SBA FORM 3502 EIDL Supporting Information

U.S. SMALL BUSINESS ADMINISTRATION
ECONOMIC INJURY DISASTER LOAN (EIDL)
SUPPORTING INFORMATION
OMB CONTROL NUMBER: 3245-xxxx
Expiration Date: XXXX

The information requested below is to be submitted in support of the application for an
EIDL loan. This request replaces the need to submit a tax return.
The estimated time for you to complete this form, including time to gather information, is
1 hour. Unless the form displays a current OMB Control number, you are not required to
respond. If you have comments about this request for information, including the
estimated time , submit them to Director, Records Management Division, Small Business
Administration, 409 Third Street, SW, Washington, DC 20416 and/or Desk Officer for SBA,
Office of Management and Budget, Office of Information and Regulatory Affairs, New Executive Office
Building , Washington, DC 20503.

Answer the following questions:
1. Gross Revenues for the twelve (12) month period prior to the disaster:
2. Cost of Goods Sold for the twelve (12) month period prior to the disaster:
3. Rental properties (residential and commercial) only—lost rents due to the disaster:
4. Non-Profit cost of operation for the twelve (12) month period prior to the disaster:
5. Compensation from other sources received as a result of the disaster (provide
amount and a brief description below):
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES
THAT THE FOREGOING IS TRUE AND CORRECT.
Signature:
SBA Form 3502

Date:

Name:
Title:

SBA Form 3502