OMB Control Number: 3245-0407 

Expiration Date: 12/31/2023

PAYCHECK PROTECTION PROGRAM 

LOAN NECESSITY QUESTIONNAIRE (NON-PROFIT BORROWERS) 

The purpose of this form is to facilitate the collection of supplemental information that will be used by 

SBA loan reviewers to evaluate the good-faith certification that you made on your PPP Borrower 

Application (SBA Form 2483 or Lender’s equivalent form) that economic uncertainty made the loan 

request necessary. Each non-profit Borrower that, together with its affiliates,1 received PPP loans with an 

original principal amount of $2 million or greater is required to complete this form and submit it, along 

with the required supporting documents, to the Lender servicing Borrower’s PPP loan. The completed 

form is due to the Lender servicing your PPP loan within ten business days of receipt from your 

Lender. 

SBA is reviewing these loans to maximize program integrity and protect taxpayer resources. The 

information collected will be used to inform SBA’s review of your good-faith certification that economic 

uncertainty made your loan request necessary to support your ongoing operations. Receipt of this form 

does not mean that SBA is challenging that certification. After this form is submitted, SBA may request 

additional information, if necessary, to complete the review. SBA’s determination will be based on the 

totality of your circumstances. 

Failure to complete the form and provide the required supporting documents may result in SBA’s 

determination that you were ineligible for either 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 complete form with all required responses, supporting 

documents, and signatures and certifications, the Lender servicing your loan is required to upload the 

form and documents to the SBA PPP Forgiveness Platform (forgiveness.sba.gov) and separately input 

your responses to each question into the web form available in the platform. 

Additional instructions are set forth on the next page. 

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 questionnaire, including gathering data needed, is 90 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. 

1 See 85 FR 20817 (April 15, 2020) regarding application of SBA’s affiliation rules. 

SBA Form 3510 (10/2020) 1 
 

 

 

 

-

Part A – Borrower Information 

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 Original Principal Amount of PPP Loan ($) 

Part B – Non-Profit Borrower Questionnaire 

Eligible types of non-profit borrowers include 501(c)(3) non-profits; 501(c)(19) veterans organizations; 

non-profit hospitals owned by governmental entities if they are described in Internal Revenue Code (IRC) 

§ 501(c)(3) (or otherwise adhere to the parameters of IRC § 501(c)(3) and rely on the income exclusion

under IRC § 115) and receive less than 50 percent of their funding from state or local government

sources, exclusive of Medicaid; and churches (including temples, mosques, synagogues, and other houses

of worship), conventions or associations of churches, and integrated auxiliaries of churches that meet the

requirements of IRC § 501(c)(3) (even if they have not applied to the IRS to receive recognition of taxexempt status).

Instructions: 

• For the Non-Profit Activity Assessment section below, you must include supporting

documentation for your answers to questions #1, 2, and 3 as part of your submission.

• For the Liquidity Assessment section below, you must include supporting documentation for your

answers to questions #1, 2.B, 3.C, and 5.B as part of your submission.

• For each question, in the right-hand column (labeled “Confidential?”), select “YES” or “NO” to

indicate whether your answers or information provided in response to the question are customarily

kept confidential.

• SBA may request additional supporting documentation as part of the loan review.

Non Profit Activity Assessment Confidential? 

1. Provide answers and supporting documentation

for questions 1.A and either 1.B or 1.C:

A. What were Borrower’s gross receipts2 in

the second calendar quarter (Q2) of 2020?

Seasonal borrowers may provide gross $ 

receipts in the third calendar quarter 

(Q3) of 2020 instead of Q2 2020. 

2 The amount of gross receipts provided to questions 1.A, 1.B, and 1.C must include gross receipts from gifts, 

grants, contributions, and similar amounts. 

SBA Form 3510 (10/2020) 2 
SBA Form 3510 (10/2020) 3

B. If Borrower existed in Q2 2019, what were

Borrower’s gross receipts in Q2 2019?

Seasonal borrowers that entered gross 

receipts in Q3 2020 for question 1.A 

must enter gross receipts in Q3 2019.

$

C. If Borrower did not exist in Q2 2019, what

were Borrower’s gross receipts in the first

calendar quarter (Q1) of 2020?

Seasonal borrowers that entered gross 

receipts in Q3 2020 for question 1.A 

must enter gross receipts in Q3 2019.

$ 

2. Provide answers and supporting documentation

for questions 2.A and either 2.B or 2.C:

A. What were Borrower’s gross receipts from

gifts, grants, contributions, and similar

amounts in Q2 2020?

Seasonal borrowers may provide gross 

receipts in Q3 2020 instead of Q2 2020.

$ 

B. If Borrower existed in Q2 2019, what were

Borrower’s gross receipts from gifts, grants,

contributions, and similar amounts in Q2

2019?

Seasonal borrowers that provided gross 

receipts in Q3 2020 for question 2.A 

must provide gross receipts in Q3 2019.

$ 

C. If Borrower did not exist in Q2 2019, what

were Borrower’s gross receipts from gifts,

grants, contributions, and similar amounts

in Q1 2020?

Seasonal borrowers that provided gross

receipts in Q3 2020 for question 2.A 

must provide gross receipts in Q3 2019. 

$ 

3. Provide answers and supporting documentation

for questions 3.A and either 3.B or 3.C:

A. What were Borrower’s expenses in Q2

2020?

Seasonal borrowers may enter expenses 

in Q3 2020 instead of Q2 2020.

$ 

B. If Borrower existed in Q2 2019, what were

Borrower’s expenses in Q2 2019?

Seasonal borrowers that provided 

expenses in Q3 2020 for question 3.A

must provide expenses in Q3 2019.

$ 

C. If Borrower did not exist in Q2 2019, what

were Borrower’s expenses in Q1 2020?

Seasonal borrowers that provided 

expenses in Q3 2020 for question 3.A 

must provide expenses in Q3 2019.

$ 
SBA Form 3510 (10/2020) 4

4. A. Since the COVID-19 National Emergency

Declaration issued by President Trump on 

March 13, 2020, has Borrower been ordered 

to shut down by a state or local authority 

due to COVID-19? 

YES NO 

B. If the answer to 4.A is YES, which state or

local authority issued the shutdown order?

C. If the answer to 4.A is YES, provide

start and end dates of the

shutdown order (if ongoing,

write “present” under “End”).

End 

5. A. At any time since March 13, 2020, has

Borrower been ordered to significantly alter 

its operations by a state or local authority 

due to COVID-19?

YES NO 

B. If the answer to 5.A is YES, provide start

and end dates of the order to alter

its operations (if ongoing, write

“present” under “End”).

C. If the answer to 5.A is YES, describe how

Borrower’s operations were altered [1,000 character max].

D. If the answer to 5.A is YES, what were

Borrower’s approximate additional cash

outlays for these mandatory alterations?

$

6. A. At any time since March 13, 2020, has

Borrower voluntarily ceased or reduced its 

operations due to COVID-19?

YES NO 

B. If the answer to 6.A is YES, provide start

and end dates when Borrower

voluntarily ceased or reduced

operations (if ongoing, write

“present” under “End”).

Start

Start End 

Start End
SBA Form 3510 (10/2020) 5

C. If the answer to 6.A is YES, please describe

how and why Borrower’s operations were voluntarily

ceased or reduced [1,000-character max].

7. A. At any time since March 13, 2020, has

Borrower voluntarily altered its operations 

due to COVID-19 (other than ceasing or 

reducing operations)?

YES NO 

B. If the answer to 7.A is YES, provide start

and end dates when the voluntary

alterations were in place (if ongoing,

write “present” under “End”; if

staggered, provide multiple start and

end dates).

C. If the answer to 7.A is YES, describe how

Borrower’s operations were voluntarily altered [1,000-character max].

D. If the answer to 7.A is YES, what were

Borrower’s approximate cash outlays for

these voluntary alterations?

$ 

8. A. Between March 13, 2020 and the end of the

loan forgiveness covered period of the PPP 

loan, did Borrower begin any new capital 

improvement projects not due to COVID19?

YES NO 

B. If the answer to 8.A is YES, what were

Borrower’s approximate cash outlays for

those projects?

$ 

9. What is Borrower’s primary six-digit NAICS

code?

Start End 
SBA Form 3510 (10/2020) 6

10. Optional – provide additional comments on any question in this

Non-Profit Activity Assessment section [1,000-character max]:

Liquidity Assessment Confidential

1. As of the last day of the calendar quarter

immediately before the date of Borrower’s PPP

loan application, how much did Borrower own

in cash, savings, and temporary cash

investments? Provide supporting

documentation.

$

2. A. Between March 13, 2020 and the end of the

loan forgiveness covered period of the PPP 

loan, has Borrower prepaid any outstanding

debt (i.e., paid before contractually due)?

YES NO 

B. If the answer to 2.A is YES, what was the

total amount of all debt prepayments

between March 13, 2020 and the end of the

loan forgiveness covered period of the PPP

loan? Provide supporting documentation.

$

3. A. During the loan forgiveness covered period

of the PPP loan, were any of Borrower’s 

employees compensated in an amount that 

exceeds $250,000 on an annualized basis? 

(Compensation for this purpose covers

gross salary, gross wages, gross tips, gross 

commissions, and allowances for dismissal 

or separation.)

YES NO 

B. If the answer to 3.A is YES, how many

employees?

C. If the answer to 3.A is YES, what was the

total amount of compensation during the

loan forgiveness covered period of all of

those employees included in the answer to

3.B? Provide supporting documentation.

$

4. A. Are there any restrictions on Borrower

using net income or cash, savings, and 

temporary cash investments for payroll and 

other costs such as mortgage interest, rent, 

and utilities payments?

YES NO 
SBA Form 3510 (10/2020) 7

B. If the answer to 4.A is YES, describe those

restrictions [1,000-character max].

5. A. Does Borrower, directly or through a

related organization (as defined in IRS 

Form 990 Instructions), hold assets in any 

endowment funds (as defined in IRS Form 

990 Instructions)?

YES NO 

B. If the answer to 5.A is YES, detail below

the types of endowment funds (including

donor-restricted endowments, quasiendowments, or similar) and the value of

the assets held in each endowment as of the

last day of the calendar quarter immediately

before the date of Borrower’s PPP loan

application. Provide supporting

documentation.

Endowment A (type): $

Endowment B (type): $

Endowment C (type): $

Endowment D (type): $

C. If the answer to 5.A is YES, describe any

restrictions that apply to the use of the

endowment assets for payroll and other

costs such as mortgage interest, rent, and

utilities payments [1,000-character max].

6. As of the last day of the calendar quarter

immediately before the date of Borrower’s PPP

loan application, what was the value of

Borrower’s non-cash investments (such as

equity, bond, and real estate holdings)?

$ 

7. A. Is Borrower a school, college, or

university? YES NO 

B. If the answer to 7.A is YES, what was

Borrower’s median tuition paid per student

for the 2019-2020 academic year?

$ 
SBA Form 3510 (10/2020) 8

C. If the answer to 7.A is YES, did Borrower

offer additional financial assistance to

students for the 2019-2020 academic year

due to COVID-19?

YES NO 

D. If the answer to 7.A is YES, did Borrower’s

revenues from tuition decrease for the

2019-2020 academic year due to COVID19 relative to the 2018-2019 academic

year?

YES NO 

E. If the answer to 7.D is YES, what was the

amount of the decline in revenue from

tuition due to COVID-19?

$

8. A. Does Borrower provide health care

services? YES NO 

B. If the answer to 8.A is YES, provide

answers for 8.B.i and either 8.B.ii or

8.B.iii:

i. What was Borrower’s program service

revenue related to patient care in Q2

2020?

Seasonal borrowers may enter 

revenue in Q3 2020 instead of Q2 

2020.

$

ii. If Borrower existed in Q2 2019, what

was Borrower’s program service

revenue related to patient care in Q2

2019?

Seasonal borrowers that entered

revenue in Q3 2020 for question 

8.B.i must enter revenue in Q3

2019.

$ 

iii. If Borrower did not exist in Q2 2019,

what was Borrower’s program service

revenue related to patient care in Q1

2020?

Seasonal borrowers that entered 

revenue in Q3 2020 for question 

8.B.i must enter revenue in Q3

2019.

$ 

C. If the answer to 8.A is YES, did Borrower

offer a discount on its patient care services

due to COVID-19?

YES NO 

9. If the answers to 7.A and 8.A are NO, did

Borrower offer a discount on its services due to

COVID-19?

YES NO 

10. A. Did Borrower directly receive any funds

from any CARES Act program other than

PPP, excluding tax benefits?

YES NO 

B. If the answer to 10.A is YES, please

provide funding amount: $ 
SBA Form 3510 (10/2020) 9

C. If the answer to 10.A is YES, please provide the program name

or describe the funding source [1,000-character max].

11. Optional – provide additional comments on any question in this

Liquidity Assessment section[1,000-character max].

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 questionnaire on behalf of the Borrower. 

_______ I certify that the information provided in this questionnaire and in all supporting documentation is 

true and correct in all material respects. I make this certification after reasonable inquiry of people, 

systems, and other information available to the 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