ERTC SURVEY Chris G.

ERTC SURVEY
Company - Legal Entity - Name
Business Owner Name
Business Owner Email
example@example.com
Business Owner Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
City
State
Zip Code
Contact Person (If different than business owner)
Contact Number (If different than business owner)
Email (If different than business owner)
example@example.com
Consultant Name
1. What is the average number of employees per quarter? (Q2-Q4 2020)
b.What is the average number of employees per quarter? (Q1 - Q3 2021)

2. What is the quarterly wage for W-2 employees (This information can be found in the quarterly wage report)?

Rows	Number of Employees	Quarterly Payroll Amount
Q2- 2020
Q3- 2020
Q4- 2020

3. What is the quarterly wage for W-2 employees (This information can be found in the quarterly wage report)?

Rows	Number of Employees	Quarterly Payroll Amount
Q1- 2021
Q2- 2021
Q3- 2021

4. What are the wages paid per quarter to any owner of 50% or greater? NOTE 1. Must be included in the payroll summary. 2) If owners are 50/50, add both wages together below.

Rows	Wages
Q2- 2020
Q3- 2020
Q4- 2020

5. What are the wages paid per quarter to any owner of 50% or greater? NOTE 1. Must be included in the payroll summary. 2) If owners are 50/50, add both wages together below.

Rows	Wages
Q1- 2021
Q2- 2021
Q3- 2021

ERTC SURVEY CONT’D
6. Wages earmarked for PPP forgiveness:
a. How much was received for the 1st round of PPP?
i. What amount went towards wages?
b. How much was received for the 2nd round of PPP?
ii. What amount went towards wages?
7. Was the business deemed non-essential during full or partial government shutdown?
8. Was the business deemed essential but had trouble sourcing equipment, supplies, etc.,?
9. What cover period was used when applying for forgiveness of the 1st PPP Loan?
a.Start date

MonthDayYear
Date
b.End date

MonthDayYear
Date
10. What cover period was used when applying for forgiveness of the 2nd PPP Loan?
a.Start date

MonthDayYear
Date
b.End date

MonthDayYear
Date
11. What type of Entity is your business?
12. Do you use a PEO?
The Estimate you will be given is a “rough” estimate based on the data provided in the client survey. It does not prove or attempt to prove that an employer qualifies for a recovery.
How to Qualify
Reduction in Gross Receipts: An employer is eligible based on reduction of Gross Receipts 2020: 50% or greater drop in Gross Receipts vs the same quarter in 2019 2021: 20% or greater drop in Gross Receipts vs the same quarter in 2019
Other Considerations
Full shutdowns
Partial shutdowns
Interrupted operations
Supply chain interruptions
Inability to access equipment
Limited capacity to operate
Inability to work with your vendors
Reduction in services or goods offered to your customers
Cut down in your hours of operation
Shifting hours to increase sanitation of your facility
* COVID Impact Statement
If you answered “YES” to any of the questions under “Other Considerations” we may request additional supporting documentation on company letterhead.
Should be Empty:

ERTC SURVEY

ERTC SURVEY CONT’D

How to Qualify

Other Considerations

* COVID Impact Statement