ERC Today Questionnaire

Client Eligibility Questionnaire

*Note: There should be one Questionnaire for each EIN*
Company Demographic Details
***Please Read***

You can save this form and come back to it using the [Save] button at the bottom of the page. You WILL NOT have to create an account to save; when prompted, simply select the option labeled "Skip Create an Account." Then you will enter your email on the next screen and select send, which will email you a link to return to your in-progress Questionnaire.
Business Legal Name (as filed on tax returns)*
Trade Name/DBA Name?*
DBA Name*
Company EIN*
How did you hear about ERC Today?*
Are you a member of a PEO?*

YesNo
*** Unfortunately, we are unable to help clients that are members of a Professional Employer Organization (PEO). We are only able to accept clients that file their own quarterly form 941s. ***
Payroll Platform*
If your payroll platform is not listed above, list them here.*
List all payroll providers used between 2019-2021*
e.g. ADP, Square, Paychex
Business Type/Industry*
If other, please clarify*
Location(s) and State(s)
List multiple if more than one location exists
Preferred Communication

The below is what we will use to reach out to you with further questions, accounting documents, and signature requests.
Preferred Email*
example@example.com
Preferred Cell Phone Number *
Alternate or Business Phone*
Preferred Method of Communication?*

EmailPhone CallText
IRS Mailing Address

What is the mailing address where the IRS should send any ERC claim payments?
ERC claims can only be sent via paper check mailed to the IRS "address of record". This must:
- Be a physical location where you currently receive mail (a personal address is allowed)
- Not be a PO Box or UPS/FedEx store box
- Not have mail forwarding, neither to nor from (the USPS will return all such checks to the IRS)
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employee Threshold Limitation

To be eligible, employers must have averaged during 2019: a) 100 or fewer full-time employees (defined as more than 130 hours/month) for the 2020 ERC program, and b) 500 or fewer full-time employees for the 2021 ERC program. This calculation is across all members of an IRS Controlled Group.
Select one:*

Our business definitely averaged less than 100 full-time employees in 2019Our business was very close to 100, and I need help determining thisOur business definitely averaged between 100 and 500 full-time employees in 2019Our business was very close to 500, and I need help determining thisOur business definitely averaged more than 500 full-time employees in 2019
Number of 2020 W-2's Filed*
Number of 2021 W-2's Filed*
Controlling Persons Chart
Is this entity a:*

For-profit businessNot-for-profit/non-profit/charity/501(c)3/other exempt entity

List any/all Relative(s) of the above Owners who were on the payroll during 2020 or 2021.
A “relative” is a person with any blood or marital relationship to a Controlling Person, such as but not limited to: Parents, Siblings, Children, Step Relationships, In-Laws, Cousins, Nephews and, Nieces, etc.)

1) Relative: * Person # Relationship:
2) Relative: Person # Relationship:
3) Relative: Person # Relationship:
4) Relative: Person # Relationship:
5) Relative: Person # Relationship:
If there are more then 5 relatives please list them here in the same format as above.
Do you or any of the persons listed above have interest/ownership/board seats/etc. in any other entities?*

YesNoUnsure
List these affiliated entities (other entities with common ownership, leadership, etc.) and describe the relationship between this and other entities:
Is there a family relation between any of the above persons? If so, please describe below:
ERC Eligibility Criteria

The below elements are critical in a) determining eligibility, and b) maximizing your potential Employee Retention Credit.
Please describe in a few sentences how COVID-19 impacted your business activities in 2020 and/or 2021:*

0/1000
Did you experience a government-imposed full/partial suspension (or capacity limitation) during the pandemic?    *
If yes, when did full/partial suspension begin? .
If yes, when did full/partial suspension end?   .
If yes, what jurisdiction issued the order?   .
Is your business deemed "essential"? Yes No*
Quarterly Sales Data

Complete the below table for quarterly gross revenue. This is the total of all sources of income, after refunds or returns. This "top line" figure is before backing out items such as costs, expenses, payroll, taxes, etc. Note: Incorrectly entering your sales data will prolong your ERC calculation process. *Accurate sales data is required to move forward.*

If you do not have sales data for one of the below periods, indicate with a "0".*

	2019	2020	2021
Q1
Q2
Q3
Q4

Recovery Start-Up Business Eligibility

*Complete if and only if your business began operations during 2020 or 2021.*
Company Start Date means when your company began Operations (i.e. first day you earned income), not when the LLC was formed.
Company Start Date: Date
Did you have < $1,000,000 in average annual sales? Yes No
Interaction with PPP or other Stimulus Programs

Please complete the below table regarding your PPP Loans:

Please leave the "If yes:" rows blank.*

	PPP 1st Draw (PPP1)	PPP 2nd Draw (PPP2)
Did you receive a PPP Loan?
If yes:
Date Received?
Amount Received?
Using 8-week, 24-week, or other period?
Did you apply non-payroll costs*?
How much non-payroll costs?
Did you receive PPP Forgiveness?
If yes:
Date forgiven?
Amount forgiven?

*Non-payroll costs are defined as mortgage, rent, and utilities during your PPP coverage period.
Do you provide medical insurance to employees?*

YesNo
During a partial/complete shutdown, did you continue to pay for a portion of insurance for employees during the shutdown?

YesNo
Did you receive other COVID-related stimulus, such as the Restaurant Revitalization Fund (RRF)?*

YesNo
If so, please describe, provide the amounts/dates received, etc.
Have you amended a 941 during 2020 or 2021?*
If yes, please provide us with a copy of an amended 941 (Form 941-X) filed for 2020 or 2021, either in the document upload below, or with your ERC Representative.
List all Year(s)/Quarter(s)*
Have you filed for the Employee Retention credit during any quarter(s) in 2020 or 2021?*
List all Year(s)/Quarter(s)*
Document Checklist

Please gather the following documents and then either a) Submit below and we can start working on your Employee Retention Credit immediately, or b) Your internal rep will reach out with a Dropbox Portal for you to upload your files.
- Form 940 for 2020 & 2021
- Quarterly Forms 941: for 2020 Q1, Q2, Q3, & Q4; for 2021 Q1, Q2, Q3, & Q4
- If applicable: Evidence of PPP Loan Amount (such as a bank statement)
- If applicable: PPP Loan Forgiveness Application
- If applicable: PPP Loan Forgiveness Resolution (such as an email from the SBA)
- MOST CRITICAL: A spreadsheet (.xls, .xlsx, .csv) data file showing gross wages by employee by paycheck for all of 2020-2021
  - Note: As an alternative, you may grant us direct access to your payroll software
- Form 940 for 2020 & 2021
- Quarterly Forms 941: for 2020 Q1, Q2, Q3, & Q4; for 2021 Q1, Q2, Q3, & Q4
- If applicable: Evidence of PPP Loan Amount (such as a bank statement)
- If applicable: PPP Loan Forgiveness Application (Form 3508, 3508S, or 3508EZ)
- If applicable: PPP Loan Forgiveness Resolution (such as an email from the SBA)
Expedited Document Upload

***Uploading your documents here is not required, however it will allow us to finish your project quicker.
Cancelof
Payroll Data Submission

Based on your above Payroll Provider, we at ERC Today are able to capture your payroll information in an ideal format through our Finch Connect Bridge. Following the submission of this form, you will receive an email from ERC Today with a unique link to access Finch Connect.
Client Statement and Affirmation
I, the undersigned representative of the company described above, do hereby affirm and acknowledge that:
1. The above information is true, accurate, and complete to the best of my ability,
2. I understand that ERC Today will use this information to consult and advise amendments to my 2020/2021 Forms 941, so that I may receive Employee Retention Credits authorized by the IRS,
3. Any inaccuracy in the information above may lead to inaccurate credit calculation, and potential penalties/interest from the IRS,
4. I agree to hold ERC Today harmless and not liable for any penalty that results from false or inaccurate information provided to ERC Today,
5. Per IRS guidance, “Section 280C(a) of the Code generally disallows a deduction for the portion of wages paid equal to the sum of certain credits determined for the taxable year”, it is my responsibility to consult my CPA and/or tax preparer to see how this may impact my specific tax situation, and
6. I enter into this transaction in good faith to utilize the IRS code and tax credits as intended and allowed.
Client Name: *
Title: *
Date: Date*
Client Representative Signature*

Clear
Should be Empty:

	Person 1	Person 2	Person 3	Person 4	Person 5
Person Name:
% Owned:
Related to Person #(s):
Relationship to Person #:

	Owner 1	Owner 2	Owner 3	Owner 4	Owner 5
Owner Name:
% Owned:
Related to Owner #(s):
Relationship to Owner #:

Client Eligibility Questionnaire

Company Demographic Details

Preferred Communication

IRS Mailing Address

Employee Threshold Limitation

Controlling Persons Chart

ERC Eligibility Criteria

Quarterly Sales Data

Recovery Start-Up Business Eligibility

Interaction with PPP or other Stimulus Programs

Document Checklist

Payroll Data Submission

Client Statement and Affirmation