Employee Retention Credit Questionnaire
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Email *
1. Business Name of ERC Applicant *
2. Name of person completing the form *
3. What is the current Business Address of the business this form is being completed for? *
4. What is the current Mailing Address of the business this form is being completed for? *
5. Title of Person Completing this form *
6. Is your business a startup company and started operations on or after 2/15/2020? *
7. If Yes to previous question, did your combined gross revenue across all businesses you own exceed $1 million in either 2020 or 2021? *
8. Does your business operate from multiple locations?
(If yes, please share list of all locations.)
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9. Did you file all of your 941s from Q2 2020 through Q3 2021?
(Please list the ones not filed, if any.)
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10. Payroll Provider used.
(If the payroll provider is not the same as it was in 2020, please list the provider before, the provider now, and when the switch happened.)
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11. How many full-time employees did you have in 2019?
(Full Time Employee is someone who works 130 or more hours a month.)
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12. How many W2 employees did you have in 2020?
(Part time and full-time employees.)
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13. How many W2 employees did you have in 2021?
(Part time and full-time employees.)
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14. Does your business owe back taxes? If yes, how much?
(Are you behind on any of your payroll taxes?)
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15. Please provide ownership information of the business. Who are the owner(s) of the business? And provide the percentage of the business owned. If multiple owners, please describe if any of the owners are related to each other.
(e.g. John Smith, owns 50% of the business. Jane Smith owns 50% of the business. John and Jane are married.)
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16. Does the owner own other businesses located in the United States?
(If yes, please list name of business and percentage owned by such owners.) 
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17. Are there anyone related to the owner(s) employed in the business? If so, please name them as listed on payroll.
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18. Did your business have a decline in GROSS revenue in ANY quarter in 2020 or 2021 compared to the same quarter in 2019?
(For example: The business had a decline in revenue 1st QTR 2021 compared to the 1st QTR in 2019.)
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Required
19. Are you able to provide documentation to support the above claims?
Either Quarterly Profit and Loss or Quarterly Income Statements will suffice. (Please be ready to provide these if needed.) 
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20. Did your business experience any government mandates or orders to shut down during the 2020-2021 pandemic?
(E.g., suspension of operations which include but are not limited to a reduction in class size [schools], closed dining [restaurants], etc.)
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21. Provide a description of how the business was subject to a government order to shutdown business operations.
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22. Provide the dates of when the business was subject to a government order to shutdown business operations.
(E.g., From 4/1/2020 to 10/15/2020)
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23. Provide any other information related to the gov't shutdown order or questions you may have regarding eligibility.
(E.g., Subject to multiple orders: classroom subject to closure until XX/XX/XXXX, then class size reduction from XX/XX/XXXX to XX/XX/XXXX, etc.)
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24. Are you able to provide documentation to support the claims made in questions 20-23?
(Please be ready to provide these documents if needed.) 
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25. In 2020/2021, did your business receive any mentioned credits/government funding?
(We are not able to use wages allocated to these credits for the ERC.)
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Required
26. If you received any of the above credits/gov't funding, please list amount, date received as well as covered period (usually 8 or 24 weeks), and percentage used for payroll (60%-100%). Please list as described below for each one you received. 
(E.g., received PPP round 1 funds of $50,000 in bank account on 04/06/2020. 24 week covered period 04/06/20 to 09/21/20. 75% used for payroll.)
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27. If you have any questions and would like to discuss your eligibility for the ERC, please provide Name, Relation to business, and Contact Information. 
(Alexis Smith, Owner, x@xxxxx.com (xxx) xxx - xxxx)
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