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* 1. Company name

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* 2. Company contact

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* 3. Email address

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* 4. Were you operating a trade or business in 2020 and 2019?

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* 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.

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* 6. What was your total number of full-time employees during calendar year 2019?
(Any employee averaging over 30 hours/week)

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* 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)

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* 8. If yes, please provide a quarter by quarter description of the business operation impacts.

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* 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?

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* 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

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* 11. How have your operations changed since COVID-19 began in March 2020?

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* 12. Did you receive a Round 1 and/or Round 2 PPP Loan?

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* 13. If yes, please provide the following:

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* 14. Did you receive any other grants during 2020 or 2021 that were used to pay wages?

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* 15. Did you receive any other wage related credits in 2020 or 2021 (ie: FFCRA, WOTC, etc)?

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