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Employee Retention Credit Questionnaire
1.
Company name
2.
Company contact
3.
Email address
4.
Were you operating a trade or business in 2020 and 2019?
Yes
No
5.
Please provide gross receipts by quarter for 2019, 2020 and 2021.
Please use the same accounting method to determine gross receipts as is used for income tax filings (ie: accrual vs. cash basis, etc). Include estimates for any quarters if actual data is not available.
2019 - Q1
2019 - Q2
2019 - Q3
2019 - Q4
2020 - Q1
2020 - Q2
2020 - Q3
2020 - Q4
2021 - Q1
2021 - Q2
6.
What was your total number of full-time employees during calendar year 2019?
(Any employee averaging over 30 hours/week)
Less than 100
100 to 500
More than 500
7.
What was your total number of full-time equivalent employees (FTEs) in 2019, as described in the employee retention credit guidance?
(The total number of hours worked by part-time employees for a month divided by 120)
Less than 100 FTEs
100 to 500 FTE
More than 500 FTEs
8.
If yes, please provide a quarter by quarter description of the business operation impacts.
9.
Are you aware of a government order from a federal, state or local government or governmental agency that has impacted how your business conducts its operations?
Yes
No
If yes, please explain briefly
10.
Have your operations been fully or partially suspended due to a government order enacted in response to the pandemic?
Please consider the following factors when determining this:
Full or partial closure of business operations, branches, locations, etc
Transition to remote workforce
Unexpected additional expenses such as sanitation, personal protective equipment, additional security, etc.
Limited operating hours due to curfews
Decreased demand/orders as a direct result of COVID-19
Business interruption insurance claims
Supply chain interruption or disruption for your suppliers
COVID-19 exposure and testing interruption
School closures impacting workforce availability
Yes
No
Maybe, not sure
11.
How have your operations changed since COVID-19 began in March 2020?
12.
Did you receive a Round 1 and/or Round 2 PPP Loan?
Yes
No
13.
If yes, please provide the following:
Loan Amount
Covered Period(s)
Forgiveness Date (if applicable)
14.
Did you receive any other grants during 2020 or 2021 that were used to pay wages?
Yes
No
If yes, please list the grants
15.
Did you receive any other wage related credits in 2020 or 2021 (ie: FFCRA, WOTC, etc)?
Yes
No
Unsure
If yes, please list the additional credits
