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COVID-19 Economic Relief Survey
1.
Do you plan on applying for any government programs for economic relief?
Yes
No
Unsure
2.
Have you applied for any of the following programs? (Check all that apply)
Maryland Small Business COVID-19 Emergency Loan Fund
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
Maryland Small Business COVID-19 Emergency Relief Grant
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
Maryland COVID-19 Layoff Aversion Fund
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
SBA Economic Injury Disaster Loan
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
SBA Economic Injury Disaster Advance Payment 10K
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
Federal Payroll Protection Program
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
Maryland COVID-19 Emergency Relief Manufacturing Fund
Yes, I have applied
No, I will not apply
Not yet, but I plan to apply
Unsure and would like more information
3.
Do you plan to apply for the Medicare Advance Payment Program? (This money must be repaid or applied against future payments.)
Yes
No
Unsure
4.
Would you like someone from MedChi to contact you regarding any of these programs?
Yes
No
5.
MedChi is advocating for physicians by working to force payers, Medicare, and other government programs to help physicians in financial crisis. Do you have any suggestions you'd like to share?
6.
Please provide your contact information.
Name
Company
City/Town
Email Address
Phone Number