS) OASIS-D. Use. Due to the buy antibiotics related Public Health Emergency, the next version of the Outcome and Assessment Information Set (OASIS), version E planned for implementation January 1, 2021, was delayed. This request is for the Office of Management and Budget (OMB) approval to extend the current OASIS-D expiration date in order for home health agencies to continue data collection required for participation in the Medicare program.

The current version of the OASIS-D, data item set was approved by OMB on December 6, 2018 and implemented on January 1, 2019. This request includes updated calculations using 2020 data for wages, number of home health agencies and number of OASIS assessments at each time point. Form Number. CMS-10545 (OMB control number. 0938-1279).

Frequency. Occasionally. Affected Public. Private Sector (Business or other for-profit and Not-for-profit institutions). Number of Respondents.

11,400. Total Annual Responses. 17,932,166. Total Annual Hours.

3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each where to buy cheap cipro collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection where to buy cheap cipro to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection 1. Type of Information Collection where to buy cheap cipro Request. Revision of a currently approved collection. Title of Information Collection. Survey of Retail Prices where to buy cheap cipro.

Use. This information collection request provides for a survey of the average acquisition costs of all covered outpatient drugs purchased by retail community pharmacies. CMS may contract with a vendor where to buy cheap cipro to conduct monthly surveys of retail prices for covered outpatient drugs. Such prices represent a nationwide average of consumer purchase prices, net of discounts and rebates. The contractor shall provide notification when a drug product becomes generally available and that the contract include such terms and conditions as the Secretary shall specify, including a requirement that the vendor monitor the marketplace.

CMS has where to buy cheap cipro developed a National Average Drug Acquisition Cost (NADAC) for states to consider when developing reimbursement methodology. The NADAC is a pricing benchmark that is based on the national average costs that pharmacies pay to acquire Medicaid covered outpatient drugs. This pricing benchmark is based on drug acquisition costs collected directly from pharmacies through a nationwide survey process. This survey is conducted on a where to buy cheap cipro monthly basis to ensure that the NADAC reference file remains current and up-to-date. Form Number.

CMS-10241 (OMB control number 0938-1041). Frequency. Monthly. Affected Public. Private sector (Business or other for-profits).

Number of Respondents. 72,000. Total Annual Responses. 72,000. Total Annual Hours.

36,000. (For policy questions regarding this collection contact. Lisa Shochet at 410-786-5445.) 2. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Outcome and Assessment Information Set (OASIS) OASIS-D. Use. Due to the buy antibiotics related Public Health Emergency, the next version of the Outcome and Assessment Information Set (OASIS), version E planned for implementation January 1, 2021, was delayed. This request is for the Office of Management and Budget (OMB) approval to extend the current OASIS-D expiration date in order for home health agencies to continue data collection required for participation in the Medicare program.

The current version of the OASIS-D, data item set was approved by OMB on December 6, 2018 and implemented on January 1, 2019. This request includes updated calculations using 2020 data for wages, number of home health agencies and number of OASIS assessments at each time point. Form Number. CMS-10545 (OMB control number. 0938-1279).

Frequency. Occasionally. Affected Public. Private Sector (Business or other for-profit and Not-for-profit institutions). Number of Respondents.

11,400. Total Annual Responses. 17,932,166. Total Annual Hours. 9,893,376.

(For policy questions regarding this collection contact Joan Proctor at 410-786-0949). Start Signature Dated. May 18, 2021. William N.

What should my health care professional know before I take Cipro?

They need to know if you have any of these conditions:

  • child with joint problems
  • heart condition
  • kidney disease
  • liver disease
  • seizures disorder
  • an unusual or allergic reaction to ciprofloxacin, other antibiotics or medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

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This interim final rule implements changes related to the forgiveness of loans made under the Paycheck Protection Program (PPP), which was originally established under the antibiotics Aid, Relief, and Economic Security Act (CARES Act) to provide economic relief to small businesses nationwide adversely impacted by the antibiotics Disease 2019 (buy antibiotics), as amended. SBA has issued a number of interim final rules implementing the PPP Program. This interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by allowing lenders to use a buy antibiotics Revenue Reduction Score at the time of forgiveness to document the required revenue reduction for Second Draw PPP Loans, and establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan foods to avoid while taking cipro forgiveness applications.

This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. Effective date. The provisions of this foods to avoid while taking cipro interim final rule are effective July 28, 2021.

Applicability date. The buy antibiotics Revenue Reduction Score foods to avoid while taking cipro portion of this interim final rule applies to all Second Draw PPP Loans for which the lender has not yet issued a loan forgiveness decision to SBA as of the effective date of this rule. The direct borrower forgiveness process portion of this rule applies to all PPP loans for which a loan forgiveness application has not been submitted by the borrower to the lender as of the effective date of this rule.

The deferment portion of the rule applies to PPP appeals filed after the effective date of this rule and to those PPP appeals filed before the effective date of this rule for which a Notice and Order has not been issued. Comment foods to avoid while taking cipro date. Comments must be received on or before August 30, 2021.

You may submit comments, identified by docket number SBA-2021-0015 through the Federal eRulemaking Portal. Http://www.regulations.gov. Follow the instructions for submitting comments.

SBA will post all comments on www.regulations.gov. If you wish to submit confidential business information (CBI) as defined in the User Notice at www.regulations.gov, please send an email to ppp-ifr@sba.gov. All other comments must be submitted through the Federal eRulemaking Portal described above.

Highlight the information that you consider to be CBI and explain why you believe SBA should hold this information as confidential. SBA will review the information and make the final determination whether it will publish the information. Start Further Info A Call Center Representative at 833-572-0502 or the local SBA Field Office.

The list of offices can be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices. If you use a telecommunications device for the deaf (TDD) or a text telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in an accessible format that may be provided in Rich Text Format (RTF) or text format (txt), a thumb drive, an mp3 file, Braille, large print, audiotape, or compact disc, or other accessible formats.

End Further Info End Preamble Start Supplemental Information I. Background Information On March 27, 2020, the antibiotics Aid, Relief, and Economic Security Act (CARES Act) (Pub. L.

116-136) was enacted to provide emergency assistance and health care response for individuals, families, and businesses affected by the antibiotics Disease 2019 (buy antibiotics) cipro. Section 1102 of the CARES Act temporarily permitted the Small Business Administration (SBA) to guarantee 100 percent of 7(a) loans under a new program titled the “Paycheck Protection Program,” pursuant to section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36)) (First Draw PPP Loans).

Section 1106 of the CARES Act provided for forgiveness of up to the full principal amount of qualifying loans guaranteed under the Paycheck Protection Program (PPP). On April 24, 2020, the Paycheck Protection Program and Health Care Enhancement Act (Pub. L.

116-139) was enacted, which provided additional funding and authority for the PPP Program. On June 5, the Paycheck Protection Program Flexibility Act of 2020 (PPP Flexibility Act) (Pub. L.

116-142) was enacted, which changed provisions of the PPP relating to the maturity of PPP loans, the deferral of PPP loan payments, and the forgiveness of PPP loans. On July 4, 2020, Public Law 116-147 extended the authority to guarantee PPP loans to August 8, 2020. On December 27, 2020, the Economic Aid to Hard-Hit Small Businesses, Nonprofits and Venues Act (Economic Aid Act) (Pub.

L. 116-260) was enacted. The Economic Aid Act reauthorized lending under the PPP through March 31, 2021.

The Economic Aid Act added a new temporary section 7(a)(37) to the Small Business Act, which authorizes SBA to guarantee additional PPP loans (Second Draw PPP Loans) to certain eligible borrowers that previously received a First Draw PPP Loan under generally the same terms and conditions available under section 7(a)(36) of the Small Business Act. Among other things, to be eligible for a Second Draw PPP Loan, the borrower must have experienced a revenue reduction of not less than 25% in at least one quarter of 2020 compared to the same quarter in 2019. The Economic Aid Act also redesignated section 1106 of the CARES Act as section 7A of the Small Business Act, to appear after section 7 of the Small Business Act.

Additionally, the Economic Aid Act provided for a simplified forgiveness application process for PPP loans of $150,000 or less. On March 11, 2021, the American Rescue Plan Act (ARPA) (Pub. L.

117-2) was enacted, and among other things, expanded eligibility for First Draw PPP Loans and Second Draw PPP Loans and revised exclusions from payroll costs for purposes of forgiveness. On March 30, 2021, the PPP Extension Act of 2021 (Pub. L.

117-6) was enacted, extending SBA's PPP program authority through June 30, 2021. From April 3, 2020, through August 8, 2020, when the 2020 round of PPP expired, SBA guaranteed over 5.2 million PPP loans made by over 5,000 PPP lenders under delegated authority. From January 11, 2021, when the PPP reopened, through June 30, 2021, when the PPP program authority expired, SBA guaranteed over 6.6 million additional PPP loans.

Thus, the total number of PPP loans guaranteed by SBA exceeds 11.8 million.[] The total dollar amount of Start Printed Page 40922the PPP loans guaranteed by SBA exceeds $806 billion. SBA posted the first interim final rule implementing the PPP on SBA's website on April 2, 2020, and published the rule in the Federal Register on April 15, 2020 (85 FR 20811). SBA subsequently issued numerous additional interim final rules.

On June 1, 2020, SBA published an interim final rule on loan forgiveness requirements (85 FR 33004) and an interim final rule on loan review procedures (85 FR 33010). Prior to the publication of the loan forgiveness and loan review interim final rules, on May 15, 2020, SBA issued SBA Form 3508, which was a loan forgiveness application to be used by all PPP borrowers. On June 26, 2020, SBA published an interim final rule revising the loan forgiveness and loan review procedures to conform to the key forgiveness changes made by the PPP Flexibility Act (85 FR 38304).

In conjunction with the rule, SBA issued a second loan forgiveness application form, SBA Form 3508EZ, which is a streamlined form that incorporates the forgiveness safe harbors established under the PPP Flexibility Act. SBA's 2020 PPP program authority expired on August 8, 2020. On August 10, 2020, SBA began accepting PPP lender decisions on PPP borrower loan forgiveness applications through SBA's Paycheck Protection Platform (Platform) (forgiveness.sba.gov).

PPP borrowers were required to submit their loan forgiveness applications to their PPP lenders, and as required by section 1106 of the CARES Act (now section 7A of the Small Business Act), lenders were required to issue a decision to SBA on the borrower's loan forgiveness application within 60 days of receipt of the application. On August 27, 2020, SBA issued an interim final rule on Appeals of SBA Loan Review Decisions under the Paycheck Protection Program (85 FR 52883). On October 2, 2020, SBA began remitting forgiveness payments to PPP lenders that submitted forgiveness decisions to SBA through the Platform.

SBA continues to remit forgiveness payments to PPP lenders, and as of July 12, 2021, SBA has remitted over 4.3 million forgiveness payments to lenders.[] On October 19, 2020, in response to borrower and lender concerns about the complexity of the loan forgiveness process for the smallest of borrowers, SBA and the Department of the Treasury (Treasury) jointly issued an interim final rule revising the loan forgiveness and loan review procedures to simplify the forgiveness process for PPP loans of $50,000 or less. Among other things, the rule exempted borrowers with loans of $50,000 or less from the full-time equivalent employee (FTE) and salary/wage reduction penalties included in section 1106 of the CARES Act, under the joint SBA/Treasury statutory authority to make de minimis exemptions to those penalties. In conjunction with the rule, SBA issued a third loan forgiveness application, SBA Form 3508S, which was a further streamlined loan forgiveness application available for use by borrowers with loans of $50,000 or less.

On January 14, 2021, SBA published interim final rules implementing the Economic Aid Act amendments to the PPP. The first interim final rule implemented Economic Aid Act changes to, among other things, PPP eligibility, and consolidated numerous prior interim final rules on PPP (86 FR 3692) (Consolidated Eligibility IFR). The second interim final rule implemented the Second Draw PPP Loan program authorized by the Economic Aid Act under section 7(a)(37) of the Small Business Act (86 FR 3712) (Second Draw IFR).

On February 5, 2021, SBA published a third interim final rule implementing Economic Aid Act changes related to the forgiveness and review of PPP loans (86 FR 8283) (Consolidated Forgiveness and Loan Review IFR). Among other things, the Consolidated Forgiveness and Loan Review IFR implemented the simplified forgiveness application process for loans of $150,000 or less required by the Economic Aid Act. In conjunction with this rule, on January 19, 2021, SBA issued a revised SBA Form 3508S, which increased the loan amount for which the form could be used from $50,000 to $150,000.[] The new SBA Form 3508S was also shortened to one page, as required by the Economic Aid Act, and no longer requires the submission of supporting forgiveness documentation, as mandated by the Economic Aid Act.

Following the publication of the interim final rules implementing the Economic Aid Act, SBA published another interim final rule on March 8, 2021, revising certain loan amount calculation and eligibility provisions for PPP (86 FR 13149). On March 22, 2021, SBA published an interim final rule implementing the PPP provisions of ARPA (86 FR 15083). As described below, this interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by (a) allowing lenders to use a buy antibiotics Revenue Reduction Score at the time of loan forgiveness to document the required revenue reduction for Second Draw PPP loans of $150,000 or less, and (b) establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications for PPP Loans of $150,000 or less.

This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. II. Comments and Immediate Effective Date This interim final rule is being issued without advance notice and public comment because section 1114 of the CARES Act and section 303 of the Economic Aid Act authorize SBA to issue regulations to implement the Paycheck Protection Program without regard to notice requirements.

Even otherwise, SBA finds good cause for setting aside the advance notice-and-public-comment procedure because that procedure would be impracticable and contrary to the public interest. The intent of the CARES Act and the Economic Aid Act is to afford SBA the flexibility to provide relief to America's small businesses and nonprofit organizations expeditiously. Given the urgent need to provide borrowers with timely relief, the purpose of the rule is to minimize the burdens of the current loan forgiveness process that, without modification, could result in borrowers unnecessarily having to make principal and interest payments on loans that should be forgiven.

If SBA were to follow the advance notice-and-public-comment process, that would delay issuance of the rule by at least three months. SBA understands—based on its expertise and consistent portfolio analysis—that a significant number of borrowers will have to apply for loan forgiveness in the next three months. Therefore, if the proposed rule is still undergoing notice and comment during that time, these borrowers will be applying under the current process, which (as noted above) would mean these borrowers could unnecessarily have to make principal and interest payments on loans that should be forgiven and would not be positively Start Printed Page 40923impacted by a later rule change.

Providing for notice and comment would render the rule effectively moot and useless for millions of intended beneficiaries. For these same reasons, SBA has determined that it is impractical and not in the public interest to provide a 30-day delayed effective date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders.

This good cause justification also supports waiver of the 60-day delayed effective date for major rules under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as the Congressional Review Act) at 5 U.S.C. 808(2). Although this interim final rule is effective immediately, comments are solicited from interested members of the public on all aspects of the interim final rule.

These comments must be submitted on or before August 30, 2021. SBA will consider these comments and the need for making any revisions as a result of these comments. III.

Paycheck Protection Program—buy antibiotics Revenue Reduction Score, Direct Borrower Forgiveness Process, and Appeals Deferment Overview A. Further Streamlining Forgiveness for PPP Loans of $150,000 or Less A key feature of the PPP is that a borrower may obtain forgiveness of up to the full amount of its PPP loan provided that the borrower complied with PPP requirements. Since SBA issued the first loan forgiveness application form (SBA Form 3508) in May 2020 and published the first loan forgiveness and loan review rules in June 2020, SBA has received comments from borrowers and lenders that the loan forgiveness process is overwhelming and difficult to manage and requesting simplification of the process.

In response to borrower and lender requests for simplification of the loan forgiveness process, Congress enacted the PPP Flexibility Act in June 2020, which created safe harbors from the FTE and salary/wage reduction penalties of section 1106 of the CARES Act, and in response, SBA issued a new streamlined loan forgiveness application (SBA Form 3508EZ) implementing those changes. In October 2020, SBA and Treasury exempted borrowers with loans of $50,000 or less from the FTE and salary/wage reduction penalties and issued a second new streamlined loan forgiveness application (SBA Form 3508S) implementing those changes. Borrowers and lenders continued to express concerns about the complexity of the loan forgiveness process, and in December 2020, Congress enacted the Economic Aid Act, which provides for a simplified loan forgiveness application process for borrowers with loans of $150,000 or less.

SBA implemented this requirement by revising the second streamlined loan forgiveness application (SBA Form 3508S) to allow all borrowers with loans of $150,000 or less to use the form. Loans of $150,000 or less represent 93 percent of the outstanding PPP loans. Despite the implementation of the streamlined loan forgiveness application for borrowers with loans of $150,000 or less, many smaller PPP lenders continue to express concerns to SBA that they do not have the technology or human resources to develop efficient electronic loan forgiveness platforms to process the new streamlined loan forgiveness application.[] SBA has also become aware that because lenders are overwhelmed by the volume of PPP loans and are mindful of the statutory 60-day requirement for lenders to issue a forgiveness decision to SBA from receipt of the borrower's loan forgiveness application, lenders are limiting when loan forgiveness applications are accepted from borrowers, creating uncertainty among borrowers that they are going to have to start making payments on their PPP loans while they are waiting for their lenders to accept and process their loan forgiveness applications.

Additionally, SBA has heard concerns from PPP lenders of all sizes that the requirement for borrowers to submit and lenders to review at the time of forgiveness the revenue reduction documentation for Second Draw PPP Loans of $150,000 or less is delaying the forgiveness process for these borrowers. To further simplify and streamline the forgiveness process for loans $150,000 or less, SBA is making two changes under this interim final rule. First, for Second Draw PPP Loans of $150,000 or less, where the borrower is required to provide revenue reduction documentation at the time of loan forgiveness, SBA is allowing lenders to use a buy antibiotics Revenue Reduction Score developed by SBA's contractor as an optional method to document the borrower's revenue reduction.

Second, SBA is making available a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method for processing borrower loan forgiveness applications for all PPP loans of $150,000 or less. 1. buy antibiotics Revenue Reduction Score Among other things, to be eligible for a Second Draw PPP Loan, a PPP borrower is required to have experienced a revenue reduction of not less than 25% during one quarter of 2020 compared to the same quarter in 2019.

Under section 7(a)(37)(I) of the Small Business Act, when a borrower applies for a Second Draw PPP Loan of $150,000 or less, the borrower can submit a certification that the borrower meets the revenue reduction standard, provided that on or before the date on which the borrower submits an application for loan forgiveness, the borrower produces adequate documentation that the borrower has met the revenue reduction standard. All Second Draw PPP Loan borrowers were required to certify on their loan applications (SBA Forms 2483-SD and 2483-SD-C) that they realized a reduction in gross receipts in excess of 25% relative to the relevant comparison time period. The Second Draw PPP Loan IFR and the Loan Forgiveness and Loan Review IFR implementing the Economic Aid Act provide that if a borrower with a Second Draw PPP Loan of $150,000 or less did not produce documentation of revenue reduction at the time of application, the borrower must, on or before the date the borrower applies for loan forgiveness, submit to the lender documentation adequate to establish that the borrower experienced a revenue reduction of 25% or greater in 2020 relative to 2019, and such documentation may include relevant tax forms, including annual tax forms, or if relevant tax forms are not available, quarterly financial statements or bank statements.

The rules also provide that where a borrower with a Second Draw PPP Loan of $150,000 or less does not provide documentation of revenue reduction with its loan application, the lender must perform a good faith review of the documents provided by the borrower at or before forgiveness, including the borrower's calculations and supporting documents.[] Start Printed Page 40924 To streamline forgiveness of Second Draw PPP Loans of $150,000 or less where the borrower did not submit documentation of revenue reduction at the time of the loan application, SBA has determined that an alternative form of revenue reduction confirmation is warranted to document the borrower's revenue reduction. An independent third-party SBA contractor has developed a buy antibiotics Revenue Reduction Score (score) based on a variety of inputs including industry, geography, and business size. The score uses current data on economic recovery and return of businesses to operational status.[] Each Second Draw PPP Loan of $150,000 or less will be assigned a score, which will be maintained in the Platform and will be visible to lenders to use on an optional basis as an alternative to document revenue reduction.

Additionally, the score will be visible to those borrowers that submit their loan forgiveness applications through the Platform using the direct borrower forgiveness process. When the score meets or exceeds the value required for validation of the borrower's revenue reduction, use of the score will satisfy the requirement for the borrower to document revenue reduction. When the score does not meet the value required for validation of the borrower's revenue reduction, and if the borrower has not already provided documentation to the lender that validates the borrower's revenue reduction, the borrower must provide documentation either directly to the lender (for those lenders that do not opt-in to the direct borrower forgiveness process) or provide documentation to the lender by uploading it to the Platform.

Shortly after issuance of this rule, SBA will be providing additional guidance regarding the procedures for lenders and borrowers to use the buy antibiotics Revenue Reduction Score, including when a score meets or exceeds the value required for validation of the required reductions in gross receipts and thus is considered adequate documentation of the borrower's revenue reduction. 2. Direct Borrower Forgiveness Process In response to PPP lender and borrower concerns, SBA is implementing a direct borrower forgiveness process.

The direct borrower forgiveness process is an optional technology solution that SBA is providing to PPP lenders that will leverage SBA's existing and proven Platform and align with and seamlessly integrate the streamlined forgiveness application for loans of $150,000 or less mandated by the Economic Aid Act. When a PPP lender opts-in to the direct borrower forgiveness process, the Platform will provide a single secure location for all of its borrowers with loans of $150,000 or less to apply for loan forgiveness through the Platform using the electronic equivalent of SBA Form 3508S. Upon receipt of notice that a borrower has applied for forgiveness through the Platform, lenders will review the loan forgiveness application in the Platform and issue a forgiveness decision to SBA inside the Platform.

SBA believes that lenders that opt-in to using the direct borrower forgiveness process will benefit with reduced costs, increased efficiency, and more timely remittance of forgiveness payments from SBA, while borrowers will benefit from the ability to submit loan forgiveness applications directly through the Platform and reduce the wait time and uncertainty associated with submission through their lender. Shortly after issuance of this rule, SBA will be issuing more detailed procedural guidance regarding (1) the process for lenders to opt-in to the direct borrower forgiveness process, (2) the process for borrowers with loans of $150,000 or less to access the Platform and submit their loan forgiveness applications directly through the Platform, and (3) the process for lenders to access the forgiveness applications in the Platform to perform reviews of their borrowers' applications, issue forgiveness decisions to SBA, and request forgiveness payments from SBA. During the transition period after the launch of the direct borrower forgiveness process, lenders that opt-in will be expected to complete the processing of any loan forgiveness applications that have already been submitted by borrowers to the lender and should inform such borrowers not to submit a duplicate loan forgiveness application through the Platform.

After the launch of the direct borrower forgiveness process, borrowers will continue to submit loan forgiveness applications to their lenders, rather than through the Platform, under the following circumstances. The PPP lender does not opt-in to use the direct borrower forgiveness process. The borrower's PPP loan amount is greater than $150,000.

The borrower does not agree with the data as provided by the SBA system of record, or cannot validate their identity in the Platform (for example, if there is an unreported change of ownership). Or For any other reason where the Platform rejects the borrower's submission. In such circumstances, borrowers must follow instructions from their lender regarding how the lender expects the borrower to submit a forgiveness application for its PPP loan.

B. Deferment Extension for OHA Appeals Currently, the rule for appeals of final SBA loan review decisions on PPP loans provides that because a PPP borrower must begin making payments of principal and interest on the remaining balance of its PPP loan when SBA remits the loan forgiveness amount to the PPP lender (or notifies the lender that no loan forgiveness is allowed), an appeal by a PPP borrower of any final SBA loan review decision does not extend the deferment period of the PPP loan. SBA is amending the appeals rule to, among other things, provide that a borrower's timely appeal of a final SBA loan review decision will extend the deferment period for the PPP loan until SBA's Office of Hearings and Appeals (OHA) issues a final decision on the appeal.

The revised OHA rule will provide that the borrower should notify the lender of the appeal so that the lender can extend the deferment period. Under the revised OHA rule, an appeal petition must be filed with OHA within 30 calendar days after the appellant's receipt of the final SBA loan review decision. SBA has determined that, in order to avoid the potential administrative burden of having to reverse implementation of the final SBA loan review decision, including the refund of borrower payments by the lender and the processing of forgiveness payments by SBA, a timely appeal by a PPP borrower of a final SBA loan review decision should extend the deferment period of the PPP loan.

SBA believes Start Printed Page 40925that allowing for continued deferment is in the best interest of the borrower. For these reasons, SBA is conforming the applicable PPP rules to provide that a timely appeal by a PPP borrower of a final SBA loan review decision extends the deferment period of the PPP loan until OHA's decision becomes final under 13 CFR 134.1211. IV.

Revisions to Prior PPP Rules Therefore, the following changes are made to PPP rules. 1st Revision. The first sentence of Part IV.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8287) is revised to read as follows. 2. Loan Forgiveness Process a.

What is the general process to obtain loan forgiveness?. To receive loan forgiveness on either a First Draw PPP Loan or a Second Draw PPP Loan, a borrower must complete and submit the Loan Forgiveness Application [] to its lender (or to the lender servicing its loan), or for loans of $150,000 or less if directed by its lender, through the Paycheck Protection Platform (forgiveness.sba.gov). * * * * * * * * 2nd Revision.

Part IV.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8288) is revised by adding a sentence to the end of the paragraph to read as follows. B.

When must a borrower apply for loan forgiveness or start making payments on a loan?. €‰[] * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 3rd Revision.

Part IV.6.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the first paragraph to read as follows. 6.

Documentation Requirements a. What must borrowers submit for forgiveness of their PPP loans?. * * * If a Second Draw PPP Loan borrower's buy antibiotics Revenue Reduction Score in the Paycheck Protection Platform meets or exceeds the value required to validate the borrower's revenue reduction, no additional documentation is required to be submitted by the borrower.

* * * * * 4th Revision. The first sentence of Part IV.6.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised to read as follows.

B. What documentation are borrowers who are individuals with self-employment income who file a Form 1040, Schedule C or F required to submit to their lender with their request for loan forgiveness?. For borrowers that received loans of $150,000 or less that use the SBA Form 3508S, the borrower must submit the certification and information required by section 7A(l)(1)(A) of the Small Business Act and, for a Second Draw PPP Loan, revenue reduction documentation (which could be the buy antibiotics Revenue Reduction Score, if applicable) if such documentation was not provided at the time of application.[] * * * * * * * * 5th Revision.

Part IV.6.c. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the third paragraph to read as follows. C.

What additional documentation must a borrower submit when the President of the United States, Vice President of the United States, the head of an Executive department, or a Member of Congress, or the spouse of any of the preceding, directly or indirectly holds a controlling interest in the borrower?. * * * * * * * * If a borrower with a First Draw PPP Loan of $150,000 or less submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the borrower must submit any required SBA Form 3508D through the Platform not later than 30 days after submitting its application through the Platform. * * * * * 6th Revision.

Footnote 82 in Part V.1.f. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8295) is revised to read as follows. See 85 FR 52833 (Aug.

27, 2020), as amended. 7th Revision. The SBA Form 3508S subsection of Part V.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. 2. The Loan Forgiveness Process for Lenders a.

What should a lender review?. * * * * * When a borrower submits SBA Form 3508S or lender's equivalent form, the lender shall. I.

Confirm receipt of the borrower certifications contained in the SBA Form 3508S or lender's equivalent form. Ii. In the case of a Second Draw PPP Loan of $150,000 or less for which the borrower did not provide documentation of revenue reduction with its application and the lender did not conduct a review of the documentation at the time of application.

If the borrower submits its loan forgiveness application to the lender, the lender may review the borrower's buy antibiotics Revenue Reduction Score (score) in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.[] If the borrower submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the lender must review the borrower's score in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must review the revenue reduction documentation uploaded by the borrower into the Platform and confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For those borrowers that are required to submit documentation regarding revenue reduction (other than a buy antibiotics Revenue Reduction Score), if the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents regarding revenue reduction, the lender should work with the borrower to remedy the issue. Providing an accurate calculation Start Printed Page 40926of the loan forgiveness amount is the responsibility of the borrower, and the borrower attests to the accuracy of its reported information and calculations on the Loan Forgiveness Application. The borrower shall not receive forgiveness without submitting all required documentation to the lender.

As the First Interim Final Rule [] and section IV.7 above indicate, lenders may rely on borrower representations. As stated in paragraph III.3.c of the First Interim Final Rule, the lender does not need to independently verify the borrower's reported information if the borrower submits documentation supporting its request for loan forgiveness (if required) and attests that it accurately verified the payments for eligible costs. 8th Revision.

The first sentence of the first paragraph of Part V.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. B.

What is the timeline for the lender's decision on a loan forgiveness application?. The lender must issue a decision to SBA on a loan forgiveness application not later than 60 days after receipt of a complete loan forgiveness application from the borrower or, if applicable, notification by the Paycheck Protection Platform (Platform) that the borrower has submitted a loan forgiveness application into the Platform. * * * * * * * * 9th Revision.

Part III.B.9. Of the Consolidated Eligibility IFR (86 FR 3692, 3703) is revised to add a fourth paragraph at the end that reads as follows. 9.

When will I have to begin paying principal and interest on my PPP loan?. * * * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 10th Revision.

Part IV.(g)(2)(v) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (g) How do I submit an application for a Second Draw PPP Loan and what documentation must I provide to demonstrate eligibility?. * * * * * (2) * * * (v) For loans with a principal amount of $150,000 or less, the applicant must submit documentation sufficient to establish that the applicant experienced a reduction in revenue as provided in subsection (c)(1)(i) of this section at the time of application, on or before the date the borrower submits an application for loan forgiveness, or, if the borrower does not apply for loan forgiveness, at SBA's request.

Such documentation may include relevant tax forms, including annual tax forms, or, if relevant tax forms are not available, a copy of the applicant's quarterly income statements or bank statements. A buy antibiotics Revenue Reduction Score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. 11th Revision.

Part IV.(h)(2)(D) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (h) What do lenders need to know and do?. (2) * * * (D) For a Second Draw PPP Loan greater than $150,000 or a loan of $150,000 or less where the borrower provides documentation of revenue reduction, confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For a loan of $150,000 or less where the borrower does not provide documentation of revenue reduction with its application, the lender shall perform this review when the borrower provides such documentation. If the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents, the lender should work with the borrower to remedy the issue. For loans of $150,000 or less where the lender elects to use the buy antibiotics Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, the lender must review the borrower's score to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts, otherwise the lender must review the borrower's supporting documentation in accordance with the foregoing requirements.

* * * * * 12th Revision. Part IV.(j) of the Second Draw IFR (86 FR 3712, 3722) is revised to read as follows. (j) Are Second Draw PPP Loans eligible for loan forgiveness?.

Second Draw PPP Loans are eligible for loan forgiveness on the same terms and conditions as First Draw PPP Loans, except that Second Draw PPP Loan borrowers with a principal amount of $150,000 or less are required to provide documentation of revenue reduction if such documentation was not provided at the time of the loan application as specified in subsections (g)(2)(iv) and (v) of this section. If a lender elects to use the buy antibiotics Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, a score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. V.

Additional Information SBA may provide further guidance, if needed, through SBA notices that will be posted on SBA's website at www.sba.gov. Questions on the Paycheck Protection Program may be directed to the Lender Relations Specialist in the local SBA Field Office. The local SBA Field Office may be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices.

Compliance With Executive Orders 12866, 12988, 13132 and 13563, the Congressional Review Act, the Administrative Procedure Act, the Paperwork Reduction Act (44 U.S.C. Ch. 35), and the Regulatory Flexibility Act (5 U.S.C.

601-612). Executive Orders 12866 and 13563 OMB's Office of Information and Regulatory Affairs (OIRA) has determined that this interim final rule is economically significant for the purposes of Executive Orders 12866 and 13563. SBA, however, is proceeding under the emergency provision at Executive Order 12866 section 6(a)(3)(D) based on the need to move expeditiously to mitigate the current economic conditions arising from the buy antibiotics emergency.

This rule is necessary to provide economic relief to small businesses and nonprofit organizations nationwide adversely impacted under the buy antibiotics Emergency Declaration. We anticipate that this rule will result in substantial benefits to small businesses, nonprofit organizations, their employees, and the communities they serve. However, we lack data to estimate the effects of this rule.Start Printed Page 40927 Congressional Review Act and Administrative Procedure Act OIRA has determined that this is a major rule for purposes of Subtitle E of the Small Business Regulatory Enforcement and Fairness Act of 1996 (also known as the Congressional Review Act or CRA) (5 U.S.C.

804(2) et seq.). Under the CRA, a major rule takes effect 60 days after the rule is published in the Federal Register. 5 U.S.C.

801(a)(3). Notwithstanding this requirement, the CRA allows agencies to dispense with the requirements of section 801 when the agency for good cause finds that such procedure would be impracticable, unnecessary, or contrary to the public interest and the rule shall take effect at such time as the agency promulgating the rule determines. 5 U.S.C.

808(2). Pursuant to section 808(2), SBA for good cause finds that a 60-day delay to provide public notice is impracticable and contrary to the public interest. Likewise, for the same reasons, SBA for good cause finds that there are grounds to waive the 30-day effective date delay under the Administrative Procedure Act.

5 U.S.C. 553(d)(3). As discussed elsewhere in this interim final rule, given the urgent need to provide borrowers with timely relief and the short period of time before certain borrowers will be required to begin making principal and interest payments if they have not yet applied for forgiveness with their lenders, SBA has determined that it is impractical and not in the public interest to provide a delayed effective date.

An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. Executive Order 12988 SBA has drafted this rule, to the extent practicable, in accordance with the standards set forth in section 3(a) and 3(b)(2) of Executive Order 12988, to minimize litigation, eliminate ambiguity, and reduce burden. The rule has no preemptive or retroactive effect.

Executive Order 13132 SBA has determined that this rule will not have substantial direct effects on the States, on the relationship between the National Government and the States, or on the distribution of power and responsibilities among the various layers of government. Therefore, SBA has determined that this rule has no federalism implications warranting preparation of a federalism assessment. Paperwork Reduction Act, 44 U.S.C.

Chapter 35 SBA has determined that this rule will require revisions to existing recordkeeping or reporting requirements of the Paycheck Protection Program (PPP) information collection, OMB Control Number 3245-0407. The revisions will affect SBA Forms 3508S and 3508D. SBA Form 3508S will be revised to incorporate the direct borrower forgiveness process and the buy antibiotics Revenue Reduction Score.

SBA Form 3508D will be revised to incorporate the direct borrower forgiveness process. SBA has requested Office of Management and Budget (OMB) emergency approval of the revisions to the information collections to give small businesses and nonprofits affected by this interim final rule the maximum amount of time to apply for loan forgiveness under the new procedures. Regulatory Flexibility Act (RFA) The Regulatory Flexibility Act (RFA) generally requires that when an agency issues a proposed rule, or a final rule pursuant to section 553(b) of the Administrative Procedure Act or another law, the agency must prepare a regulatory flexibility analysis that meets the requirements of the RFA and publish such analysis in the Federal Register.

5 U.S.C. 603, 604. Rules that are exempt from notice and comment are also exempt from the RFA requirements, including conducting a regulatory flexibility analysis, when among other things the agency for good cause finds that notice and public procedure are impracticable, unnecessary, or contrary to the public interest.

SBA Office of Advocacy guide. How to Comply with the Regulatory Flexibility Act, Ch.1. P.9.

Since this rule is exempt from notice and comment, SBA is not required to conduct a regulatory flexibility analysis. Start Authority 15 U.S.C. 636(a)(36).

636m. antibiotics Aid, Relief, and Economic Security Act, Pub. L.

116-136, section 1114, and Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act, Pub. L. 116-260, section 303.

End Authority Start Signature Isabella Casillas Guzman, Administrator. End Signature End Supplemental Information [FR Doc. 2021-16358 Filed 7-28-21.

Start Preamble where to buy cheap cipro Start click for source Printed Page 40921 U.S. Small Business Administration. Interim final rule where to buy cheap cipro.

This interim final rule implements changes related to the forgiveness of loans made under the Paycheck Protection Program (PPP), which was originally established under the antibiotics Aid, Relief, and Economic Security Act (CARES Act) to provide economic relief to small businesses nationwide adversely impacted by the antibiotics Disease 2019 (buy antibiotics), as amended. SBA has issued a number of interim final rules implementing the PPP Program. This interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by allowing lenders to use a buy antibiotics Revenue Reduction Score at the time of forgiveness to document the required revenue reduction where to buy cheap cipro for Second Draw PPP Loans, and establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications.

This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. Effective date. The provisions of this interim final rule are effective July 28, 2021 where to buy cheap cipro.

Applicability date. The buy antibiotics Revenue Reduction Score portion of this interim final rule applies to all Second Draw PPP Loans where to buy cheap cipro for which the lender has not yet issued a loan forgiveness decision to SBA as of the effective date of this rule. The direct borrower forgiveness process portion of this rule applies to all PPP loans for which a loan forgiveness application has not been submitted by the borrower to the lender as of the effective date of this rule.

The deferment portion of the rule applies to PPP appeals filed after the effective date of this rule and to those PPP appeals filed before the effective date of this rule for which a Notice and Order has not been issued. Comment where to buy cheap cipro date. Comments must be received on or before August 30, 2021.

You may submit comments, identified by docket number SBA-2021-0015 through the Federal eRulemaking Portal. Http://www.regulations.gov. Follow the instructions for submitting comments.

SBA will post all comments on www.regulations.gov. If you wish to submit confidential business information (CBI) as defined in the User Notice at www.regulations.gov, please send an email to ppp-ifr@sba.gov. All other comments must be submitted through the Federal eRulemaking Portal described above.

Highlight the information that you consider to be CBI and explain why you believe SBA should hold this information as confidential. SBA will review the information and make the final determination whether it will publish the information. Start Further Info A Call Center Representative at 833-572-0502 or the local SBA Field Office.

The list of offices can be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices. If you use a telecommunications device for the deaf (TDD) or a text telephone (TTY), call the Federal Relay Service (FRS), toll free, at 1-800-877-8339. Individuals with disabilities can obtain this document in an accessible format that may be provided in Rich Text Format (RTF) or text format (txt), a thumb drive, an mp3 file, Braille, large print, audiotape, or compact disc, or other accessible formats.

End Further Info End Preamble Start Supplemental Information I. Background Information On March 27, 2020, the antibiotics Aid, Relief, and Economic Security Act (CARES Act) (Pub. L.

116-136) was enacted to provide emergency assistance and health care response for individuals, families, and businesses affected by the antibiotics Disease 2019 (buy antibiotics) cipro. Section 1102 of the CARES Act temporarily permitted the Small Business Administration (SBA) to guarantee 100 percent of 7(a) loans under a new program titled the “Paycheck Protection Program,” pursuant to section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36)) (First Draw PPP Loans).

Section 1106 of the CARES Act provided for forgiveness of up to the full principal amount of qualifying loans guaranteed under the Paycheck Protection Program (PPP). On April 24, 2020, the Paycheck Protection Program and Health Care Enhancement Act (Pub. L.

116-139) was enacted, which provided additional funding and authority for the PPP Program. On June 5, the Paycheck Protection Program Flexibility Act of 2020 (PPP Flexibility Act) (Pub. L.

116-142) was enacted, which changed provisions of the PPP relating to the maturity of PPP loans, the deferral of PPP loan payments, and the forgiveness of PPP loans. On July 4, 2020, Public Law 116-147 extended the authority to guarantee PPP loans to August 8, 2020. On December 27, 2020, the Economic Aid to Hard-Hit Small Businesses, Nonprofits and Venues Act (Economic Aid Act) (Pub.

L. 116-260) was enacted. The Economic Aid Act reauthorized lending under the PPP through March 31, 2021.

The Economic Aid Act added a new temporary section 7(a)(37) to the Small Business Act, which authorizes SBA to guarantee additional PPP loans (Second Draw PPP Loans) to certain eligible borrowers that previously received a First Draw PPP Loan under generally the same terms and conditions available under section 7(a)(36) of the Small Business Act. Among other things, to be eligible for a Second Draw PPP Loan, the borrower must have experienced a revenue reduction of not less than 25% in at least one quarter of 2020 compared to the same quarter in 2019. The Economic Aid Act also redesignated section 1106 of the CARES Act as section 7A of the Small Business Act, to appear after section 7 of the Small Business Act.

Additionally, the Economic Aid Act provided for a simplified forgiveness application process for PPP loans of $150,000 or less. On March 11, 2021, the American Rescue Plan Act (ARPA) (Pub. L.

117-2) was enacted, and among other things, expanded eligibility for First Draw PPP Loans and Second Draw PPP Loans and revised exclusions from payroll costs for purposes of forgiveness. On March 30, 2021, the PPP Extension Act of 2021 (Pub. L.

117-6) was enacted, extending SBA's PPP program authority through June 30, 2021. From April 3, 2020, through August 8, 2020, when the 2020 round of PPP expired, SBA guaranteed over 5.2 million PPP loans made by over 5,000 PPP lenders under delegated authority. From January 11, 2021, when the PPP reopened, through June 30, 2021, when the PPP program authority expired, SBA guaranteed over 6.6 million additional PPP loans.

Thus, the total number of PPP loans guaranteed by SBA exceeds 11.8 million.[] The total dollar amount of Start Printed Page 40922the PPP loans guaranteed by SBA exceeds $806 billion. SBA posted the first interim final rule implementing the PPP on SBA's website on April 2, 2020, and published the rule in the Federal Register on April 15, 2020 (85 FR 20811). SBA subsequently issued numerous additional interim final rules.

On June 1, 2020, SBA published an interim final rule on loan forgiveness requirements (85 FR 33004) and an interim final rule on loan review procedures (85 FR 33010). Prior to the publication of the loan forgiveness and loan review interim final rules, on May 15, 2020, SBA issued SBA Form 3508, which was a loan forgiveness application to be used by all PPP borrowers. On June 26, 2020, SBA published an interim final rule revising the loan forgiveness and loan review procedures to conform to the key forgiveness changes made by the PPP Flexibility Act (85 FR 38304).

In conjunction with the rule, SBA issued a second loan forgiveness application form, SBA Form 3508EZ, which is a streamlined form that incorporates the forgiveness safe harbors established under the PPP Flexibility Act. SBA's 2020 PPP program authority expired on August 8, 2020. On August 10, 2020, SBA began accepting PPP lender decisions on PPP borrower loan forgiveness applications through SBA's Paycheck Protection Platform (Platform) (forgiveness.sba.gov).

PPP borrowers were required to submit their loan forgiveness applications to their PPP lenders, and as required by section 1106 of the CARES Act (now section 7A of the Small Business Act), lenders were required to issue a decision to SBA on the borrower's loan forgiveness application within 60 days of receipt of the application. On August 27, 2020, SBA issued an interim final rule on Appeals of SBA Loan Review Decisions under the Paycheck Protection Program (85 FR 52883). On October 2, 2020, SBA began remitting forgiveness payments to PPP lenders that submitted forgiveness decisions to SBA through the Platform.

SBA continues to remit forgiveness payments to PPP lenders, and as of July 12, 2021, SBA has remitted over 4.3 million forgiveness payments to lenders.[] On October 19, 2020, in response to borrower and lender concerns about the complexity of the loan forgiveness process for the smallest of borrowers, SBA and the Department of the Treasury (Treasury) jointly issued an interim final rule revising the loan forgiveness and loan review procedures to simplify the forgiveness process for PPP loans of $50,000 or less. Among other things, the rule exempted borrowers with loans of $50,000 or less from the full-time equivalent employee (FTE) and salary/wage reduction penalties included in section 1106 of the CARES Act, under the joint SBA/Treasury statutory authority to make de minimis exemptions to those penalties. In conjunction with the rule, SBA issued a third loan forgiveness application, SBA Form 3508S, which was a further streamlined loan forgiveness application available for use by borrowers with loans of $50,000 or less.

On January 14, 2021, SBA published interim final rules implementing the Economic Aid Act amendments to the PPP. The first interim final rule implemented Economic Aid Act changes to, among other things, PPP eligibility, and consolidated numerous prior interim final rules on PPP (86 FR 3692) (Consolidated Eligibility IFR). The second interim final rule implemented the Second Draw PPP Loan program authorized by the Economic Aid Act under section 7(a)(37) of the Small Business Act (86 FR 3712) (Second Draw IFR).

On February 5, 2021, SBA published a third interim final rule implementing Economic Aid Act changes related to the forgiveness and review of PPP loans (86 FR 8283) (Consolidated Forgiveness and Loan Review IFR). Among other things, the Consolidated Forgiveness and Loan Review IFR implemented the simplified forgiveness application process for loans of $150,000 or less required by the Economic Aid Act. In conjunction with this rule, on January 19, 2021, SBA issued a revised SBA Form 3508S, which increased the loan amount for which the form could be used from $50,000 to $150,000.[] The new SBA Form 3508S was also shortened to one page, as required by the Economic Aid Act, and no longer requires the submission of supporting forgiveness documentation, as mandated by the Economic Aid Act.

Following the publication of the interim final rules implementing the Economic Aid Act, SBA published another interim final rule on March 8, 2021, revising certain loan amount calculation and eligibility provisions for PPP (86 FR 13149). On March 22, 2021, SBA published an interim final rule implementing the PPP provisions of ARPA (86 FR 15083). As described below, this interim final rule further streamlines the forgiveness process for PPP loans of $150,000 or less by (a) allowing lenders to use a buy antibiotics Revenue Reduction Score at the time of loan forgiveness to document the required revenue reduction for Second Draw PPP loans of $150,000 or less, and (b) establishing a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method of processing loan forgiveness applications for PPP Loans of $150,000 or less.

This interim final rule also extends the loan deferment period for those PPP loans where the borrower timely files an appeal of a final SBA loan review decision with the SBA Office of Hearings and Appeals. II. Comments and Immediate Effective Date This interim final rule is being issued without advance notice and public comment because section 1114 of the CARES Act and section 303 of the Economic Aid Act authorize SBA to issue regulations to implement the Paycheck Protection Program without regard to notice requirements.

Even otherwise, SBA finds good cause for setting aside the advance notice-and-public-comment procedure because that procedure would be impracticable and contrary to the public interest. The intent of the CARES Act and the Economic Aid Act is to afford SBA the flexibility to provide relief to America's small businesses and nonprofit organizations expeditiously. Given the urgent need to provide borrowers with timely relief, the purpose of the rule is to minimize the burdens of the current loan forgiveness process that, without modification, could result in borrowers unnecessarily having to make principal and interest payments on loans that should be forgiven.

If SBA were to follow the advance notice-and-public-comment process, that would delay issuance of the rule by at least three months. SBA understands—based on its expertise and consistent portfolio analysis—that a significant number of borrowers will have to apply for loan forgiveness in the next three months. Therefore, if the proposed rule is still undergoing notice and comment during that time, these borrowers will be applying under the current process, which (as noted above) would mean these borrowers could unnecessarily have to make principal and interest payments on loans that should be forgiven and would not be positively Start Printed Page 40923impacted by a later rule change.

Providing for notice and comment would render the rule effectively moot and useless for millions of intended beneficiaries. For these same reasons, SBA has determined that it is impractical and not in the public interest to provide a 30-day delayed effective date. An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders.

This good cause justification also supports waiver of the 60-day delayed effective date for major rules under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as the Congressional Review Act) at 5 U.S.C. 808(2). Although this interim final rule is effective immediately, comments are solicited from interested members of the public on all aspects of the interim final rule.

These comments must be submitted on or before August 30, 2021. SBA will consider these comments and the need for making any revisions as a result of these comments. III.

Paycheck Protection Program—buy antibiotics Revenue Reduction Score, Direct Borrower Forgiveness Process, and Appeals Deferment Overview A. Further Streamlining Forgiveness for PPP Loans of $150,000 or Less A key feature of the PPP is that a borrower may obtain forgiveness of up to the full amount of its PPP loan provided that the borrower complied with PPP requirements. Since SBA issued the first loan forgiveness application form (SBA Form 3508) in May 2020 and published the first loan forgiveness and loan review rules in June 2020, SBA has received comments from borrowers and lenders that the loan forgiveness process is overwhelming and difficult to manage and requesting simplification of the process.

In response to borrower and lender requests for simplification of the loan forgiveness process, Congress enacted the PPP Flexibility Act in June 2020, which created safe harbors from the FTE and salary/wage reduction penalties of section 1106 of the CARES Act, and in response, SBA issued a new streamlined loan forgiveness application (SBA Form 3508EZ) implementing those changes. In October 2020, SBA and Treasury exempted borrowers with loans of $50,000 or less from the FTE and salary/wage reduction penalties and issued a second new streamlined loan forgiveness application (SBA Form 3508S) implementing those changes. Borrowers and lenders continued to express concerns about the complexity of the loan forgiveness process, and in December 2020, Congress enacted the Economic Aid Act, which provides for a simplified loan forgiveness application process for borrowers with loans of $150,000 or less.

SBA implemented this requirement by revising the second streamlined loan forgiveness application (SBA Form 3508S) to allow all borrowers with loans of $150,000 or less to use the form. Loans of $150,000 or less represent 93 percent of the outstanding PPP loans. Despite the implementation of the streamlined loan forgiveness application for borrowers with loans of $150,000 or less, many smaller PPP lenders continue to express concerns to SBA that they do not have the technology or human resources to develop efficient electronic loan forgiveness platforms to process the new streamlined loan forgiveness application.[] SBA has also become aware that because lenders are overwhelmed by the volume of PPP loans and are mindful of the statutory 60-day requirement for lenders to issue a forgiveness decision to SBA from receipt of the borrower's loan forgiveness application, lenders are limiting when loan forgiveness applications are accepted from borrowers, creating uncertainty among borrowers that they are going to have to start making payments on their PPP loans while they are waiting for their lenders to accept and process their loan forgiveness applications.

Additionally, SBA has heard concerns from PPP lenders of all sizes that the requirement for borrowers to submit and lenders to review at the time of forgiveness the revenue reduction documentation for Second Draw PPP Loans of $150,000 or less is delaying the forgiveness process for these borrowers. To further simplify and streamline the forgiveness process for loans $150,000 or less, SBA is making two changes under this interim final rule. First, for Second Draw PPP Loans of $150,000 or less, where the borrower is required to provide revenue reduction documentation at the time of loan forgiveness, SBA is allowing lenders to use a buy antibiotics Revenue Reduction Score developed by SBA's contractor as an optional method to document the borrower's revenue reduction.

Second, SBA is making available a direct borrower forgiveness process for lenders that choose to opt-in as an alternative method for processing borrower loan forgiveness applications for all PPP loans of $150,000 or less. 1. buy antibiotics Revenue Reduction Score Among other things, to be eligible for a Second Draw PPP Loan, a PPP borrower is required to have experienced a revenue reduction of not less than 25% during one quarter of 2020 compared to the same quarter in 2019.

Under section 7(a)(37)(I) of the Small Business Act, when a borrower applies for a Second Draw PPP Loan of $150,000 or less, the borrower can submit a certification that the borrower meets the revenue reduction standard, provided that on or before the date on which the borrower submits an application for loan forgiveness, the borrower produces adequate documentation that the borrower has met the revenue reduction standard. All Second Draw PPP Loan borrowers were required to certify on their loan applications (SBA Forms 2483-SD and 2483-SD-C) that they realized a reduction in gross receipts in excess of 25% relative to the relevant comparison time period. The Second Draw PPP Loan IFR and the Loan Forgiveness and Loan Review IFR implementing the Economic Aid Act provide that if a borrower with a Second Draw PPP Loan of $150,000 or less did not produce documentation of revenue reduction at the time of application, the borrower must, on or before the date the borrower applies for loan forgiveness, submit to the lender documentation adequate to establish that the borrower experienced a revenue reduction of 25% or greater in 2020 relative to 2019, and such documentation may include relevant tax forms, including annual tax forms, or if relevant tax forms are not available, quarterly financial statements or bank statements.

The rules also provide that where a borrower with a Second Draw PPP Loan of $150,000 or less does not provide documentation of revenue reduction with its loan application, the lender must perform a good faith review of the documents provided by the borrower at or before forgiveness, including the borrower's calculations and supporting documents.[] Start Printed Page 40924 To streamline forgiveness of Second Draw PPP Loans of $150,000 or less where the borrower did not submit documentation of revenue reduction at the time of the loan application, SBA has determined that an alternative form of revenue reduction confirmation is warranted to document the borrower's revenue reduction. An independent third-party SBA contractor has developed a buy antibiotics Revenue Reduction Score (score) based on a variety of inputs including industry, geography, and business size. The score uses current data on economic recovery and return of businesses to operational status.[] Each Second Draw PPP Loan of $150,000 or less will be assigned a score, which will be maintained in the Platform and will be visible to lenders to use on an optional basis as an alternative to document revenue reduction.

Additionally, the score will be visible to those borrowers that submit their loan forgiveness applications through the Platform using the direct borrower forgiveness process. When the score meets or exceeds the value required for validation of the borrower's revenue reduction, use of the score will satisfy the requirement for the borrower to document revenue reduction. When the score does not meet the value required for validation of the borrower's revenue reduction, and if the borrower has not already provided documentation to the lender that validates the borrower's revenue reduction, the borrower must provide documentation either directly to the lender (for those lenders that do not opt-in to the direct borrower forgiveness process) or provide documentation to the lender by uploading it to the Platform.

Shortly after issuance of this rule, SBA will be providing additional guidance regarding the procedures for lenders and borrowers to use the buy antibiotics Revenue Reduction Score, including when a score meets or exceeds the value required for validation of the required reductions in gross receipts and thus is considered adequate documentation of the borrower's revenue reduction. 2. Direct Borrower Forgiveness Process In response to PPP lender and borrower concerns, SBA is implementing a direct borrower forgiveness process.

The direct borrower forgiveness process is an optional technology solution that SBA is providing to PPP lenders that will leverage SBA's existing and proven Platform and align with and seamlessly integrate the streamlined forgiveness application for loans of $150,000 or less mandated by the Economic Aid Act. When a PPP lender opts-in to the direct borrower forgiveness process, the Platform will provide a single secure location for all of its borrowers with loans of $150,000 or less to apply for loan forgiveness through the Platform using the electronic equivalent of SBA Form 3508S. Upon receipt of notice that a borrower has applied for forgiveness through the Platform, lenders will review the loan forgiveness application in the Platform and issue a forgiveness decision to SBA inside the Platform.

SBA believes that lenders that opt-in to using the direct borrower forgiveness process will benefit with reduced costs, increased efficiency, and more timely remittance of forgiveness payments from SBA, while borrowers will benefit from the ability to submit loan forgiveness applications directly through the Platform and reduce the wait time and uncertainty associated with submission through their lender. Shortly after issuance of this rule, SBA will be issuing more detailed procedural guidance regarding (1) the process for lenders to opt-in to the direct borrower forgiveness process, (2) the process for borrowers with loans of $150,000 or less to access the Platform and submit their loan forgiveness applications directly through the Platform, and (3) the process for lenders to access the forgiveness applications in the Platform to perform reviews of their borrowers' applications, issue forgiveness decisions to SBA, and request forgiveness payments from SBA. During the transition period after the launch of the direct borrower forgiveness process, lenders that opt-in will be expected to complete the processing of any loan forgiveness applications that have already been submitted by borrowers to the lender and should inform such borrowers not to submit a duplicate loan forgiveness application through the Platform.

After the launch of the direct borrower forgiveness process, borrowers will continue to submit loan forgiveness applications to their lenders, rather than through the Platform, under the following circumstances. The PPP lender does not opt-in to use the direct borrower forgiveness process. The borrower's PPP loan amount is greater than $150,000.

The borrower does not agree with the data as provided by the SBA system of record, or cannot validate their identity in the Platform (for example, if there is an unreported change of ownership). Or For any other reason where the Platform rejects the borrower's submission. In such circumstances, borrowers must follow instructions from their lender regarding how the lender expects the borrower to submit a forgiveness application for its PPP loan.

B. Deferment Extension for OHA Appeals Currently, the rule for appeals of final SBA loan review decisions on PPP loans provides that because a PPP borrower must begin making payments of principal and interest on the remaining balance of its PPP loan when SBA remits the loan forgiveness amount to the PPP lender (or notifies the lender that no loan forgiveness is allowed), an appeal by a PPP borrower of any final SBA loan review decision does not extend the deferment period of the PPP loan. SBA is amending the appeals rule to, among other things, provide that a borrower's timely appeal of a final SBA loan review decision will extend the deferment period for the PPP loan until SBA's Office of Hearings and Appeals (OHA) issues a final decision on the appeal.

The revised OHA rule will provide that the borrower should notify the lender of the appeal so that the lender can extend the deferment period. Under the revised OHA rule, an appeal petition must be filed with OHA within 30 calendar days after the appellant's receipt of the final SBA loan review decision. SBA has determined that, in order to avoid the potential administrative burden of having to reverse implementation of the final SBA loan review decision, including the refund of borrower payments by the lender and the processing of forgiveness payments by SBA, a timely appeal by a PPP borrower of a final SBA loan review decision should extend the deferment period of the PPP loan.

SBA believes Start Printed Page 40925that allowing for continued deferment is in the best interest of the borrower. For these reasons, SBA is conforming the applicable PPP rules to provide that a timely appeal by a PPP borrower of a final SBA loan review decision extends the deferment period of the PPP loan until OHA's decision becomes final under 13 CFR 134.1211. IV.

Revisions to Prior PPP Rules Therefore, the following changes are made to PPP rules. 1st Revision. The first sentence of Part IV.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8287) is revised to read as follows. 2. Loan Forgiveness Process a.

What is the general process to obtain loan forgiveness?. To receive loan forgiveness on either a First Draw PPP Loan or a Second Draw PPP Loan, a borrower must complete and submit the Loan Forgiveness Application [] to its lender (or to the lender servicing its loan), or for loans of $150,000 or less if directed by its lender, through the Paycheck Protection Platform (forgiveness.sba.gov). * * * * * * * * 2nd Revision.

Part IV.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8288) is revised by adding a sentence to the end of the paragraph to read as follows. B.

When must a borrower apply for loan forgiveness or start making payments on a loan?. €‰[] * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 3rd Revision.

Part IV.6.a. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the first paragraph to read as follows. 6.

Documentation Requirements a. What must borrowers submit for forgiveness of their PPP loans?. * * * If a Second Draw PPP Loan borrower's buy antibiotics Revenue Reduction Score in the Paycheck Protection Platform meets or exceeds the value required to validate the borrower's revenue reduction, no additional documentation is required to be submitted by the borrower.

* * * * * 4th Revision. The first sentence of Part IV.6.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised to read as follows.

B. What documentation are borrowers who are individuals with self-employment income who file a Form 1040, Schedule C or F required to submit to their lender with their request for loan forgiveness?. For borrowers that received loans of $150,000 or less that use the SBA Form 3508S, the borrower must submit the certification and information required by section 7A(l)(1)(A) of the Small Business Act and, for a Second Draw PPP Loan, revenue reduction documentation (which could be the buy antibiotics Revenue Reduction Score, if applicable) if such documentation was not provided at the time of application.[] * * * * * * * * 5th Revision.

Part IV.6.c. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8293) is revised by adding a sentence to the end of the third paragraph to read as follows. C.

What additional documentation must a borrower submit when the President of the United States, Vice President of the United States, the head of an Executive department, or a Member of Congress, or the spouse of any of the preceding, directly or indirectly holds a controlling interest in the borrower?. * * * * * * * * If a borrower with a First Draw PPP Loan of $150,000 or less submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the borrower must submit any required SBA Form 3508D through the Platform not later than 30 days after submitting its application through the Platform. * * * * * 6th Revision.

Footnote 82 in Part V.1.f. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8295) is revised to read as follows. See 85 FR 52833 (Aug.

27, 2020), as amended. 7th Revision. The SBA Form 3508S subsection of Part V.2.a.

Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. 2. The Loan Forgiveness Process for Lenders a.

What should a lender review?. * * * * * When a borrower submits SBA Form 3508S or lender's equivalent form, the lender shall. I.

Confirm receipt of the borrower certifications contained in the SBA Form 3508S or lender's equivalent form. Ii. In the case of a Second Draw PPP Loan of $150,000 or less for which the borrower did not provide documentation of revenue reduction with its application and the lender did not conduct a review of the documentation at the time of application.

If the borrower submits its loan forgiveness application to the lender, the lender may review the borrower's buy antibiotics Revenue Reduction Score (score) in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.[] If the borrower submits its loan forgiveness application through the Paycheck Protection Platform (Platform), the lender must review the borrower's score in the Platform to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts. If the borrower's score does not meet or exceed the required value, the lender must review the revenue reduction documentation uploaded by the borrower into the Platform and confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For those borrowers that are required to submit documentation regarding revenue reduction (other than a buy antibiotics Revenue Reduction Score), if the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents regarding revenue reduction, the lender should work with the borrower to remedy the issue. Providing an accurate calculation Start Printed Page 40926of the loan forgiveness amount is the responsibility of the borrower, and the borrower attests to the accuracy of its reported information and calculations on the Loan Forgiveness Application. The borrower shall not receive forgiveness without submitting all required documentation to the lender.

As the First Interim Final Rule [] and section IV.7 above indicate, lenders may rely on borrower representations. As stated in paragraph III.3.c of the First Interim Final Rule, the lender does not need to independently verify the borrower's reported information if the borrower submits documentation supporting its request for loan forgiveness (if required) and attests that it accurately verified the payments for eligible costs. 8th Revision.

The first sentence of the first paragraph of Part V.2.b. Of the Consolidated Forgiveness and Loan Review IFR (86 FR 8283, 8296) is revised to read as follows. B.

What is the timeline for the lender's decision on a loan forgiveness application?. The lender must issue a decision to SBA on a loan forgiveness application not later than 60 days after receipt of a complete loan forgiveness application from the borrower or, if applicable, notification by the Paycheck Protection Platform (Platform) that the borrower has submitted a loan forgiveness application into the Platform. * * * * * * * * 9th Revision.

Part III.B.9. Of the Consolidated Eligibility IFR (86 FR 3692, 3703) is revised to add a fourth paragraph at the end that reads as follows. 9.

When will I have to begin paying principal and interest on my PPP loan?. * * * * * Notwithstanding the foregoing, a borrower's timely appeal of a final SBA loan review decision extends the deferment period on the PPP loan until SBA's Office of Hearings and Appeals issues a final decision on the appeal under 13 CFR 134.1211. 10th Revision.

Part IV.(g)(2)(v) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (g) How do I submit an application for a Second Draw PPP Loan and what documentation must I provide to demonstrate eligibility?. * * * * * (2) * * * (v) For loans with a principal amount of $150,000 or less, the applicant must submit documentation sufficient to establish that the applicant experienced a reduction in revenue as provided in subsection (c)(1)(i) of this section at the time of application, on or before the date the borrower submits an application for loan forgiveness, or, if the borrower does not apply for loan forgiveness, at SBA's request.

Such documentation may include relevant tax forms, including annual tax forms, or, if relevant tax forms are not available, a copy of the applicant's quarterly income statements or bank statements. A buy antibiotics Revenue Reduction Score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. 11th Revision.

Part IV.(h)(2)(D) of the Second Draw IFR (86 FR 3712, 3721) is revised to read as follows. (h) What do lenders need to know and do?. (2) * * * (D) For a Second Draw PPP Loan greater than $150,000 or a loan of $150,000 or less where the borrower provides documentation of revenue reduction, confirm the dollar amount and percentage of the borrower's revenue reduction by performing a good faith review, in a reasonable time, of the borrower's calculations and supporting documents concerning the borrower's revenue reduction.

For a loan of $150,000 or less where the borrower does not provide documentation of revenue reduction with its application, the lender shall perform this review when the borrower provides such documentation. If the lender identifies errors in the borrower's calculation or material lack of substantiation in the borrower's supporting documents, the lender should work with the borrower to remedy the issue. For loans of $150,000 or less where the lender elects to use the buy antibiotics Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, the lender must review the borrower's score to confirm that it meets or exceeds the value required to validate the required reduction in gross receipts, otherwise the lender must review the borrower's supporting documentation in accordance with the foregoing requirements.

* * * * * 12th Revision. Part IV.(j) of the Second Draw IFR (86 FR 3712, 3722) is revised to read as follows. (j) Are Second Draw PPP Loans eligible for loan forgiveness?.

Second Draw PPP Loans are eligible for loan forgiveness on the same terms and conditions as First Draw PPP Loans, except that Second Draw PPP Loan borrowers with a principal amount of $150,000 or less are required to provide documentation of revenue reduction if such documentation was not provided at the time of the loan application as specified in subsections (g)(2)(iv) and (v) of this section. If a lender elects to use the buy antibiotics Revenue Reduction Score (score) in the Paycheck Protection Platform (Platform) or where the lender has opted-in to the direct borrower forgiveness process and the borrower submits a loan forgiveness application to the lender through the Platform, a score that meets or exceeds the value required to validate the required reduction in gross receipts will be considered adequate documentation of the borrower's revenue reduction. V.

Additional Information SBA may provide further guidance, if needed, through SBA notices that will be posted on SBA's website at www.sba.gov. Questions on the Paycheck Protection Program may be directed to the Lender Relations Specialist in the local SBA Field Office. The local SBA Field Office may be found at https://www.sba.gov/​tools/​local-assistance/​districtoffices.

Compliance With Executive Orders 12866, 12988, 13132 and 13563, the Congressional Review Act, the Administrative Procedure Act, the Paperwork Reduction Act (44 U.S.C. Ch. 35), and the Regulatory Flexibility Act (5 U.S.C.

601-612). Executive Orders 12866 and 13563 OMB's Office of Information and Regulatory Affairs (OIRA) has determined that this interim final rule is economically significant for the purposes of Executive Orders 12866 and 13563. SBA, however, is proceeding under the emergency provision at Executive Order 12866 section 6(a)(3)(D) based on the need to move expeditiously to mitigate the current economic conditions arising from the buy antibiotics emergency.

This rule is necessary to provide economic relief to small businesses and nonprofit organizations nationwide adversely impacted under the buy antibiotics Emergency Declaration. We anticipate that this rule will result in substantial benefits to small businesses, nonprofit organizations, their employees, and the communities they serve. However, we lack data to estimate the effects of this rule.Start Printed Page 40927 Congressional Review Act and Administrative Procedure Act OIRA has determined that this is a major rule for purposes of Subtitle E of the Small Business Regulatory Enforcement and Fairness Act of 1996 (also known as the Congressional Review Act or CRA) (5 U.S.C.

804(2) et seq.). Under the CRA, a major rule takes effect 60 days after the rule is published in the Federal Register. 5 U.S.C.

801(a)(3). Notwithstanding this requirement, the CRA allows agencies to dispense with the requirements of section 801 when the agency for good cause finds that such procedure would be impracticable, unnecessary, or contrary to the public interest and the rule shall take effect at such time as the agency promulgating the rule determines. 5 U.S.C.

808(2). Pursuant to section 808(2), SBA for good cause finds that a 60-day delay to provide public notice is impracticable and contrary to the public interest. Likewise, for the same reasons, SBA for good cause finds that there are grounds to waive the 30-day effective date delay under the Administrative Procedure Act.

5 U.S.C. 553(d)(3). As discussed elsewhere in this interim final rule, given the urgent need to provide borrowers with timely relief and the short period of time before certain borrowers will be required to begin making principal and interest payments if they have not yet applied for forgiveness with their lenders, SBA has determined that it is impractical and not in the public interest to provide a delayed effective date.

An immediate effective date will allow SBA to expedite loan forgiveness to small businesses and nonprofit organizations and remit forgiveness payments to lenders. Executive Order 12988 SBA has drafted this rule, to the extent practicable, in accordance with the standards set forth in section 3(a) and 3(b)(2) of Executive Order 12988, to minimize litigation, eliminate ambiguity, and reduce burden. The rule has no preemptive or retroactive effect.

Executive Order 13132 SBA has determined that this rule will not have substantial direct effects on the States, on the relationship between the National Government and the States, or on the distribution of power and responsibilities among the various layers of government. Therefore, SBA has determined that this rule has no federalism implications warranting preparation of a federalism assessment. Paperwork Reduction Act, 44 U.S.C.

Chapter 35 SBA has determined that this rule will require revisions to existing recordkeeping or reporting requirements of the Paycheck Protection Program (PPP) information collection, OMB Control Number 3245-0407. The revisions will affect SBA Forms 3508S and 3508D. SBA Form 3508S will be revised to incorporate the direct borrower forgiveness process and the buy antibiotics Revenue Reduction Score.

SBA Form 3508D will be revised to incorporate the direct borrower forgiveness process. SBA has requested Office of Management and Budget (OMB) emergency approval of the revisions to the information collections to give small businesses and nonprofits affected by this interim final rule the maximum amount of time to apply for loan forgiveness under the new procedures. Regulatory Flexibility Act (RFA) The Regulatory Flexibility Act (RFA) generally requires that when an agency issues a proposed rule, or a final rule pursuant to section 553(b) of the Administrative Procedure Act or another law, the agency must prepare a regulatory flexibility analysis that meets the requirements of the RFA and publish such analysis in the Federal Register.

5 U.S.C. 603, 604. Rules that are exempt from notice and comment are also exempt from the RFA requirements, including conducting a regulatory flexibility analysis, when among other things the agency for good cause finds that notice and public procedure are impracticable, unnecessary, or contrary to the public interest.

SBA Office of Advocacy guide. How to Comply with the Regulatory Flexibility Act, Ch.1. P.9.

Since this rule is exempt from notice and comment, SBA is not required to conduct a regulatory flexibility analysis. Start Authority 15 U.S.C. 636(a)(36).

636m. antibiotics Aid, Relief, and Economic Security Act, Pub. L.

116-136, section 1114, and Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act, Pub. L. 116-260, section 303.

End Authority Start Signature Isabella Casillas Guzman, Administrator. End Signature End Supplemental Information [FR Doc. 2021-16358 Filed 7-28-21.

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The Centers for Disease Control and Prevention (CDC) has issued new info on just how little time it takes for a person to get infected by buy antibiotics.A study has found that even brief exposures within 6 feet in cipro vs levaquin for diverticulitis a 24-hour period may increase the risk of buy antibiotics transmission, which could change the way businesses and schools are operating amid the cipro.The new guidance, released by the CDC on Wednesday, Oct. 21, is expected to have the biggest impact on workplaces, schools, and other group settings, including family gatherings, where people are in contact with others.Under previous CDC advisories, “close contact” was defined as someone who spent 15 consecutive minutes or more within 6 feet of cipro vs levaquin for diverticulitis an infected individual. The new advisory now defines close contact as someone who was within 6 feet of an infected individual for a total of 15 minutes or more over a period of 24 hours, with those minutes not necessarily consecutive.The updated guidance can be viewed here. Click here to sign up for Daily Voice's free daily emails and news alerts.Despite protestations from some Hudson Valley communities, there will be no change in the status of the buy antibiotics micro-clusters in Rockland and Orange County, though rates are trending in the right direction.In the Rockland County micro-cluster, the red zone has seen an rate drop from 11.6 percent to 4.8 percent, and from 9.1 to 6 percent in the cipro vs levaquin for diverticulitis yellow zone in the past 10 days.Orange County recently saw a spike in buy antibiotics rates, with some areas reaching a 34.2 percent positive rate, and Rockland peaking at 13.1 percent in the last week of September.In the past week, those numbers have dipped to 4.2 percent in Orange County and 4.8 percent in Rockland.Following the spike, New York Gov. Andrew Cuomo isolated certain clusters where the rate was rising the quickest, implementing new restrictions on certain communities that were designated in “red,” “orange,” and “yellow” zones.Restrictions include the closure of schools and non-essential businesses, limits on the number of people permitted to congregate or gather at any one time, and a rollback on restaurants.New York Gov cipro vs levaquin for diverticulitis.

Andrew Cuomo said the state has been working to identify where outbreaks began, trace it back, contain it, and eliminate it. €œWe’ve been identifying the micro-cluster, and we call it a red zone … then we put a buffer around it and you have an orange zone … then you put cipro vs levaquin for diverticulitis a buffer around that and you have your yellow zone,” he said during a buy antibiotics briefing on Wednesday, Oct. 21 in cipro vs levaquin for diverticulitis Albany. €œIt’s like dropping a pebble in a pond,” he added. €œYou have your ripples and those concentric circles, and that’s how buy antibiotics spreads.” Despite the improved numbers, Cuomo said that there will be no cipro vs levaquin for diverticulitis changes made in the yellow or red zone, and there will be an increase in community testing.In Orange County, the red zone has seen a reduction from 12.8 percent to 4.2 percent in the past 10 days, and the yellow zone has plummeted from 19 percent to 1.6 percent, though there will also be no changes to either zone.“This is much better than what we were doing and what many states are doing, which is shutting down an entire state due to only having statewide data,” Cuomo said.

€œWe went from reducing activities in the entire state to doing that in regions, and now we can reduce activities in a small area so it’s only in your area cipro vs levaquin for diverticulitis. It allows our economy to run with less disruption.”Cuomo said that the state will review the data after two weeks to determine whether a micro-cluster has reduced the viral spread, at which point there could potentially be a reduction in the area’s designation. The state will adjust zones based on the rate cipro vs levaquin for diverticulitis data. To exit a cipro vs levaquin for diverticulitis red zone. Less than 3 percent after 10 days (4 percent in less populated areas);To exit an orange zone.

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There are currently 942 people hospitalized with the cipro and there were 12 new fatalities.Since the cipro began, New York has administered 13,072,715 buy antibiotics tests, with 486,480 testing positive. A total of 25,672 New Yorkers have died since mid-March."We have what we believe is the cipro vs levaquin for diverticulitis most sophisticated buy antibiotics detection and elimination system of any state because we've spent time, we've invested and because New Yorkers are invested. What's the cipro vs levaquin for diverticulitis best you can do?. Detect the smallest outbreak as soon as it happens," Cuomo said. "Trace it back to where it starts, find a small outbreak cipro vs levaquin for diverticulitis or cluster, and jump on it.

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The Centers for Disease Control Online viagra prescription and Prevention (CDC) has issued new info on just how little time it takes for a person to get infected by buy antibiotics.A study has found that even brief exposures within 6 feet in a 24-hour period may where to buy cheap cipro increase the risk of buy antibiotics transmission, which could change the way businesses and schools are operating amid the cipro.The new guidance, released by the CDC on Wednesday, Oct. 21, is expected to have the biggest impact on workplaces, schools, and other group settings, including family gatherings, where people where to buy cheap cipro are in contact with others.Under previous CDC advisories, “close contact” was defined as someone who spent 15 consecutive minutes or more within 6 feet of an infected individual. The new advisory now defines close contact as someone who was within 6 feet of an infected individual for a total of 15 minutes or more over a period of 24 hours, with those minutes not necessarily consecutive.The updated guidance can be viewed here.

Click here to sign up for Daily Voice's free daily emails and news alerts.Despite protestations from some Hudson Valley communities, there will be no change in the status of the where to buy cheap cipro buy antibiotics micro-clusters in Rockland and Orange County, though rates are trending in the right direction.In the Rockland County micro-cluster, the red zone has seen an rate drop from 11.6 percent to 4.8 percent, and from 9.1 to 6 percent in the yellow zone in the past 10 days.Orange County recently saw a spike in buy antibiotics rates, with some areas reaching a 34.2 percent positive rate, and Rockland peaking at 13.1 percent in the last week of September.In the past week, those numbers have dipped to 4.2 percent in Orange County and 4.8 percent in Rockland.Following the spike, New York Gov. Andrew Cuomo isolated certain clusters where the rate was rising the where to buy cheap cipro quickest, implementing new restrictions on certain communities that were designated in “red,” “orange,” and “yellow” zones.Restrictions include the closure of schools and non-essential businesses, limits on the number of people permitted to congregate or gather at any one time, and a rollback on restaurants.New York Gov. Andrew Cuomo said the state has been working to identify where outbreaks began, trace it back, contain it, and eliminate it.

€œWe’ve been identifying the micro-cluster, and we call it a red zone … then we put a buffer around it and you have an orange zone … then you where to buy cheap cipro put a buffer around that and you have your yellow zone,” he said during a buy antibiotics briefing on Wednesday, Oct. 21 in Albany where to buy cheap cipro. €œIt’s like dropping a pebble in a pond,” he added.

€œYou have your ripples and those concentric circles, and that’s how buy antibiotics spreads.” Despite the improved numbers, Cuomo said that there will be no changes made in the yellow where to buy cheap cipro or red zone, and there will be an increase in community testing.In Orange County, the red zone has seen a reduction from 12.8 percent to 4.2 percent in the past 10 days, and the yellow zone has plummeted from 19 percent to 1.6 percent, though there will also be no changes to either zone.“This is much better than what we were doing and what many states are doing, which is shutting down an entire state due to only having statewide data,” Cuomo said. €œWe went from reducing activities in the entire state to doing that in regions, and now we can reduce activities in a small area so it’s only where to buy cheap cipro in your area. It allows our economy to run with less disruption.”Cuomo said that the state will review the data after two weeks to determine whether a micro-cluster has reduced the viral spread, at which point there could potentially be a reduction in the area’s designation.

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€œA cluster does not happen unless two things happen, a where to buy cheap cipro lack of compliance, and a lack of enforcement.“We’re going to see small flare-ups in these micro-clusters because they’re in such small areas,” he added. €œWe can’t where to buy cheap cipro be alarmed by the micro-cluster, because their rates are still lower than most states.” Statewide, there were 90,540 buy antibiotics tests administered yesterday, with 1,201 (1.32 percent) testing positive. There are currently 942 people hospitalized with the cipro and there were 12 new fatalities.Since the cipro began, New York has administered 13,072,715 buy antibiotics tests, with 486,480 testing positive.

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Page updated: 01.06.2010 21:00