Form SBA Form 3511 SBA Form 3511 Affiliation Worksheet Revised

OMB Control Number: 3245-0416
Expiration Date: XX/XX/2024

PAYCHECK PROTECTION PROGRAM
AFFILIATION WORKSHEET
The purpose of this Affiliation Worksheet is to collect information from a borrower that answered “YES” to Question 3 on its Paycheck Protection
Program (PPP) Loan Application (SBA Form 2483, SBA Form 2483-C, SBA Form 2483-SD, SBA Form 2483-SD-C, or lender’s equivalent) or a
borrower for which information available to the Small Business Administration (SBA) indicates that the borrower may have affiliates. SBA requires this
additional information regarding the size of the borrower and its affiliates to evaluate the borrower’s certification on its PPP Loan Application that it was
eligible to receive a PPP loan under the SBA’s rules in effect at the time the application was submitted.
Please complete this Affiliation Worksheet to provide information regarding the size standard that you (Borrower) used when making your eligibility
certification and regarding the size of your affiliates. You must disclose all of your affiliates for purposes of this worksheet. Affiliation is defined in 13
CFR 121.301(f) and summarized here: https://www.sba.gov/document/support-affiliation-rules-paycheck-protection-program. 1 Affiliation rules apply to
non-profit borrowers in the same manner as with respect to for-profit borrowers.
The completed worksheet is due to the Lender servicing your PPP loan within ten business days of receipt from your Lender. Failure to complete
the worksheet may result in SBA’s determination that you were ineligible for the PPP loan, the PPP loan amount, or any forgiveness amount claimed,
and SBA may seek repayment of the loan or pursue other available remedies.
Within five business days after you provide a completed worksheet with all required responses, signatures, and certifications, the Lender servicing your
loan is required to upload the worksheet to the SBA Paycheck Protection Platform (forgiveness.sba.gov).

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 worksheet,
including gathering data needed, is 45 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 WORKSHEETS TO THESE
ADDRESSES.

SBA Form 3511 (06/2021)

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Part A – Borrower Information

Borrower Legal Name

DBA or Tradename, if applicable

Borrower Address

TIN (EIN, SSN, ITIN)

Work Phone
(

)

-

Primary Contact
SBA PPP Loan Number

First Draw PPP Loan

E-mail Address

Original Principal Amount of PPP Loan ($)



Second Draw PPP Loan



Part B – Affiliation Information
Section I. Affiliation Waiver
Answer questions 1, 2, 3, 4, 5 and 6 below. In the right-hand column (labeled “Confidential?”), check the box if the answers or information provided in response to the
question are customarily kept confidential. 2
If you answer “YES” to any of the questions in Section I, you do not need to complete Sections II, III, and IV.
Confidential?
1. Is Borrower assigned a North American Industry Classification System (NAICS) code beginning with
72 (Accommodation and Food Service Industries)?
YES
NO
See https://www.census.gov/eos/www/naics/ for an explanation of NAICS code 72.
2. Is Borrower a franchisee whose franchise identifier code is listed in SBA’s Franchise Directory?
YES
NO
See https://www.sba.gov/sba-franchise-directory for SBA’s Franchise Directory.
3. Does Borrower receive financial assistance from a Small Business Investment Company licensed by
YES
NO
the SBA?
4. Is Borrower majority owned or controlled by a business concern that is assigned a NAICS code
beginning with 511110 or 5151 or a nonprofit organization that is assigned a NAICS code beginning
YES
NO
with 5151?
See https://www.census.gov/eos/www/naics/ for an explanation of NAICS code 511110 or 5151.
5. Is Borrower assigned a NAICS code of 519130, has Borrower certified in good faith as an internetonly publisher, is Borrower engaged in the collection and distribution of local or regional and national
news and information, and is Borrower majority owned or controlled by a business concern that is
YES
NO
assigned NAICS 519130?
See https://www.census.gov/eos/www/naics/ for an explanation of NAICS code 519130.
6. Is Borrower a faith-based organization? 3
YES
NO
SBA Form 3511 (06/2021)

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Section II. Borrower’s Size Standard
Select the size standard below that was used to evaluate Borrower’s size to determine Borrower’s eligibility for a PPP loan (check one). 4 For Second Draw PPP Loans,
only the employee-based size standard is applicable. 5
A. Employee-based Size Standard

□

B. Receipt-based Size Standard

□

C. Alternative Size Standard

□

Section III. Borrower’s Size-Standard and Industry Information
Provide information in columns #1 and 2 below for Borrower. For #2, provide information under A, B, or C depending on the size standard you indicated in Section II
(as noted above, only the employee-based size standard is applicable to Second Draw PPP Loans, so information must be provided under A):
•

Use 2.A if Borrower used A. Employee-based Size Standard;

•

Use 2.B if Borrower used B. Receipt-based Size Standard; or

• Use 2.C (both the TNW and ANI columns) if Borrower used C. Alternative Size Standard.
In the right-hand column (labeled “Confidential?”), check the box if the information in your answers to 2.A, 2.B, or 2.C is customarily kept confidential.

1.

2.

B.

C.
Alternative Size Standard (as of March 27, 2020)

A.

Primary Six-Digit
NAICS Code

Employees 6

Average Annual Receipts
over last 3 completed fiscal
years before the date of the
Borrower’s PPP application 7
(“Receipts”)
$

SBA Form 3511 (06/2021)

Average Net Income after Federal
taxes (excluding any carryover
losses) for last 2 completed fiscal
years
(“ANI”)

Tangible Net Worth
(“TNW”)
$

$

3

Confidential?

Section IV. Borrower’s Affiliates Information 8
Provide information in columns #1, 2, 3, 4, and 5 below for all of Borrower’s affiliates.
For #2, select all types of relationships to Borrower that apply. For each type that is selected, provide additional detail about that relationship in the text field “Additional
detail on Affiliate relationship to Borrower”:
•
•
•
•

If “Affiliation based on ownership” is selected, identify the owner (the Borrower, the Affiliate, another specified entity, or a specified individual) and the
percentage of ownership (e.g., Affiliate is a 60% owner of Borrower; Borrower is a 51% owner of Affiliate). 9
If “Affiliation arising under stock options, convertible securities, and agreements to merge” is selected, identify whether the basis for affiliation is stock
options, convertible securities, or an agreement to merge. 10
If “Affiliation based on management” is selected, identify the common manager or management agreement. 11
If “Affiliation based on identity of interest” is selected, identify the close relative(s) and the business or economic interest. 12

For #5, provide information for A, B, or C depending on the size standard you indicated in Section II (as noted above, only the employee-based size standard is
applicable to Second Draw PPP Loans, so information must be provided under A for all affiliates):
•

Use 5.A if Borrower used A. Employee-based Size Standard;

•

Use 5.B if Borrower used B. Receipt-based Size Standard; or

•

Use 5.C (both the TNW and ANI columns) if Borrower used C. Alternative Size Standard.

If additional rows are needed to list all affiliates, provide information on a separate sheet identified as Addendum A. In the right-hand column (labeled “Confidential?”),
indicate whether the information in your answers is customarily kept confidential by entering 1, 2, 3, 4, 5.A, 5.B, and/or 5.C.

SBA Form 3511 (06/2021)

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1.

2.

Affiliate Name

Relationship to Borrower
(select all that apply)

Affiliation based on ownership

Affiliation arising under stock
options, convertible securities, and
agreements to merge
Affiliation based on management

3.
Primary
SixDigit
NAICS
Code

4.
Did
affiliate
receive
PPP
loan(s)?

A.

B.

Employees 13

Receipts 14

YES/
NO

$

5.

C.
Alternative Size Standard as of
March 27, 2020
TNW

ANI

$

$

$

$

$

$

$

$

$

$

$

Affiliation based on identity of
interest
Additional detail on Affiliate relationship to Borrower (1,000 character max):

Affiliation based on ownership
Affiliation arising under stock
options, convertible securities, and
agreements to merge
Affiliation based on management

YES/
NO

Affiliation based on identity of
interest
Additional detail on Affiliate relationship to Borrower (1,000 character max):

Affiliation based on ownership
Affiliation arising under stock
options, convertible securities, and
agreements to merge
Affiliation based on management

YES/
NO

Affiliation based on identity of
interest
Additional detail on Affiliate relationship to Borrower (1,000 character max):

Affiliation based on ownership
Affiliation arising under stock
options, convertible securities, and
agreements to merge
Affiliation based on management

SBA Form 3511 (06/2021)

YES/
NO

5

Confidential?

Affiliation based on identity of
interest
Additional detail on Affiliate relationship to Borrower (1,000 character max):

Affiliation based on ownership
Affiliation arising under stock
options, convertible securities, and
agreements to merge
Affiliation based on management

YES/
NO

$

Affiliation based on identity of
interest
Additional detail on Affiliate relationship to Borrower (1,000 character max):

SBA Form 3511 (06/2021)

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$

$

CERTIFICATIONS
The Authorized Representative of Borrower must certify to all of the below by initialing next to each item:
_______ I certify that I have the authority to sign and submit this worksheet on behalf of Borrower.
_______ I certify that the information provided in this worksheet identifies all known affiliates of Borrower and is true and correct in all material respects. I make this
certification after reasonable inquiry of people, systems, and other information available to Borrower.
_______ I understand that knowingly making a false statement to obtain a guaranteed loan or forgiveness of an SBA-guaranteed loan is punishable under the law, including
under 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.
__________________________________________
Signature of Authorized Representative of Borrower
__________________________________________
Print Name
__________________________________________
Title
__________________________________________
Date

SBA Form 3511 (06/2021)

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Endnotes:
See also 85 FR 20817 (April 15, 2020), as amended by 86 FR 3692 (January 14, 2021), and 86 FR 15083 (March 22, 2021) regarding application of SBA’s affiliation
rules. For the affiliation rules applicable to Second Draw PPP Loans, see 86 FR 3712 (January 14, 2021).
1

2

The same affiliation waivers apply to First Draw and Second Draw PPP Loans.

See 85 FR 20817 (April 15, 2020) regarding application of SBA’s affiliation rules and the exemption of certain qualified faith-based organizations from SBA’s
affiliation rules. See also, 86 FR 3692 (January 14, 2021).
3

An applicant can be eligible for a First Draw PPP loan if the applicant, together with its affiliates (if applicable), (1) is an independent contractor, self-employed
individual, or sole proprietor with no employees; (2) if not a housing cooperative, eligible 501(c)(6) organization, other eligible 501(c) organization, or eligible
destination marketing organization, employs no more than the greater of 500 employees or, if applicable, the size standard in number of employees established by SBA
in 13 C.F.R. 121.201 for the Applicant’s industry; (3) if a housing cooperative, employs no more than 300 employees; (4) if an eligible 501(c)(6) organization, other
eligible 501(c) organization, or eligible destination marketing organization, employs no more than 300 employees per physical location; (5) if NAICS 72 or a 501(c)(3)
organization, employs no more than 500 employees per physical location; (6) if a news organization that is majority owned or controlled by a NAICS code 511110 or
5151 business, a nonprofit public broadcasting entity with a trade or business under NAICS code 511110 or 5151, or an Internet-only news or periodical publisher
assigned NAICS code 519130 and engaged in the collection and distribution of local or regional and national news and information, employs no more than 500
employees (or, if applicable, the size standard in number of employees established by SBA in 13 C.F.R. 121.201 for the Applicant’s industry) per location; or (7) is a
small business under the applicable revenue-based size standard established by SBA in 13 C.F.R. 121.201 for the Applicant’s industry or under the SBA alternative size
standard.
In order to qualify under the SBA alternative size standard, a business must have met both tests in SBA’s “alternative size standard” as of March 27, 2020: (1)
maximum tangible net worth of the business is not more than $15 million; and (2) the average net income after Federal income taxes (excluding any carry-over losses)
of the business for the two full fiscal years before the date of the application is not more than $5 million. The alternative size standard is available only to for-profit
borrowers, not non-profit organizations.
4

An applicant can be eligible for a Second Draw PPP loan if the applicant, together with its affiliates (if applicable): (1) is an independent contractor, self-employed
individual, or sole proprietor with no employees; (2) employs no more than 300 employees; (3) if NAICS 72, employs no more than 300 employees per physical
location; (4) if a news organization that is majority owned or controlled by a NAICS code 511110 or 5151 business, a nonprofit public broadcasting entity with a trade
or business under NAICS code 511110 or 5151, or an Internet-only news or periodical publisher assigned NAICS code 519130 and engaged in the collection and
distribution of local or regional and national news and information, employs no more than 300 employees per physical location; or (5) if a 501(c)(3) organization, an
eligible 501(c)(6) organization, other eligible 501(c) organization, or eligible destination marketing organization, employs no more than 300 employees per physical
location.

5

Calculate the number of employees using the average number of employees per pay period in the same time period Borrower used to calculate average monthly
payroll. For example, if Borrower calculated average monthly payroll based on calendar year 2019, Borrower’s number of employees is the average number for all pay
periods in calendar year 2019. See 13 CFR 121.106 for the full definition.

6

Receipts generally are the sum of “total income” plus “cost of goods sold” reported on Federal taxes. See 13 CFR 121.104 for the full definition. For Borrowers with
fewer than three completed fiscal years, average annual receipts means the total receipts for the period the Borrower had been in existence as of the date of PPP loan
application, divided by the number of weeks in existence, multiplied by 52.

7

SBA Form 3511 (06/2021)

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For an explanation of the four tests for affiliation that apply to participants in the Paycheck Protection Program, see https://www.sba.gov/document/support-affiliationrules-paycheck-protection-program and 85 FR 20817 (April 15, 2020).
8

For purposes of determining affiliation based on equity ownership, an entity is an affiliate of an individual, concern, or entity that owns or has the power to control
more than 50 percent of the entity’s voting equity. If no individual, concern, or entity is found to control, SBA will deem the Board of Directors or President or Chief
Executive Officer (CEO) (or other officers, managing members, or partners who control the management of the entity) to be in control of the entity. SBA will deem a
minority shareholder to be in control, if that individual or entity has the ability, under the entity’s charter, bylaws, or shareholder’s agreement, to prevent a quorum or
otherwise block action by the board of directors or shareholders. See 13 CFR 121.301(f)(1). In determining affiliation based on ownership for nonprofit organizations,
the organization may use its IRS Form 990, Schedule R, which requires the nonprofit organization to provide information on certain tax-exempt and taxable related
organizations, as defined in 26 USC 512(b)(13).
9

For purposes of determining size, SBA considers stock options, convertible securities, and agreements to merge (including agreements in principle) to have a present
effect on the power to control an entity. SBA treats such options, convertible securities, and agreements as though the rights granted have been exercised. Agreements to
open or continue negotiations towards the possibility of a merger or a sale of stock at some later date are not considered “agreements in principle” and are thus not given
present effect. Options, convertible securities, and agreements that are subject to conditions precedent which are incapable of fulfillment, speculative, conjectural, or
unenforceable under state or Federal law, or where the probability of the transaction (or exercise of the rights) occurring is shown to be extremely remote, are not given
present effect. An individual, concern or other entity that controls one or more other entities cannot use options, convertible securities, or agreements to appear to
terminate such control before actually doing so. SBA will not give present effect to individuals’, concerns’, or other entities’ ability to divest all or part of their
ownership interest in order to avoid a finding of affiliation. See 13 CFR 121.301(f)(2). This basis for affiliation is unlikely to apply to nonprofit organizations because,
generally, they do not issue stock or securities. If, however, a nonprofit organization has an agreement to merge with another organization, SBA would treat such an
agreement, including an agreement in principle, to have present effect under the affiliation rule.
10

Affiliation based on management arises where the CEO or President of the PPP borrower (or other officers, managing members, or partners who control the
management of the borrower) also controls the management of one or more other entities. Affiliation also arises where a single individual, concern, or entity that
controls the Board of Directors or management of one entity also controls the Board of Directors or management of one of more other entities. Affiliation also arises
where a single individual, concern or entity controls the management of the PPP borrower through a management agreement. See 13 CFR 121.301(f)(3). Management
affiliation is particularly relevant to nonprofit organizations because they operate through their officers and board members. A common officer may cause the nonprofit
organization to be affiliated with another entity, if the officer controls the borrower’s management and also controls the management of one or more other organizations,
businesses, or entities. A nonprofit organization could be affiliated where a single board member or entity that controls the borrower’s board also controls the board or
management of one or more other organizations, businesses, or entities. Additionally, for organizations that elect their board through member voting, the organization
would be affiliated through a business, entity, or individual that controls more than 50% of the organization’s voting rights, with any other entities similarly situated.
11

Affiliation based on identity of interest arises when there is identity of interest between close relatives with identical or substantially identical business or economic
interests (such as where the close relatives operate entities in the same or similar industry in the same geographic area). See 13 CFR 121.301(f)(4). “Close relative” is a
spouse; a parent; or a child or sibling; or the spouse of any such person. See 13 CFR 120.10.

12

13
Calculate the number of employees using the affiliate’s average number of employees based on numbers of employees for each of the pay periods for the preceding
completed 12 calendar months before the date of the Borrower’s PPP application. Part-time and temporary employees are counted the same as full-time employees. If an
affiliate has not been in business for 12 months, use the average number of employees for each of the pay periods the affiliate has been in business. See 13 CFR
121.106.
14

See note 6 for information on how to calculate average annual receipts over last three completed fiscal years before the date of the Borrower’s PPP application.

SBA Form 3511 (06/2021)

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