ERC Data Request Questionnaire

Let’s Put Much Needed Dollars Back Into Your Pockets.

Contact Information

Please fill in the following information for the Main Point Of Contact For ERC Data Collection.

Mailing Address

This will be the address that we will mail out deliverables to for your SIGNATURE, before we can file your ERC refund with the IRS

Is The Business Address Above The Address You Can Receive Documents In The Mail For Signature?*

Yes

If No, Fill out the Following For Your Best Mailing Address:

Legal Business Name*

When did you start your business?*

Before February 15, 2020

After February 15, 2020

Did You Receive PPP Round 1 (2020)?*

Yes

Did You Receive PPP Round 2 (2021)?*

Yes

Was Your PPP Forgiven?*

Yes

Have You Already Filed For The Employee Retention Credit?*

Yes

Does The Owner/Combination Of Owners Own Any Other Businesses?*

Yes

Have you filed your tax return for 2020?*

Yes

Have you filed your tax return for 2021?*

Yes

If Yes, How Many Total Businesses Does The Majority Owner Of The Business Own? List Each Business Below.*

For the following questions below, Total Full Time Employees (FTE) can be found by “counting each employee who worked 130+ hours each month, adding each monthly total and dividing by 12)

How Many Full Time W2 Employees Did The Business Have In 2019?*

How Many Full Time W2 Employees Did The Business Have In 2020?*

How Many Full Time W2 Employees Did The Business Have In 2021?*

Is this business part of a larger organizational structure? (Example: Has a Parent Company, Subsidiary Companies or Private Equity Owned.)*

Yes

Is there more than one entity applying (or plan to apply) for ERC?*

Yes

Does Your Company Have Any Other Forms Of Income That Do Not Come From Direct Sales Of Products Or Services (Other Forms of Income Includes Investments, Interest, Dividends, Rents, Royalties, Fees, Or Commissions, Reduced By Returns And Allowances)?

List the owners and their % ownership (if one owner, put 100%)*
THE TOTAL MUST ADD UP TO 100% FOR THE FORM TO BE COMPLETE*

Name*

% Ownership

– Remove Entry + Add another owner

Does the owner(s) have any family on the payroll?

Yes

Family members

EX: Janno Calitcz - brother ; Theo rose - Sister in law ; .....

Work Opportunity Tax Credits (WOTC): Do you participate in the credit program associated with hiring disenfranchised individuals (veterans, those on assistance, etc.)?*

Yes

R&D Credit: Do you file for the R&D credit?*

Yes

Venues/Auditoriums/Theaters: Have you received a Shuttered Venue Grant?*

Yes

Restaurants: Have you received a Restaurant Revitalization Grant?*

Yes

Did you receive any grants that reimbursed payroll?*

Yes

Is your payroll provider a PEO?*

A PEO is a Professional Employer Organization. In this type of arrangement, you partner with a PEO to outsource all payroll and HR tasks (the employees technically work for the PEO), and enter into co-employer status which gives them the legal liability of paying your employees.

Yes

Full or partial suspension of operations refers to any government mandates relating to COVID-19 that caused limitations on the ability to conduct business operations.

Please CHECK EACH BOX below that applies to your business for nominal impacts.

Note: Nominal impacts refers to mandates that affected an operation of your business where either:
1. The gross receipts from that portion of the business operations is greater than 10 percent of the total gross receipts (this is determined using the gross receipts of the same calendar quarter in 2019)
2. The hours of service performed by employees in that portion of the business is not less than 10 percent of the total number of hours of service performed by all employees in the employer's business (this is determined using the number of hours of service performed by employees in the same calendar quarter in 2019).

IMPORTANT: If you're unsure about this, please do not guess or exaggerate. Refer to your accountant or tax professional to clarify. In order to accurately calculate your Employee Retention Credit, Adelphi Solutions relies on these answers."

Please select the quarters you believe you were affected by based on above selections

In addition to the boxes checked above, please detail any negative effects your business encountered due to government regulations during the pandemic unique to your operation.*

By submitting this questionnaire, I fully attest that the information contained herein is full, and to the best of my knowledge, in good faith, accurate and in no way fraudulent or false information