HIREtech Disaster Relief Credit Questionnaire

1. How many locations were affected by the hurricane?
Examples:
* The business location was closed due to voluntary or mandatory evacuation
* The surrounding streets were flooded and employees or customers could not access the business location
* The surrounding streets were impassable due to debris and employees or customers could not access the business location
* The business location flooded
* Any other situation where the business location could not perform significant operations due to the hurricane This question requires a valid number format.

(Enter number of affected locations.)

2. How many of the affected locations have resumed significant operations? This question requires a valid number format.

(Enter number of locations that have reopened.)

3. Approximately how many total employees were paid wages while their location was affected, regardless of whether they worked?
Please include any employee who was placed in another location due to their original location being closed.
Examples:
* Paid for working at a different location, including working from home
* Paid but did not work (such as salaried employees)
* Paid for working at this location
* The employee took vacation or paid time off This question requires a valid number format.

(Enter number of employees.)

4. Do you have non-GHRA businesses that may have been affected?
(restaurants, hotels, drycleaners, etc.)

5. Please provide the following information for your additional affected businesses:

Space Cell	Name of business	Number of affected locations	Number of employees paid
1	1: Name of business	1: Number of affected locations	1: Number of employees paid
2	2: Name of business	2: Number of affected locations	2: Number of employees paid
3	3: Name of business	3: Number of affected locations	3: Number of employees paid
4	4: Name of business	4: Number of affected locations	4: Number of employees paid
5	5: Name of business	5: Number of affected locations	5: Number of employees paid

6. Please enter your information below. *This question is required.

First Name

Last Name

Title

Company Name

Zip

Email Address

Phone Number

7. Do you have any additional notes or comments?

HIREtech Disaster Relief Credit Questionnaire - GHRA