Form SBA Form 3502 SBA Form 3502 COVID-19 EIDL Supporting Info

OMB Control Number 3245-0406
Expiration Date: 9/30/2020

U.S. SMALL BUSINESS ADMINISTRATION
ECONOMIC INJURY DISASTER LOAN
SUPPORTING INFORMATION
The information requested below is to be submitted in support of the application for an
Economic Injury Disaster 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:
Gross Revenues for the twelve (12) month period prior to the disaster:
Cost of Goods Sold for the twelve (12) month period prior to the disaster:
Rental properties (residential and commercial) only—lost rents due to the disaster:
Non-Profit or Agricultural Enterprise cost of operation for the twelve (12) month
period prior to the disaster:
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:
Name:
Title:
SBA Form 3502 (04/20)

Date: