Paycheck Protection Program 

 PPP Loan Forgiveness Application Form 3508EZ 

OMB Control No. 3245-0407

Expiration date: 12/31/2023

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: ________________________ Lender PPP Loan Number: __________________________ 

PPP Loan Amount: _____________________________ PPP Loan Disbursement Date: ________________________ 

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

EIDL Advance Amount: ________________________ EIDL Application Number: __________________________ 

Payroll Schedule: The frequency with which payroll is paid to employees is: 

☐ Weekly ☐ Biweekly (every other week) ☐ Twice a month ☐ Monthly ☐ Other _____________

Covered Period: ________________________ to ________________________ 

Alternative Payroll Covered Period, if applicable: ________________________ to _______________________ 

If Borrower (together with affiliates, if applicable) received PPP loans in excess of $2 million, check here: ☐

Forgiveness Amount Calculation: 

Payroll and Nonpayroll Costs 

Line 1. Payroll Costs: _____________________ 

Line 2. Business Mortgage Interest Payments: _____________________ 

Line 3. Business Rent or Lease Payments: _____________________ 

Line 4. Business Utility Payments: _____________________ 

Potential Forgiveness Amounts 

Line 5. Add the amounts on lines 1, 2, 3, and 4: _____________________ 

Line 6. PPP Loan Amount: _____________________ 

Line 7. Payroll Cost 60% Requirement (divide Line 1 by 0.60): _____________________ 

Forgiveness Amount 

Line 8. Forgiveness Amount (enter the smallest of Lines 5, 6, and 7): _____________________ 

SBA Form 3508EZ (06/20) 

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_____________________________________________________ ____________________________ 

_____________________________________________________ ____________________________ 

Paycheck Protection Program 

PPP Loan Forgiveness Application Form 3508EZ 

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 dollar amount for which forgiveness is requested: 

• was used to pay costs that are eligible for forgiveness (payroll costs to retain employees; business mortgage interest

payments; business rent or lease payments; or business utility payments);

• includes payroll costs equal to at least 60% of the forgiveness amount;

• if a 24-week Covered Period applies, does not exceed 2.5 months’ worth of 2019 compensation for any owneremployee or self-employed individual/general partner, capped at $20,833 per individual; and

• if the Borrower has elected an 8-week Covered Period, does not exceed 8 weeks’ worth of 2019 compensation for

any owner-employee or self-employed individual/general partner, capped at $15,385 per individual.

_____ I understand that 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. 

_____ The Borrower did not reduce salaries or hourly wages by more than 25 percent for any employee during the Covered Period 

or Alternative Payroll Covered Period compared to the period between January 1, 2020 and March 31, 2020. For purposes 

of this certification, the term “employee” includes only those employees that did not receive, during any single period during 

2019, wages or salary at an annualized rate of pay in an amount more than $100,000. 

_____ The Borrower has accurately verified the payments for the eligible payroll and nonpayroll costs for which the Borrower is 

requesting forgiveness. 

_____ I have submitted to the Lender the required documentation verifying payroll costs, the existence of obligations and service 

(as applicable) prior to February 15, 2020, and eligible business mortgage interest payments, business rent or lease payments, 

and business utility payments. 

_____ The information provided in this application and the information provided in all supporting documents and forms is true 

and correct in all material respects. I understand that knowingly making a false statement to obtain forgiveness of an SBAguaranteed loan is punishable under the law, including 18 USC 1001 and 3571 by imprisonment of not more than five years 

and/or a fine of up to $250,000; under 15 USC 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 USC 1014 by imprisonment of not more than thirty 

years and/or a fine of not more than $1,000,000. 

_____ The tax documents I have submitted to the Lender are consistent with those the Borrower has submitted/will submit to 

the IRS and/or state tax or workforce agency. I also understand, acknowledge, and agree that the Lender can share the 

tax information with SBA’s authorized representatives, including authorized representatives of the SBA Office of 

Inspector General, for the purpose of ensuring compliance with PPP requirements and all SBA reviews. 

_____ I understand, acknowledge, and agree that SBA may request additional information for the purposes of evaluating the 

Borrower’s eligibility for the PPP loan and for loan forgiveness, and that 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 a denial of the 

Borrower’s loan forgiveness application. 

In addition, the Authorized Representative of the Borrower must certify by initialing at least ONE of the following two items: 

_____ 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 (other than any reductions that arose from an inability to rehire individuals who were 

employees on February 15, 2020, if the Borrower was unable to hire similarly qualified employees for unfilled positions on 

or before December 31, 2020, and reductions in an employee’s hours that a borrower offered to restore and were refused). 

_____ The Borrower was unable to operate between February 15, 2020, and the end of 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, 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. 

The Borrower’s eligibility for loan forgiveness will be evaluated in accordance with the PPP regulations and guidance issued by 

SBA through the date of this application. 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 3508EZ (06/20) 

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Paycheck Protection Program 

PPP Loan Forgiveness Application Form 3508EZ 

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 

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 

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 20 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 3508EZ (06/20) 

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