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Paycheck Protection Program OMB Control No.: 3245-0407
Expiration Date: 9/30/2021
PPP Loan Forgiveness Application Form 3508EZ Revised January 19, 2021
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 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).
Forgiveness Amount Calculation (see Summary of Costs Eligible for Forgiveness below):
Line 1: Enter total eligible payroll costs incurred or paid during the Covered Period. To calculate these costs, add the following:
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 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.
Line 2: Enter the amount of business mortgage interest payments paid or incurred during the Covered Period for any business
SBA Form 3508EZ (01/21)
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