Employee Retention Credit Questionnaire Question Title * 1. Company name Question Title * 2. Company contact Question Title * 3. Email address Question Title * 4. Were you operating a trade or business in 2020 and 2019? Yes No Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 8. If yes, please provide a quarter by quarter description of the business operation impacts. Question Title * 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 Question Title * 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 Question Title * 11. How have your operations changed since COVID-19 began in March 2020? Question Title * 12. Did you receive a Round 1 and/or Round 2 PPP Loan? Yes No Question Title * 13. If yes, please provide the following: Loan Amount Covered Period(s) Forgiveness Date (if applicable) Question Title * 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 Question Title * 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 Next