ERC Questionnaire

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Company Name *

Contact Name *

Email *

1. If your business was partially, temporarily, or permanently suspended due to COVID government mandate at any point in 2020 or 2021, please enter the date the suspension BEGAN. *

Click to learn more about ERC eligibility.

2. If your business was partially, temporarily, or permanently suspended due to COVID government mandate at any point in 2020 or 2021, please enter the date the suspension ENDED. *

3. If applicable, enter details of the suspension below to assist in determining your program eligibility. *

4. Did you begin your trade or business before February 15, 2020? *

5. Did your average annual gross receipts for 2021 exceed $1,000,000? *

6. To determine if your business suffered a significant gross receipts decline when compared to the same quarter in 2019, please fill in your total gross receipt amounts per quarter in the sections below:

Q1 2019 *

Q2 2019 *

Q3 2019 *

Q4 2019 *

Q1 2020 *

Q2 2020 *

Q3 2020 *

Q4 2020 *

Q1 2021 *

Q2 2021 *

Q3 2021 *

7. Enter the number of “Full-time employees” (FTE) PER MONTH that you averaged throughout 2019? (FTE is defined as any employee who had either an average of at least 30 hours of service per week or 130 hours of service in the month.) *

8. As an employer, did you continue to pay qualified health plan expenses for employees at temporarily or permanently suspended locations due to COVID government mandates? (These expenses are any amounts paid or incurred by an employer to maintain a group health plan and includes employer payments plus employee contributions on a pre-tax basis.) *

9. If you received any PPP Loan Forgiveness in 2020, please enter the amount below. *

10. What was your 2020 PPP Loan start date? *

11. If you received any PPP Loan Forgiveness in 2021, please enter the amount below. *

12. What was your 2021 PPP Loan start date? *

13. As an employer, did you receive any Federal or State grants in 2020 or 2021? *

14. Please list any owners and their immediate family that may be included in gross wages for 2020 or 2021, as well as their percent of ownership. *

Employee Retention Credit under the CARES Act Tax Credit Questionnaire

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