Iowa Small Business Relief Grant & Tax Deferral Application Information

This is only information - It is not the actual application. Use this document to prepare to complete the application online at:
https://www.iowaeconomicdevelopment.com/programDetails?pid=136&ppid=26

​Go to this website to read FAQs:
​https://tax.iowa.gov/COVID-19

​Online application deadline is Tuesday, March 31st at 12pm (noon).

​Iowa Small Business Relief Grant & Tax Deferral Application

The State of Iowa is currently issuing grants and tax deferrals for small businesses in Iowa. The website to make this application may be inaccessible due to high traffic volume. If you are planning to apply, have the following information ready to enter:
​
Disaster Event: COVID -19 Pandemic

______ # of employees
______ Are you also applying for the tax deferral?
______ Grant amount requested
______ Describe the Economic Injury (Loss of Sales or Revenue)

Section 1: Business Information

1. Business Legal Name:
2. D/B/A (doing business as):
3. Organization Type:  ______ For Profit    ____Non-Profit
4. FEIN (SS, if a sole proprietorship):
5. Business Withholding Permit Number:
6. Sales Tax Permit Number:
7. Physical Business Address:
8. County of Business Address: (pick one from pull down menu)
9. Mailing Address (if different):
10. Business Phone Number:
11. Contact Email:
12. Primary Business Activity:
13. Date Business Established:
14. Do you need assistance with withholding taxes through Department of Revenue? __Yes   __No
15. Do you need assistance with Sales & Use Tax through Department of Revenue __ Yes   ___ No

 
Section II: Ownership Information

Owner Applicant 1
Full Legal Name:
Title:
% Owned:
 
Owner Applicant 2
Full Legal Name:
Title:
% Owned:
 
Section III: Impact of Disaster

1. Employment on March 1st:
2. Current Number of Employees:
3. Number of Employees Working Remotely as Result of Disaster:
4. What is the estimated loss of revenues from March 15 to April 15:
5. Describe how the funds will be utilized to maintain business operations or reopen after disaster:

 
Section IV: Attachments

1. 3-month income statement
2. Revenues March 2019
3. Revenues March 2020 – to date
4. Balance Sheet (as of application date)
5. Payroll prior to March 17th, 2020 (do not send employee SS information. Use example Excel template if needed
6. Attach completed Business W-9 form

 
Section V: Certification & Release

1. Are there any judgements or court actions completed or pending against the applicant entity, or current owners?
2. Has any current owner been accused or convicted of any wrongdoing or crime, other than a simple misdemeanor?
3. Have there been any current or past bankruptcies on the part of the applicant entity, or on the part of the any owners?
4. In the last five years has there been, or are there currently any investigations of public violations of public health, safety or environmental laws by the applicant entity, or any current owner?
5. In the last five years has there been, or are there currently any violations of antitrust laws by the applicant entity, or any current owner?
6. Is the applicant entity up to date and in good standing with the Department of Revenue for filings and payments of sales, use, and withholding taxes?
7. If yes to any of the questions1 to 5 above, please provide explanation.

 
 
Sign Off

I hereby give permission to the Iowa Economic Development Authority (IEDA) and Iowa Department of Revenue (IDR) to research the Business’ history, make credit checks, contact the Business’ financial institutions, insurance carriers, and perform other related activities necessary for reasonable evaluation of this application. I also hereby authorize the Iowa Department of Revenue to provide to IDEA state tax information pertinent to the Business’ state income tax, sales and use tax, and state tax credits claimed.
 
I understand that all information submitted to IEDA and IDR related to this application is subject to Iowa’s Open Record Law (Iowa Code, Chapter 22), unless specifically marked as confidential section.

I understand the IDEA reserves the right to negotiate the financial assistance.
Furthermore, I am aware that the funds will not be disbursed until a contract has been executed and the appropriate terms have been met.
​
I hereby certify that all representations, warranties, or statements made or furnished to IDEA and IDR in connection with this application are true and correct in all material respect. I understand that it is a criminal violation under Iowa law to engage in deception or knowingly make, or cause to be made, directly or indirectly, a false statement in writing for the purpose of procuring economic development assistance from a state agency or subdivision.
 
Authorized Business Signature:
Print Name:
Date:

******

​If you are interested in applying for the Iowa Small Business Relief Grant & Tax Deferral Program, you may have found the website to complete the application is overloaded. The information listed above is the transcribed application. THIS IS NOT AN ACTUAL APPLICATION but rather all the information needed to complete that online form. Use this tool to prepare your information so that once you are able to gain access to the online form, you can complete the form in one visit. This includes gathering e-documents to attach to the application online.
 
For clarification; the form is actually a combined document that serves two purposes.

1. An application for a relief grant for business with between 2-25 employees.
2. An application for tax deferrals for ALL businesses, regardless of employee count.

 
Do visit the FAQ website (address is also provided above) for further information. Access to that page was more easily reached than the online form.