ERC Survey 2, Part 1 of 2 Parts- Impact of Shutdown Orders and Nominal Impact- Version 3- TPA

ERC Survey 2- Part 1 of 2 Parts- Full or Partial Shutdown and Nominal Impact- Version 3
This survey is in two parts;

1) Part 1. You will be asked a series of questions to determine the impact on your business due to COVID, such as travel restrictions, operational impact, customer impact, and supply chain disruptions. Also, in Part 1, you will be asked to indicate what state(s) your business operates out of. Based on the state or states that your business operates in, you will be provided a link to Part 2 of the survey for each state that your business operates out of.

2) Part 2. In part 2, you will be asked to indicate the full or partial suspension by a government order(s) you were operating under AND, MORE IMPORTANTLY, the dates that your business was impacted by each separate full or partial suspension by a government order(s).

Note: Part 1 without Part 2 will not allow us to qualify your business under full or partial suspension by a government order(s) for two reasons;

1) Your business, your customer(s), and your suppliers must be subject to full or partial suspension by a government order(s) to qualify under full or partial suspension by a government order(s); therefore, we MUST know the specific full or partial suspension by a government order(s) that your business was subject to.

2) The qualification under full or partial suspension by a government order(s) is limited to the time period that your business was subject to each separate full or partial suspension by a government order; therefore, it is absolutely critical that you provide the period of time that your business was subject to each separate full or partial suspension by a government order.

Note: Survey 2, Part 2, provides you with a comprehensive list of full or partial suspension by a government order(s) based on the state(s) that you indicated in Survey 2, Part 1, that your business operates out of. The list of full or partial suspension by a government order(s) is clickable; therefore, you can click the link and view each separate shutdown order if you need to determine which period of time the order covers and if it applies to you.
NOTE: You can save and continue this form multiple times, but you must hit "Save and continue" bottom of each section.

If you do not have an account with Jotform, you will need to click on the “Skip Create an Account" link to be able to get the session link and come back later.

Business Legal Name*
Trade Name, if any
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Name*

First NameLast Name
Owners Phone*
Please enter a valid phone number.
Your Name*

First NameLast Name
What is your position with the company?*
Your Phone Number*
Please enter a valid phone number.
Relationship to the owner?*
Email*
example@example.com

Operational Impact
In what cities and states does your business have operations? Please list the cities and states where your offices, retail stores, and/or warehouses are located and a quick summary of the type conducted at each.
Did your company close any office/retail/warehouse locations to comply with governmental orders related to COVID? For example, a "Stay Safe", or "Stay Healthy" order?*

YesNo
If yes, please describe the negative impact on your business
Did your company reduce capacity at any office/retail/warehouse location? For example, a "Stay Safe", or "Stay Healthy" order?*

YesNo
If yes, please describe the negative impact on your business.
Please describe any changes your business made to its operations (i.e., additional sanitation, purchase of laptops, remote work, etc.) as a result of COVID, or other ways you have altered your business operations as a result of COVID Orders (i.e. reconfigured work spaces, reduced capacity, outdoor seating, etc)*
Did your business incur any additional costs as a result of COVID, for example, to purchase laptops for remote workers?*

YesNo
If yes, please describe the negative impact on your business.
What was the additional spend that would not have been incurred had it not been spend had it not been for COVID? *

Customer Impact
Please list any cities and states your clients travel FROM to conduct business with you.*
In what states does your company have clients?*
Did any customers close operations or reduce operations as a result of a COVID government order?*

YesNo
If yes, please describe how this negatively impacted your business.*
Were any key customers impacted as a result of COVID?*

YesNo
If yes, please describe.*
Please describe how customer interactions changed as a result of COVID. For example, if you are a restaurant and shut down part of your facility and move mostly to take-out. Or a real estate firm that went to virtual tours of properties.*
Are there any meetings that would traditionally happen in person that became virtual?*

YesNo
If yes, please describe how this negatively impacted your business.
Were there any project timelines that were impacted?*

YesNo
If yes, please describe how this negatively impacted your business.

Supplier Chain Impact
Did any key suppliers have difficulty getting raw materials or goods to you as a result of COVID?*

YesNo
If yes, please describe how this negatively impacted your business.*
Please describe any interruptions or challenges with your supply chain as a result of COVID. *
Did your company experience any difficulties obtaining raw materials as a result of travel restrictions? For example not being able to obtain goods from China or other countries. Or, not being able to meet with suppliers in China or other countries?*

YesNo
If yes, please describe how this negatively impacted your business.*

Since your business does not full qualify under "Revenue Reduction" we will need to include a narrative with your application of the impact of your business as a result of COVID. Please provide detailed responses to each of the questions below. They, as well as the answers above, will be edited and included as part of the narrative included with your application. Remember, we want to convice the IRS Agent reviewing your case, while your revenue did not decrease by the required percentages in any or all of the eligible quarters, your business was still "nominally impacted" or "effected" by COVID.
Revenue activities: Explain your business operations and how you typically generate revenue.*
Changes in income-producing strategies: Include details on how you adjusted your operations throughout the pandemic to continue bringing in cash flow.*
Total revenue: Analyze precisely how much your revenue was projected to increase in 2020 and 2021, that did not happen as a result of COVID.*
Operating locations: Be specific with all the different states and jurisdictions in which you operate.*
Employee working hours: Talk about any changes in employee scheduling and the number of hours of work that had to be adjusted to comply with social distancing best practices.*
Sales metrics: Give detail to exactly how your business sales were impacted. Perhaps your foot traffic significantly dropped, or you had difficulty closing deals over video or phone compared to in-person meetings. *
Vendor disruptions: Even essential businesses experienced troubles, particularly from other vendors who may not have continued smooth operations. List out vendor names, dates, and specific challenges and setbacks your business experiences because of third parties.*
Alabama- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Alabama by clicking the link below.

https://form.jotform.com/231697673501158

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Alaska- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Alabama by clicking the link below.

Alaska Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Arizona- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Arizona by clicking the link below.

Arizona Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Arkansas- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Arkansas by clicking the link below.

Arkansas Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
California- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of California by clicking the link below.

California Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Colorado- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Colorado by clicking the link below.

Colorado Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Connecticut- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Connecticut by clicking the link below.

Connecticut Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Delaware- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Delaware by clicking the link below.

Delaware Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Florida- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Florida by clicking the link below.

Florida Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Georgia- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Georgia by clicking the link below.

Georgia Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Hawaii- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Hawaii by clicking the link below.

Hawaii Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Idaho- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Idaho by clicking the link below.

Idaho Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Illinois- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Illinois by clicking the link below.

Illinois Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Indiana- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Indiana by clicking the link below.

Indiana Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Iowa- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Iowa by clicking the link below.

Iowa Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Kansas- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Kansas by clicking the link below.

Kansas Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Kentucky- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Kentucky by clicking the link below.

Kentucky Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Louisiana- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Louisiana by clicking the link below.

Louisiana Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Maine- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Maine by clicking the link below.

Maine Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Maryland- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Maryland by clicking the link below.

Maryland Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Massachusetts- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Massachusetts by clicking the link below.

Massachusetts Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Michigan- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Michigan by clicking the link below.

Michigan Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Minnesota- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Minnesota by clicking the link below.

Minnesota Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Mississippi- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Mississippi by clicking the link below.

Mississippi Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Missouri- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Missouri by clicking the link below.

Missouri Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Montana- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Montana by clicking the link below.

Montana Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Nebraska- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Nebraska by clicking the link below.

Nebraska Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Nevada- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Nevada by clicking the link below.

Nevada Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
New Hampshire- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of New Hampshire by clicking the link below.

New Hampshire Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
New Jersey- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of New Jersey by clicking the link below.

New Jersey Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
New Mexico- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of New Mexico by clicking the link below.

New Mexico Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
New York- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of New York by clicking the link below.

New York Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
North Carolina- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of North Carolina by clicking the link below.

North Carolina Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
North Dakota- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of North Carolina by clicking the link below.

North Dakota Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Ohio- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Ohio by clicking the link below.

Ohio Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Oklahoma- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Oklahoma by clicking the link below.

Oklahoma Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Oregon- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Oregon by clicking the link below.

Oregon Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Pennsylvania- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Pennsylvania by clicking the link below.

Pennsylvania Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Rhode Island- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Rhode Island by clicking the link below.

Rhode Island Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
South Carolina- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of South Carolina by clicking the link below.

South Carolina Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
South Dakota- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of South Dakota by clicking the link below.

South Dakota Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Tennesse- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Tennesse by clicking the link below.

Tennessee Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Texas- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Texas by clicking the link below.

Texas Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Utah- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Utah by clicking the link below.

Utah Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Vermont- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Vermont by clicking the link below.

Vermont Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Virginia- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Virginia by clicking the link below.

Virginia Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Washington- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Washington by clicking the link below.

Washington Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
West Virginia- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of West Virginia by clicking the link below.

West Virginia Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Wisconsin- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Wisconsin by clicking the link below.

Wisconsin Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Wyoming- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the state of Wyoming by clicking the link below.

Wyoming Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
American Samoa- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the US Territory of American Samoa by clicking the link below.

American Samoa Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
District of Columbia- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental order of the District of Columbia by clicking the link below.

District of Columbia Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Guam- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the US Territory of Guam by clicking the link below.

Guam Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Northern Mariana Islands- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the US Territory of the Northern Mariana Islands by clicking the link below.

Northern Mariana Island Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Puerto Rico- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the US Territory of Puerto Rico by clicking the link below.

Puerto Rico Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
US Virgin Islands- Based on your answer(s) to the question above regarding the state(s) of operations, please complete the survey for the governmental orders of the US Territoty of the US Virgins Islands by clicking the link below.

US Virgin Islands Governmental Shutdown Orders

Please hold off on submitting the survey until you have completed All states and US Territories for which you have governmental orders that impacted your business
Please confirm you did follow the link for the Governmental Shutdown order(s) survey for the state(s) that your business operates out of and you have completed the survey(s) and submitted Part 2 of Survey 2. Note this is a completely different submission from this survey*

YesNo
Should be Empty:

ERC Survey 2- Part 1 of 2 Parts- Full or Partial Shutdown and Nominal Impact- Version 3

Full or Partial Governmental Shutdown Orders

Travel Restrictions

Operational Impact

Customer Impact

Supplier Chain Impact