OMB Control Number: 3245-0407 

Expiration Date: 12/31/2023

PAYCHECK PROTECTION PROGRAM 

LOAN NECESSITY QUESTIONNAIRE (FOR-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 for-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 3509 (10/2020) 
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 – For-Profit Borrower Questionnaire 

Eligible types of for-profit borrowers include sole proprietors, partnerships, C-corporations, Scorporations, limited liability companies, independent contractors, eligible self-employed individuals, 

Tribal businesses (sec. 31(b)(2)(C) of Small Business Act), and electric and telephone cooperatives 

exempt from federal income taxation under section 501(c)(12) of the Internal Revenue Code. 

Instructions: 

• For the Business Activity Assessment section below, you must include supporting documentation

for your answers to question #1 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.B, 4.C, and 5.C 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.

Business Activity Assessment Confidential? 

1. Provide answers and supporting documentation

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

A. What was Borrower’s gross revenue in the

second calendar quarter (Q2) of 2020?

Seasonal borrowers may provide gross 

revenue in the third calendar quarter 

(Q3) of 2020 instead of Q2 2020. 

$ 

B. If Borrower existed in Q2 2019, what was

Borrower’s gross revenue in Q2 2019?

Seasonal borrowers that entered gross $ 

revenue in Q3 2020 for question 1.A 

must enter gross revenue in Q3 2019. 

2 

SBA Form 3509 (10/2020) 
3

SBA Form 3509 (10/2020) 

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

was Borrower’s gross revenue in the first

calendar quarter (Q1) of 2020?

Seasonal borrowers that entered gross 

revenue in Q3 2020 for question 1.A 

must enter gross revenue in Q3 2019.

$

2. 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 2.A is YES, which state or

local authority issued the shutdown order?

C. If the answer to 2.A is YES, provide start

and end dates of the shutdown order (if

ongoing, write “present” under “End”).

Start End 

3. 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 3.A is YES, provide start

and end dates of the order to alter its

operations (if ongoing, write “present”

under “End”).

Start End 

C. If the answer to 3.A is YES, how were

Borrower’s operations altered due to the

order? (select all that apply)

i. The number of people permitted in a

location at one time was reduced or

capped.

YES NO

ii. Service was restricted to outdoors. YES NO

iii. Employee workspaces were

reconfigured. YES NO

iv. Other (please describe) [1,000-character max].

D. If the answer to 3.A is YES, what were

Borrower’s approximate additional cash

outlays for these mandatory alterations?

$
4

SBA Form 3509 (10/2020) 

4. 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 4.A is YES, provide start

and end dates when Borrower voluntarily

ceased or reduced operations (if ongoing,

write “present” under “End”).

Start End 

C. If the answer to 4.A is YES, why did

Borrower voluntarily cease or reduce

operations? (select all that apply)

i. Employee(s) contracted COVID-19.

YES NO

ii. COVID-19 significantly disrupted

Borrower’s supply chain (e.g., a supplier

of goods or services that are essential to

Borrower’s operations was unable to

deliver due to COVID-19).

YES NO

iii. Other (please describe) [1,000-character max].

5. 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 5.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).

Start End

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

Borrower’s operations voluntarily altered?

(select all that apply)

i. The number of people permitted in a

location at one time was reduced or

capped.

YES NO

ii. Service was restricted to outdoors. YES NO

iii. Employee workspaces were

reconfigured. YES NO
5

SBA Form 3509 (10/2020) 

iv. Other (please describe) [1,000-character max].

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

Borrower’s approximate additional cash

outlays for these voluntary alterations?

$ 

6. 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 6.A is YES, what were

Borrower’s approximate cash outlays for

those projects?

$

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

code?

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

Business 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 and cash equivalents? Provide

supporting documentation.

$ 

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

loan forgiveness covered period of the PPP 

loan, has Borrower paid any dividends or 

other capital distributions (other than for 

pass-through estimated tax payments2) to its

owners?

YES NO

2 Distributions made by a partnership or S-corporation that are designed to be used only for owners’ estimated 

quarterly tax payments are excepted, as long as they do not exceed the tax liability on profits earned in the first three 

quarters of 2020, 110 percent of the pro-rata share of last year’s tax liability on distributions, and/or 100 percent of 

the pro-rata share of tax liability on total distributions in 2020.
6

SBA Form 3509 (10/2020) 

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

total amount of all dividends or other capital

distributions between March 13, 2020 and

the end of the loan forgiveness covered

period of the PPP loan? Provide supporting

documentation.

$ 

3. 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 3.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.

$ 

4. 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 4.A is YES, how many

employees?

C. If the answer to 4.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

4.B? Provide supporting documentation.

$ 

5. A. During the loan forgiveness covered period

of the PPP loan, were any of Borrower’s 

owners who work at Borrower compensated

by Borrower 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 5.A is YES, how many

owners?

C. If the answer to 5.A is YES, what was the

total amount of compensation during the

loan forgiveness covered period of all of

those owners included in the answer to 5.B?

Provide supporting documentation.

$ 

6. A. On the date of Borrower’s PPP loan

application, were any of Borrower’s equity 

securities listed on a national securities 

exchange?

YES NO
7

SBA Form 3509 (10/2020) 

B. If the answer to 6.A is YES, what was

Borrower’s market capitalization on the date

of Borrower’s PPP loan application?

$ 

7. A. On the date of Borrower’s PPP loan

application, did any publicly traded 

company own 20 percent or more of any 

class of Borrower’s outstanding equity

securities?

YES NO

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

name and market capitalization of the

publicly traded company on the date of

Borrower’s PPP loan application?

Company A (name): $

Company B (name): $

Company C (name): $

Company D (name): $

Company E (name): $

8. If the answer to 6.A is NO, what was the book

value (shareholders’ equity value) of Borrower

as of the last day of the calendar quarter

immediately before the date of Borrower’s PPP

loan application?

$ 

9. A. On the date of Borrower’s PPP loan

application, was Borrower a subsidiary of 

(i.e., was at least 50 percent of Borrower’s 

common equity, or equivalent equity 

interest, owned by) another company (the 

parent company)?

YES NO

B. If the answer to 9.A is YES, what was the

name of the parent company?

C. If the answer to 9.A is YES, was the parent

company organized or incorporated under

the laws of a jurisdiction outside the U. S.?

YES NO

D. If the answer to 9.A is YES, and if any of

the equity securities of Borrower’s parent

company are listed on a national securities

exchange or on a securities exchange in a

non-U.S. jurisdiction, what was the market

capitalization of the parent company on the

date of Borrower’s PPP loan application?

$ 

10. On the date of Borrower’s PPP loan application,

was 20 percent or more of any class of

Borrower’s outstanding equity securities owned

by a private equity firm, venture capital firm, or

hedge fund (including a fund managed by any

such firm)?

YES NO
8

SBA Form 3509 (10/2020) 

11. A. On the date of Borrower’s PPP loan

application, was Borrower an affiliate3 or a

subsidiary (i.e., was at least 50 percent of 

Borrower’s common equity, or equivalent 

equity interest, directly or indirectly owned 

or controlled by) of a foreign, state-owned 

enterprise (i.e., a company at least 50 

percent owned by a foreign state) or of a 

department, agency, or instrumentality of a 

foreign state?

YES NO

B. If the answer to 11.A is YES, what was the

name of the foreign, state-owned enterprise

or of the foreign state’s department, agency,

or instrumentality?

12. 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 12.A is YES, please provide

funding amount. $ 

C. If the answer to 12.A is YES, please provide the program name

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

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

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

3 For purposes of this question, apply the affiliation test as described in SBA’s interim final rule on affiliates, 85 FR 

20817 (April 15, 2020).
 

 

 

 

 

 

 

 

 

 

__________________________________________ 

__________________________________________ 

__________________________________________ 

__________________________________________ 

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 

9 

SBA Form 3509 (10/2020)