PPP Loan Forgiveness Application (Revised 6.16.2020)
PPP Loan Forgiveness Application (Revised 6.16.2020)
PPP Loan Forgiveness Application (Revised 6.16.2020)
Loan Forgiveness Application Revised June 16, 2020 Expiration Date: 10/31/2020
Payroll Schedule: The frequency with which payroll is paid to employees is:
Covered Period: to
If Borrower (together with affiliates, if applicable) received PPP loans in excess of $2 million, check here: ☐
Line 6. Add the amounts on lines 1, 2, 3, and 4, then subtract the amount entered in line 5:
Line 7. FTE Reduction Quotient (enter the number from PPP Schedule A, line 13):
Forgiveness Amount
Line 11. Forgiveness Amount (enter the smallest of lines 8, 9, and 10):
By Signing Below, You Make the Following Representations and Certifications on Behalf of the Borrower:
The authorized representative of the Borrower certifies to all of the below by initialing next to each one.
I understand that if the funds were knowingly used for unauthorized purposes, the federal government may pursue recovery
of loan amounts and/or civil or criminal fraud charges.
The Borrower has accurately verified the payments for the eligible payroll and nonpayroll costs for which the Borrower is
requesting forgiveness.
I have submitted to the Lender the required documentation verifying payroll costs, the existence of obligations and service
(as applicable) prior to February 15, 2020, and eligible business mortgage interest payments, business rent or lease
payments, and business utility payments.
The information provided in this application and the information provided in all supporting documents and forms is true
and correct in all material respects. I understand that knowingly making a false statement to obtain forgiveness of an
SBA-guaranteed loan is punishable under the law, including 18 U.S.C. 1001 and 3571 by imprisonment of not more than
five years and/or a fine of up to $250,000; under 15 U.S.C. 645 by imprisonment of not more than two years and/or a fine
of not more than $5,000; and, if submitted to a Federally insured institution, under 18 U.S.C. 1014 by imprisonment of not
more than thirty years and/or a fine of not more than $1,000,000.
The tax documents I have submitted to the Lender are consistent with those the Borrower has submitted/will submit
to the IRS and/or state tax or workforce agency. I also understand, acknowledge, and agree that the Lender can share
the tax information with SBA’s authorized representatives, including authorized representatives of the SBA Office of
Inspector General, for the purpose of ensuring compliance with PPP requirements and all SBA reviews.
I understand, acknowledge, and agree that SBA may request additional information for the purposes of evaluating the
Borrower’s eligibility for the PPP loan and for loan forgiveness, and that the Borrower’s failure to provide information
requested by SBA may result in a determination that the Borrower was ineligible for the PPP loan or a denial of the
Borrower’s loan forgiveness application.
______ If the Borrower has checked the box for FTE Reduction Safe Harbor 1 on PPP Schedule A, the Borrower was unable
to operate between February 15, 2020 and the end of the Covered Period at the same level of business activity as
before February 15, 2020 due to compliance with requirements established or guidance issued between March 1, 2020
and December 31, 2020, by the Secretary of Health and Human Services, the Director of the Centers for Disease Control
and Prevention, or the Occupational Safety and Health Administration, related to the maintenance of standards of sanitation,
social distancing, or any other work or customer safety requirement related to COVID-19.
The Borrower’s eligibility for loan forgiveness will be evaluated in accordance with the PPP regulations and guidance issued by SBA
through the date of this application. SBA may direct a lender to disapprove the Borrower’s loan forgiveness application if SBA
determines that the Borrower was ineligible for the PPP loan.
_____________________________________________________ ____________________________
Signature of Authorized Representative of Borrower Date
_____________________________________________________ ____________________________
Print Name Title
PPP Schedule A
Line 2. Enter Average FTE (Box 2) from PPP Schedule A Worksheet, Table 1:
Line 3. Enter Salary/Hourly Wage Reduction (Box 3) from PPP Schedule A Worksheet, Table 1:
If the average annual salary or hourly wage for each employee listed on the PPP
Schedule A Worksheet, Table 1 during the Covered Period or the Alternative Payroll
Covered Period was at least 75% of such employee’s average annual salary or hourly
wage between January 1, 2020 and March 31, 2020, check here ☐ and enter 0 on line 3.
Line 5. Enter Average FTE (Box 5) from PPP Schedule A Worksheet, Table 2:
Non-Cash Compensation Payroll Costs During the Covered Period or the Alternative Payroll Covered Period
Line 6. Total amount paid or incurred by Borrower for employer contributions for employee health insurance:
Line 7. Total amount paid or incurred by Borrower for employer contributions to employee retirement plans:
Line 8. Total amount paid or incurred by Borrower for employer state and local taxes assessed on employee
compensation:
Compensation to Owners
Line 9. Total amount paid to owner-employees/self-employed individual/general partners:
This amount may not be included in PPP Schedule A Worksheet, Table 1 or 2. If there is
more than one individual included, attach a separate table that lists the names of and
payments to each.
No reduction in employees or average paid hours: If you have not reduced the number of employees or the average paid hours of
your employees between January 1, 2020 and the end of the Covered Period, check here ☐.
FTE Reduction Safe Harbor 1: If you were unable to operate between February 15, 2020, and the end of the Covered Period at the
same level of business activity as before February 15, 2020 due to compliance with requirements established or guidance issued
between March 1, 2020 and December 31, 2020, by the Secretary of Health and Human Services, the Director of the Centers for Disease
Control and Prevention, or the Occupational Safety and Health Administration related to the maintenance of standards for sanitation,
social distancing, or any other worker or customer safety requirement related to COVID-19, check here ☐.
FTE Reduction Safe Harbor 2: If you satisfy FTE Reduction Safe Harbor 2 (see PPP Schedule A Worksheet), check here ☐.
Line 11. Average FTE during the Borrower’s chosen reference period:
Line 13. FTE Reduction Quotient (divide line 12 by line 11) or enter 1.0 if any of the above criteria are met: ___________________
Step 1. Enter the borrower’s total average FTE between February 15, 2020 and April 26, 2020. Follow the same method that
was used to calculate Average FTE in the PPP Schedule A Worksheet Tables. Sum across all employees and enter:
.
Step 2. Enter the borrower’s total FTE in the Borrower’s pay period inclusive of February 15, 2020. Follow the same method
that was used in step 1: .
Step 3. If the entry for step 2 is greater than step 1, proceed to step 4. Otherwise, FTE Reduction Safe Harbor 2 is not
applicable and the Borrower must complete line 13 of PPP Schedule A by dividing line 12 by line 11 of that schedule.
Step 4. Enter the borrower’s total FTE as of the earlier of December 31, 2020, and the date this application is submitted: .
Step 5. If the entry for step 4 is greater than or equal to step 2, enter 1.0 on line 13 of PPP Schedule A; the FTE Reduction Safe
Harbor 2 has been satisfied. Otherwise, FTE Reduction Safe Harbor 2 does not apply and the Borrower must complete
line 13 of PPP Schedule A by dividing line 12 by line 11 of that schedule.
Instructions
Disclosure is voluntary and will have no bearing on the loan forgiveness decision
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMB Control
Number. The estimated time for completing this application, including gathering data needed, is 180 minutes. Comments about this time or the
information requested should be sent to Small Business Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC
20416, and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC 20503. PLEASE DO
NOT SEND FORMS TO THESE ADDRESSES.