SBA Form 3508 S PPP Loan Forgiveness Application

OMB Control No.: 3245-0407
Expiration Date: XX/XX/XXXX

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S Revised July 30, 2021
A BORROWER MAY USE THIS FORM ONLY IF THE BORROWER RECEIVED A PPP LOAN OF $150,000 OR LESS
Business Legal Name (“Borrower”)
Business Address

DBA or Tradename, if applicable
NAICS Code

Business TIN (EIN, SSN, ITIN)
Primary Contact

(

)

Business Phone

-

E-mail Address

☐ First Draw PPP Loan ☐ Second Draw PPP Loan (check one)
SBA PPP Loan Number: ________________________

Lender PPP Loan Number: __________________________

PPP Loan Amount: _____________________________

PPP Loan Disbursement Date: ________________________

Amount of PPP Loan Increase (if applicable): ________________
Employees at Time of Loan Application: ___________

Date of PPP Loan Increase (if applicable): _______________

Employees at Time of Forgiveness Application: __________

Covered Period: ________________________ to ________________________
Amount of Loan Spent on Payroll Costs: _______________ Requested Loan 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 Borrower has complied with all requirements in the Paycheck Protection Program Rules (Sections 7(a)(36),
(7)(a)(37), and 7A of the Small Business Act, the PPP interim final rules, and guidance issued by SBA through the date
of this application), including the rules related to:
• eligible uses of PPP loan proceeds;
• the amount of PPP loan proceeds that must be used for payroll costs (including proprietor expenses for
Borrowers that applied for loans using SBA Forms 2483-C or 2483-SD-C);
• the calculation and documentation of the Borrower’s revenue reduction (if applicable); and
• the calculation of the Borrower’s Requested Loan Forgiveness Amount.
Information regarding these requirements may be found in the Form 3508S Instructions and the Paycheck Protection
Program Rules.
The information provided in this application 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.

Following submission of this forgiveness application, the Borrower must retain all records necessary to prove compliance with
Paycheck Protection Program Rules for four years for employment records and for three years for all other records. SBA may request
additional information for the purposes of evaluating the Borrower’s eligibility for the PPP loan and for loan forgiveness, and 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 in a denial of the Borrower’s loan forgiveness application.
The Borrower’s eligibility for loan forgiveness will be evaluated in accordance with the Paycheck Protection Program Rules. 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 (07/21)

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S Revised July 30, 2021

OMB Control No.: 3245-0407
Expiration Date: XX/XX/XXXX

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.
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

Principal Position

Select Response Below:
□ Non-Veteran; □ Veteran; □ Service-Disabled Veteran; □ Spouse of Veteran; □ Not
Disclosed
Gender
□ Male; □ Female; □ Not Disclosed
Race (more than 1 □ American Indian or Alaska Native; □ Asian; □ Black or African-American; □ Native
may be selected) Hawaiian or Pacific Islander; □ White; □ Not Disclosed
Ethnicity
□ Hispanic or Latino; □ Not Hispanic or Latino; □ Not Disclosed
Disclosure is voluntary and will have no bearing on the loan forgiveness decision
Veteran

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 (07/21)