SBA Form 3508S Wor PPP Forgiveness Application

OMB Control No.: 3245-0407

Expiration Date: XX/XX/XXXX

Paycheck Protection Program

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

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

Business Legal Name (“Borrower”)		DBA or Tradename, if applicable
Business Address	NAICS Code	Business TIN (EIN, SSN, ITIN)	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: ________________________

Amount of PPP Loan Increase (if applicable): ________________ Date of PPP Loan Increase (if applicable): _______________

Employees at Time of Loan Application: ___________ 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

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. 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:
Veteran	□ Non-Veteran; □ Veteran; □ Service-Disabled Veteran; □ Spouse of Veteran; □ Not Disclosed
Gender	□ Male; □ Female; □ Not Disclosed
Race (more than 1 may be selected)	□ American Indian or Alaska Native; □ Asian; □ Black or African-American; □ Native 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

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)