Fillable Paycheck Protection Program PPP Loan Forgiveness Application Form (United Bank)

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Paycheck Protection Program PPP Loan Forgiveness Application Form (United Bank)

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Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S Revised January 19, 2021

A BORROWER MAY USE THIS FORM ONLY IF THE BORROWER RECEIVED A PPP LOAN OF $150,000 OR LESS

SBA Form 3508S (01/21)

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

Business Legal Name (“Borrower”)

DBA or Tradename, if applicable

Business Address

NAICS Code

Business TIN (EIN, SSN)

Business Phone

( ) -

Primary Contact

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: ________________________

Employees at Time of Loan Application: ___________ Employees at Time of Forgiveness Application: __________

Covered Period: ________________________ to ________________________

If Borrower (Together with Affiliates, if Applicable) Received First Draw PPP Loans of $2 Million or More or Second Draw

PPP Loans of $2 Million or More, Check Here: ☐

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;

• 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

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signature

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Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S Revised January XX, 2021

SBA Form 3508S (01/21)

PPP Borrower Demographic Information Form (Optional)

Instructions

1. Purpose. Veteran/gender/race/ethnicity data is collected for program reporting purposes only.

2. Description. This form requests information about each of the Borrower’s Principals. Add additional sheets if necessary.

3. 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.

4. Principal Name. Insert the full name of the Principal.

5. 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

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.

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

may be selected)

1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native

Hawaiian or Pacific Islander; 5=White; X=Not Disclosed

Ethnicity

H=Hispanic or Latino; N=Not Hispanic or Latino; X=Not Disclosed

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S Revised January 19, 2021

SBA Form 3508S (01/21)

Page 1

PPP LOAN FORGIVENESS APPLICATION FORM 3508S INSTRUCTIONS FOR BORROWERS

You (the Borrower) can apply for forgiveness of your First or Second Draw Paycheck Protection Program (PPP) Loan using this

SBA Form 3508S only if the loan amount you received from your Lender was $150,000 or less for an individual First or Second

Draw PPP Loan. If you are not eligible to use this form, you must apply for forgiveness of your PPP loan using SBA Form 3508

or 3508EZ (or lender’s equivalent form). Each PPP loan must use a separate loan forgiveness application form. You cannot use

one form to apply for forgiveness of both a First and Second Draw PPP loan.

SBA Form 3508S requires fewer calculations and less documentation for eligible borrowers. SBA Form 3508S does not require

borrowers to show the calculations used to determine their loan forgiveness amount. However, SBA may request information and

documents to review those calculations as part of its loan review or audit processes. Complete this SBA Form 3508S in

accordance with the instructions below, and submit it to your Lender (or the Lender that is servicing your loan). Borrowers may

also complete this application electronically through their Lender.

If this application is being submitted for a First Draw PPP Loan approved on or before August 8, 2020 and the Borrower is

required to submit an SBA Form 3508D disclosure of a controlling interest, that disclosure must be submitted to the lender not

later than 30 days after submission of this loan forgiveness application. See subsection B.16 of SBA’s interim final rule posted on

January 6, 2021 (86 FR 3692).

If this loan forgiveness application is being submitted for a Second Draw PPP Loan, the Borrower must submit simultaneously to

its lender documentation supporting the gross receipts reduction certification on the Borrower’s loan application (if the Borrower

did not previously submit such documentation to the lender).

Instructions for PPP Loan Forgiveness Application Form 3508S

Business Legal Name (“Borrower”)/DBA or Tradename (if applicable)/Business TIN (EIN, SSN): Enter the same

information as on your Borrower Application Form (SBA Form 2483, SBA Form 2483-SD, or lender’s equivalent).

Business Address/NAICS Code/Business Phone/Primary Contact/E-mail Address: Enter the same information as on your

Borrower Application Form, unless there has been a change in address or contact information. If NAICS Code was not on the

Borrower Application Form, match the business activity code provided on IRS income tax filings, if applicable.

First Draw PPP Loan or Second Draw PPP Loan: Select the box that describes the PPP loan that this forgiveness application is

for. If you only have one PPP loan, select First Draw PPP Loan.

SBA PPP Loan Number: Enter the loan number assigned by SBA at the time of loan approval. Request this number from the

Lender if necessary.

Lender PPP Loan Number: Enter the loan number assigned to the PPP loan by the Lender.

PPP Loan Amount: Enter the disbursed principal amount of the PPP loan (the total loan amount you received from the Lender).

PPP Loan Disbursement Date: Enter the date that you received the PPP loan proceeds from the Lender. If loan proceeds were

received on more than one date, enter the first date on which you received PPP loan proceeds. If you received an authorized

increase on your First Draw PPP Loan after December 27, 2020, you must enter the date on which you received the original

disbursement of your PPP loan proceeds.

Employees at Time of Loan Application: Enter the total number of employees at the time of the PPP loan application.

Employees at Time of Forgiveness Application: Enter the total number of employees at the time the Borrower is applying for

loan forgiveness.

Covered Period: The Covered Period begins on the date the loan was originally disbursed. It ends on a date selected by the

Borrower that is at least 8 weeks following the date of loan disbursement and not more than 24 weeks after the date of loan

disbursement. For example, if the Borrower received their PPP loan proceeds on Monday, April 20, 2020, the first day of the

Covered Period is Monday, April 20, 2020, and the final day of the Covered Period is any date selected by the Borrower between

Sunday, June 14, 2020, and Sunday, October 4, 2020.

If Borrower, Together with its Affiliates, if Applicable, Received First Draw PPP Loans of $2 Million or More or

Second Draw PPP Loans of $2 Million or More: Check the box if the Borrower, together with its affiliates (to the extent

required under subsection D.3. of SBA’s interim final rule posted on January 6, 2021 (86 FR 3692) and not waived under 15

U.S.C. 636(a)(36)(D)(iv)), received (a) First Draw PPP Loans with an original principal amount of $2 million or more (if this

is a First Draw PPP Loan forgiveness application), or (b) Second Draw PPP Loans with an original principal amount of $2

million or more (if this is a Second Draw PPP Loan forgiveness application).

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S (revised January 19, 2021)

SBA Form 3508S (01/21)

Page 2

Amount of Loan Spent on Payroll Costs: Borrowers are generally eligible for forgiveness for the payroll costs paid and payroll

costs incurred during the Covered Period. To calculate eligible payroll costs incurred or paid during the Covered Period, add Cash

Compensation, Employee Benefits, and Owner Compensation, as follows:

Cash Compensation: The sum of gross salary, gross wages, gross tips, gross commissions, paid leave (vacation, family,

medical or sick leave, not including leave covered by the Families First Coronavirus Response Act), and allowances for

dismissal or separation paid or incurred during the Covered Period. Do not include qualified wages taken into account in

determining the Employer Retention Credit. For each individual employee, the total amount of cash compensation eligible

for forgiveness may not exceed an annual salary of $100,000, as prorated for the Covered Period. For example, for an 8-

week Covered Period, the maximum is $15,385; for a 24-week Covered Period, the maximum is $46,154. You can only

include compensation of employees who were employed by the Borrower at any point during the Covered Period and whose

principal place of residence is in the United States.

Employee Benefits: The total amount paid by the Borrower for:

1. Employer contributions for employee group health, life, disability, vision, or dental insurance, including employer

contributions to a self-insured, employer-sponsored group health plan, but excluding any pre-tax or after-tax

contributions by employees. Do not add contributions for these benefits made on behalf of a self-employed

individual, general partners, or owner-employees of an S-corporation, because such payments are already included

in their compensation.

2. Employer contributions to employee retirement plans, excluding any pre-tax or after-tax contributions by

employees. Do not add employer retirement contributions made on behalf of a self-employed individual or general

partners, because such payments are already included in their compensation.

3. Employer state and local taxes paid by the Borrower and assessed on employee compensation (e.g., state

unemployment insurance tax), excluding any taxes withheld from employee earnings.

Owner Compensation: Any amounts the Borrower paid to owners (owner-employees (with an ownership stake of 5% or

more), a self-employed individual, or general partners). For each individual owner in total across all businesses, this

amount is capped at (a) $20,833 (the 2.5-month equivalent of $100,000 per year), or (b) the 2.5-month equivalent of the

individual’s applicable compensation in the year that was used to calculate the loan amount (2019 or 2020), whichever is

lower.

Payroll costs are considered paid on the day that paychecks are distributed or that the Borrower originates an ACH credit

transaction. Payroll costs are considered incurred on the day that the employee’s pay is earned. Payroll costs incurred but not paid

during the Borrower’s last pay period of the Covered Period are eligible for forgiveness if paid on or before the next regular

payroll date. Otherwise, payroll costs must be paid during the Covered Period. Count payroll costs that were both paid and

incurred only once. Include only payroll costs for employees whose principal place of residence is in the United States. For

information on what qualifies as payroll costs, see SBA’s interim final rule posted on January 6, 2021 (86 FR 3692).

Requested Loan Forgiveness Amount: Enter the total amount of your PPP loan that is eligible for loan forgiveness. This

amount is the “Amount of Loan Spent on Payroll Costs” plus any amount spent on eligible nonpayroll costs (described below)

minus any required reductions (described below), up to the principal amount of the PPP loan.

Nonpayroll Costs: Eligible nonpayroll costs consist of:

a. covered mortgage obligations: payments of mortgage interest (not including any prepayment or payment of principal) on any

business mortgage obligation on real or personal property incurred before February 15, 2020 (“business mortgage interest

payments”);

b. covered rent obligations: business rent or lease payments pursuant to lease agreements for real or personal property in force

before February 15, 2020 (“business rent or lease payments”);

c. covered utility payments: business payments for a service for the distribution of electricity, gas, water, telephone,

transportation, or internet access for which service began before February 15, 2020 (“business utility payments”);

d. covered operations expenditures: payments for any business software or cloud computing service that facilitates business

operations, product or service delivery, the processing, payment, or tracking of payroll expenses, human resources, sales and

billing functions, or accounting of tracking of supplies, inventory, records, and expenses;

e. covered property damage costs: costs related to property damage and vandalism or looting due to public disturbances that

occurred during 2020 that were not covered by insurance or other compensation;

f. covered supplier costs: expenditures made to a supplier of goods for the supply of goods that are essential to the operations of

the Borrower at the time at which the expenditure is made, and made pursuant to a contract, order, or purchase order in effect

prior to the beginning of the Covered Period (for perishable goods, the contract, order, or purchase order may have been in

effect before or at any time during the Covered Period); and

g. covered worker protection expenditures: operating or capital expenditures that facilitate the adaptation of the business

activities of an entity to comply with the requirements established or guidance issued by the Department of Health and

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S (revised January 19, 2021)

SBA Form 3508S (01/21)

Page 3

Human Services, the Centers for Disease Control, or the Occupational Safety and Health Administration, or any equivalent

requirements established or guidance issued by a State or local government, during the period starting March 1, 2020 and

ending on the date on which the national emergency declared by the President with respect to the Coronavirus Disease 2019

(COVID-19) expires related to maintenance standards for sanitation, social distancing, or any other worker or customer

safety requirement related to COVID-19, but does not include residential real property or intangible property.

Eligible nonpayroll costs cannot exceed 40% of the total forgiveness amount. An eligible nonpayroll cost must be either paid

during the Covered Period or incurred during the Covered Period and paid on or before the next regular billing date, even if the

billing date is after the Covered Period. Count nonpayroll costs that were both paid and incurred only once.

FTE and Salary/Wage Reductions: Borrowers that received a PPP loan of more than $50,000 and Borrowers of $50,000 or less that

together with their affiliates received First Draw PPP Loans totaling $2 million or more or Second Draw PPP Loans totaling $2

million or more must adjust their “Requested Loan Forgiveness Amount” due to statutory requirements concerning reductions in

either full-time equivalent employees or employee salary and wages. Such a Borrower is not subject to any reductions if the

Authorized Representative of the Borrower can attest (1) that the Borrower did not reduce annual salaries or hourly wages of any

employee by more than 25 percent during the Covered Period compared to the most recent full quarter before the Covered Period,

and (2) that either (a) the Borrower did not reduce the number of employees or the average paid hours of employees between

January 1, 2020 and the end of the Covered Period or (b) the Borrower was unable to operate during the Covered Period at the same

level of business activity as before February 15, 2020, due to compliance with requirements established or guidance issued between

March 1, 2020, and December 31, 2020 (or, for a PPP loan made after December 27, 2020, requirements established or guidance

issued between March 1, 2020 and the last day of the Covered Period) by the Secretary of Health and Human Services, the Director

of the Centers for Disease Control and Prevention, or the Occupational Safety and Health Administration, related to the maintenance

of standards of sanitation, social distancing, or any other work or customer safety requirement related to COVID-19. If the

Borrower does not satisfy these requirements and is potentially subject to reductions in its Requested Loan Forgiveness Amount, the

Borrower must follow SBA Form 3508 and its instructions to calculate its Requested Loan Forgiveness Amount. The Borrower is

not required to submit the Form 3508 or any related documentation with this forgiveness application. However, SBA may request

information and documents to review those calculations as part of its loan review and audit processes.

Borrower Responsibilities: The Borrower must comply 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 SBA guidance issued through the date of this

application), and must attest to its compliance on the Loan Forgiveness Application. Those requirements include the following:

• Requested Loan Forgiveness Amount (which may not exceed the principal amount of the PPP loan):

o must have been used by the Borrower to pay business costs that are eligible for forgiveness (payroll costs to retain

employees, business mortgage interest payments, business rent or lease payments, business utility payments,

covered operations expenditures, covered property damage costs, covered supplier costs, or covered worker

protection expenditures) during the Covered Period;

o must include payroll costs equal to at least 60% of the Requested Loan Forgiveness Amount;

o for any owner-employee (with an ownership stake of 5% or more) or self-employed individual/general partner, must

not exceed 2.5 months’ worth of compensation received during the year used to calculate the PPP loan amount,

capped at $20,833 per individual in total across all businesses; and

o for loans of more than $50,000 and loan of $50,000 or less to Borrowers that together with their affiliates received

First Draw PPP Loans totaling $2 million or more or Second Draw PPP Loans totaling $2 million or more, must

meet the requirements of either (A) or (B): (A) is not subject to reductions because the Borrower did not reduce

annual salaries or hourly wages of any employee by more than 25 percent during the Covered Period compared to

the most recent full quarter before the Covered Period and either (1) the Borrower did not reduce the number of

employees or the average paid hours of employees between January 1, 2020 and the end of the Covered Period or

(2) the Borrower was unable to operate during the Covered Period at the same level of business activity as before

February 15, 2020, due to compliance with requirements established or guidance issued between March 1, 2020 and

December 31, 2020 (or, for a PPP loan made after December 27, 2020, requirements established or guidance issued

between March 1, 2020 and the last day of the Covered Period the last day of the Covered Period) by the Secretary

of Health and Human Services, the Director of the Centers for Disease Control and Prevention, or the Occupational

Safety and Health Administration, related to the maintenance of standards of sanitation, social distancing, or any

other work or customer safety requirement related to COVID-19, or (B) the Borrower has included any required

reductions as described in SBA Form 3508 and its instructions.

• The Borrower must accurately calculate the Requested Loan Forgiveness Amount and verify the payments for the eligible

costs included in it.

• If the loan forgiveness application is being submitted for a Second Draw PPP Loan, the borrower must submit or have

already submitted all required revenue reduction documentation and have used all First Draw PPP Loan amounts on eligible

expenses prior to disbursement of the Second Draw PPP Loan.

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.

Paycheck Protection Program

PPP Loan Forgiveness Application Form 3508S (revised January 19, 2021)

SBA Form 3508S (01/21)

Page 4

Documents that Each Borrower Must Maintain but is Not Required to Submit

Payroll: Documentation verifying the eligible cash compensation and non-cash benefit payments from the Covered Period

consisting of each of the following:

a. Bank account statements or third-party payroll service provider reports documenting the amount of cash compensation paid

to employees.

b. Tax forms (or equivalent third-party payroll service provider reports) for the periods that overlap with the Covered Period:

i. Payroll tax filings reported, or that will be reported, to the IRS (typically, Form 941); and

ii. State quarterly business and individual employee wage reporting and unemployment insurance tax filings reported,

or that will be reported, to the relevant state.

c. Payment receipts, cancelled checks, or account statements documenting the amount of any employer contributions to

employee group health, life, disability, vision or dental insurance and retirement plans that the Borrower included in the

Requested Loan Forgiveness Amount.

Nonpayroll: For categories a-c, documentation verifying existence of the obligations/services prior to February 15, 2020 and, for

all categories, eligible payments from the Covered Period.

a. Business mortgage interest payments: Copy of lender amortization schedule and receipts or cancelled checks verifying

eligible payments from the Covered Period; or lender account statements from February 2020 and the months of the Covered

Period through one month after the end of the Covered Period verifying interest amounts and eligible payments.

b. Business rent or lease payments: Copy of current lease agreement and receipts or cancelled checks verifying eligible

payments from the Covered Period; or lessor account statements from February 2020 and from the Covered Period through

one month after the end of the Covered Period verifying eligible payments.

c. Business utility payments: Copy of invoices from February 2020 and those paid during the Covered Period and receipts,

cancelled checks, or account statements verifying those eligible payments.

d. Covered operations expenditures: Copy of invoices, orders, or purchase orders paid during the Covered Period and receipts,

cancelled checks, or account statements verifying those eligible payments.

e. Covered property damage costs: Copy of invoices, orders, or purchase orders paid during the Covered Period and receipts,

cancelled checks, or account statements verifying those eligible payments, and documentation that the costs were related to

property damage and vandalism or looting due to public disturbances that occurred during 2020 and such costs were not

covered by insurance or other compensation.

f. Covered supplier costs: Copy of contracts, orders, or purchase orders in effect at any time before the Covered Period (except

for perishable goods), copy of invoices, orders, or purchase orders paid during the Covered Period and receipts, cancelled

checks, or account statements verifying those eligible payments.

g. Covered worker protection expenditures: Copy of invoices, orders, or purchase orders paid during the Covered Period and

receipts, cancelled checks, or account statements verifying those eligible payments, and documentation that the expenditures

were used by the Borrower to comply with applicable COVID-19 guidance during the Covered Period.

Other Records: All records relating to the Borrower’s PPP loan, including documentation submitted with its PPP loan

application, documentation supporting the Borrower’s certifications as to its eligibility for a PPP loan (including the Borrower’s

gross receipt reduction certification for a Second Draw PPP Loan, if applicable), documentation necessary to support the

Borrower’s loan forgiveness application, and documentation demonstrating the Borrower’s material compliance with PPP

requirements.

Records Retention Requirement: The Borrower must retain all employment records/payroll documentation in its files for four

years and all other documentation for three years after the date the loan forgiveness application is submitted to the lender, and

permit authorized representatives of SBA, including representatives of its Office of Inspector General, to access such files upon

request. The Borrower must provide documentation independently to a lender to satisfy relevant Federal, State, local or other

statutory or regulatory requirements or in connection with an SBA loan review or audit.

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