2021 ERTC Request Form

2021 ERTC Request Form

3/9/2022
Company Number*
Company Name*
Client Number
Client Name
Contact Name*
Date*

MonthDayYear
Date
The COVID-19 stimulus package allows for a refundable tax credit of $7,000 per employee, per quarter based on a 70% tax credit for qualified wages up to $10,000 through the first two quarters of 2021.

ALERT: Consideration must be made prior to completing this form. Employers must review eligibility with their CPA or Tax Accountant to ensure that your company is eligible for the ERTC or have plans to apply for other programs in 2021. PayData is not responsible for determining ERTC eligibility.

Please refer to this website for eligibility guidelines:

https://www.irs.gov/newsroom/new-law-extends-covid-tax-credit-for-employers-who-keep-workers-on-payroll

PayData ERTC Service fees do apply in calculating the value of the ERTC credits. Client understands and agrees to PayData ERTC service fee of 5% of the clients approved ERTC credit amount, with a cap of $1,000 per quarter. The service fees will be debited within the next 30 days or the company's next payroll, whichever comes first.

To begin applying the 2021 ERTC credit, please complete this 2021 ERTC Credit Request form.
Please enter the date range your company was eligible for the ERTC.
ERTC Begin Date*

MonthDayYear
Date
ERTC End Date*

MonthDayYear
Date
(Note: PayData ERTC service is based on current legislation and is subject to change. The 2021 ERTC is set to expire 12/31/2021)
Did you use Payroll Protection Program (PPP) funds in payroll during the period you were eligible for ERTC?*
Please Note: If you have received and applied any PPP funding for payrolls processed within this date range, please indicate the payroll check dates that these funds were applied. These dates will be excluded from ERTC calculations.
PPP payroll check dates

MonthDayYear
Date
End Date

MonthDayYear
Date
Apply the ERTC credit with EACH Payroll using a scheduled ED code on all employees to determine credit until the credit has exhausted or until PayData is instructed to suspend. (Note: Client acknowledges that they have reviewed, are eligible for the ERTC and accept responsibility if any adjustments, corrections, or penalties may apply.)Apply the ERTC as a LUMP SUM amount at the end of each calendar quarter. (Note: Client acknowledges that they have reviewed, are eligible for the ERTC and accept responsibility if any adjustments, corrections, or penalties may apply.)
Please indicate below all employees that should be excluded from ERTC calculations.
Please note: relatives to the employer or individuals owning over 50% should not be included.

Determining Qualified Wages for COVID-19 Related Employee Retention Credits
Exclude the following employees from ERTC calculations:
Please check this box if you would like to include Qualified Health Plan Expenses in your retention credit calculation.
Authorized Client Representative*
Title*
Signature*
Date

MonthDayYear
Date
Should be Empty: