(608) 416-1610

Affected businesses should complete the form and submit to Justin Phillips via email at WEDC.

404-331-0333 | www.sba.gov
Field Operations Center East | 101 Marietta Street NW, Suite 700 | Atlanta, Georgia 30303-2725

How to Request a SBA EIDL Declaration

The Governor may request an SBA Economic Injury Declaration by certifying:

  1. At least five (5) businesses in the disaster area suffered SUBSTANTIAL ECONOMIC INJURY as a result of the incident; and
  2. The degree of Economic Injury suffered is so severe that financial assistance, at reasonable rates and terms is not otherwise available, thereby creating the necessity for Federal involvement in the form of subsidized loans; and
  3. The Governor’s certification must be received by the SBA Field Office Center East Office within 120 days of the incident period and must be accompanied by supporting documentation of individual small businesses; general industry statistics are not acceptable.
    Businesses can only seek assistance for economic injury (not physical damage) as a result of the incident. Substantial economic injury occurs when a business concern is unable to meet its obligations as they mature or to pay its ordinary and necessary operating expenses.
    Establishing economic injury is a comparison between the financial information from the period in the prior year to the injury period of the current year (this period must be associated to the disaster and cannot be attributed to a downturn in local economy or other unrelated issues. For example, if a water line break closed the business, and the business was not able to be re-established for two months, the business should consider how long it will take for things to normalize. If it’s three months, the analysis should show the financial data for the same three months of last year and the anticipated financial data for the same period this year. The loans are not intended to replace lost sales or profits, rather they are intended to pay fixed debts, payroll, accounts payable, and other expenses that could have been paid had the disaster not occurred. Analyzing a drop in sales, the length of time the business will be impacted, the type of business and typical business cycle of the industry, provides the SBA with the requisite data needed to determine if the economic injury is considered substantial.
    Enclosed is documentation needed for the Governor to request an SBA Economic Injury Declaration.
    All SBA programs and services are extended to the public on a nondiscriminatory basis.
    The first document is an Estimated Disaster Economic Injury Worksheet. The State may use this form to assist in gathering the information from individual businesses to determine if there is sufficient economic injury to request a declaration. The State sends this form to the County Emergency Manager for completion by each business. An instruction sheet for this form is also enclosed.
    The information from the Estimated Disaster Economic Injury Worksheet is used to complete the second document, Governor’s Certification of Economically Injured Small Businesses by County.
    The third document is also a Governor’s Certification of Economically Injured Small Businesses by County, but includes the Percent of Economic Loss for each business.
    Only submit the second and third document along with the Governor’s request letter. We have included a sample Governor’s request letter for an SBA Economic Injury Declaration.
    Please address your SBA request letter to Kem R. Fleming, Director (use address in letterhead above.)
    For more information, please contact:
    Kem Fleming, Director (404) 331-0333 ext. 2174
    kem.fleming@sba.gov (404) 655-3780 SBA Cell
    Edward Fears, Field Operations Manager (404) 331-0333 ext. 2114
    edward.fears@sba.gov (404) 859-7519 SBA Cell
    Jerome Strong, Field Operations Supervisor (404) 331-0333 ext. 2113
    jerome.strong@sba.gov (404) 909-1533 SBA Cell
    Grady Billingslea, Field Operations Supervisor (404) 331-0333 ext. 2115
    grady.billingslea@sba.gov (404) 387-1680 SBA Cell
    Michael Lampton, Public Affairs Manager (404) 331-0333 ext. 2177
    michael.lampton@sba.gov (404)909-9471 SBA Cell
    Accurate responses to the questions below will assist in evaluating a request for an economic injury disaster declaration from the U.S. Small Business Administration.
  4. Name of Property Owner: _____________________________________________
    Name of Property Owner: _____________________________________________
    Business/Property Address: ____________________________________________
    Mailing Address: ____________________________________________________
    Telephone Numbers: Business: Home: ______________
  5. Estimated Adverse Economic Impact
    Did the disaster economically impact your business? If so, when did the impact start and end?
    _ to _
    (month/year) (month/year)
    What were your business’ revenues during that period? $_______________
    What were your business’ revenues during the same period of the prior year? $________________
  6. Amount of business interruption insurance received or anticipated, if any: $_______________
  7. Provide a brief explanation of what adverse economic effects the disaster had on
    your business:

  1. How many people did you employ prior to the disaster? _________
    How many people did you employ after the disaster? _________
    If your business also suffered property damage, answer the following questions:
  2. Estimated dollar loss to:
    Real property (building), if owned: $____________________
    Contents (machinery and equipment, furniture and fixtures,
    inventory, leasehold improvements, etc): $ ________
  3. Insurance recovery received or anticipated for property damages: $ ________

Signature of Business Owner/Representative Date
Instructions for Completing the
“Estimated Disaster Economic Injury Worksheet for Business”
Item 1
Line 1
Enter the property owner’s name. If different than the business name, also enter the business name.
Line 2
If more than one owner, enter the co-owner’s name or names
Line 3
Enter the street address of the business location.
Line 4
Enter the mailing address of the business
Line 5
Enter the telephone numbers of the business and owner’s home.

Item 2
Line 3
Enter the date that the economic impact to your business due to the disaster started or is estimated to start. Economic impact can be defined as a decrease in revenues from normal levels resulting in decreased gross profit. Then enter the date that revenues and gross profits returned to normal levels. This date may be in the future and will require an estimate.
Line 4
Enter the business’ revenues between the two dates you showed
Line 4
Enter the business’ revenues between the same two dates of the previous year.
________________________________________________________________________Item 3
Line 1
If you have business interruption insurance to cover losses due to the disaster, enter the amount received or anticipated. Enter zero if none.
________________________________________________________________________Item 4
Line 1
Enter a brief narrative explaining how the disaster affected your business’ revenues and operations

Item 5
Line 1
Enter the number of employees, including management and part-time employees, of the business prior to the date of the disaster.
Line 2
Enter the number of employees, including management and part-time employees, of the business after the end of the disaster. This may require an estimate.

Item 6
Line 2
Enter the estimated loss, in dollars, to the building occupied by the business, if owned by the business or an owner of the business..
Line 3
Enter the estimated loss, in dollars, to the contents of the business’ building.

Item 7
Line 1
Enter the insurance recovery received or expected for disaster damage to the building and/or contents.

Signature and Date
Provide the signature of the business’ owner or representative and enter the date the form was prepared.