SBA Form 3508S App Paycheck Protection Program S PPP Loan Forgiveness Appli

Paycheck Protection Program

OMB Control No. 3245-0407
Expiration date: 10/31/2020

PPP Loan Forgiveness Application Form 3508S

A BORROWER MAY USE THIS FORM ONLY IF THE BORROWER RECEIVED A PPP LOAN OF $50,000 OR LESS.
A Borrower that, together with its affiliates, received PPP loans totaling $2 million or greater cannot use this form.
Business Legal Name (“Borrower”)

DBA or Tradename, if applicable

Business Address

Business TIN (EIN, SSN)

Business Phone

(

)

Primary Contact

E-mail Address

SBA PPP Loan Number: ________________________

Lender PPP Loan Number: __________________________

PPP Loan Amount: _____________________________

PPP Loan Disbursement Date: ________________________

Employees at Time of Loan Application: ___________

Employees at Time of Forgiveness Application: __________

EIDL Advance Amount: ________________________

EIDL Application Number: __________________________

Forgiveness Amount: ___________________________
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.
_____

The dollar amount for which forgiveness is requested does not exceed the principal amount of the PPP loan and:
• was used to pay costs that are eligible for forgiveness (payroll costs to retain employees; business mortgage interest
payments; business rent or lease payments; or business utility payments);
• includes payroll costs equal to at least 60% of the forgiveness amount;
• if a 24-week Covered Period applies, does not exceed 2.5 months’ worth of 2019 compensation for any owneremployee or self-employed individual/general partner, capped at $20,833 per individual; and
• if the Borrower has elected an 8-week Covered Period, does not exceed 8 weeks’ worth of 2019 compensation for
any owner-employee or self-employed individual/general partner, capped at $15,385 per individual.

_____

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, and has accurately calculated the forgiveness amount requested.

_____

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 SBAguaranteed loan is punishable under the law, including 18 USC 1001 and 3571 by imprisonment of not more than five years
and/or a fine of up to $250,000; under 15 USC 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 USC 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.

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

SBA Form 3508S (10/20)

Paycheck Protection Program
PPP Loan Forgiveness Application Form 3508S
PPP Borrower Demographic Information Form (Optional)
Instructions
1.
2.
3.

4.
5.

Purpose. Veteran/gender/race/ethnicity data is collected for program reporting purposes only.
Description. This form requests information about each of the Borrower’s Principals. Add additional sheets if necessary.
Definition of Principal. The term “Principal” means:
• For a self-employed individual, independent contractor, or a sole proprietor, the self-employed individual, independent
contractor, or sole proprietor.
• For a partnership, all general partners and all limited partners owning 20% or more of the equity of the Borrower, or any
partner that is involved in the management of the Borrower’s business.
• For a corporation, all owners of 20% or more of the Borrower, and each officer and director.
• For a limited liability company, all members owning 20% or more of the Borrower, and each officer and director.
• Any individual hired by the Borrower to manage the day-to-day operations of the Borrower (“key employee”).
• Any trustor (if the Borrower is owned by a trust).
• For a nonprofit organization, the officers and directors of the Borrower.
Principal Name. Insert the full name of the Principal.
Position. Identify the Principal’s position; for example, self-employed individual; independent contractor; sole proprietor;
general partner; owner; officer; director; member; or key employee.

Principal Name

Position

Veteran

1=Non-Veteran; 2=Veteran; 3=Service-Disabled Veteran; 4=Spouse of Veteran; X=Not
Disclosed
Gender
M=Male; F=Female; X=Not Disclosed
Race (more than 1 1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native
may be selected) Hawaiian or Pacific Islander; 5=White; X=Not Disclosed
Ethnicity
H=Hispanic or Latino; N=Not Hispanic or Latino; X=Not Disclosed
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 15 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.
SBA Form 3508S (10/20)
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