Alert to small business owners – information needed now for state applications

Published 12:27 pm Friday, March 20, 2020

It is not too early for business owners to begin thinking about the economic losses that will be incurred over the next year and more because of the pandemic. Local merchants and other business owners can best help Panola County receive the most aid possible by fully participating in reporting on-the-ground statistics to state officials. This will directly affect the type and extent of financial help that will ultimately reach hourly and salaried employees.

Panola County Emergency Management Director Daniel Cole has asked the newspaper to make available forms that are necessary to gain information on the economic loss to small businesses as a result of the COVID-19 outbreak. Below is the text of a worksheet and from an instruction sheet. There is a link below that will allow users to access and print their own copies.

The Mississippi Emergency Management Agency is collecting the information so that Mississippi request an Economic Injury Declaration from the Small Business Administration to aid in the economic loss suffered as a result of the COVID-19 event.

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Following is more information from MEMA:

Attached are two documents. First is the actual worksheet. Second is an instruct sheet. Please disseminate this worksheet and instructions to any small business within your respective counties that may have suffered economic hardship as a result of the response efforts of the COVID-19 event.   After business owners complete these worksheets, they can submit them directly to the MEMA State Coordinating Officer Todd DeMuth, for inclusion into the SBA declaration request.

These documents are also loaded on the COVID-19 SITRoom at:



This form is not required, but is a convenience in clarifying the supporting documentation the state is required to submit to the U.S. Small Business Administration when requesting an Economic Injury Disaster Loan Declaration. This information in any other format would also be acceptable. For your convenience, this form may be filled our electronically or manually.

Name of Business:

Last Name: Work Phone: Home Phone:

Address: City:

Address: City:

Type of Business:

Owner Details

First Name:

Property Owner:



Business Owner Mailing Address

Zip Code:

Business Street Address

Zip Code:



Same As Above

Estimated Adverse Economic Impact

When did the impact start and what is the estimated end date?
What were your businesses’ revenues during the affected damage period?

What were your businesses’ revenues during that SAME period of the prior year? Amount of business interruption insurance received or anticipated, if any:

From: To:

Please provide a brief explanation of what adverse economic effects the disaster had on your business:

How many people did you employ prior to disaster? How many did you employ after disaster:

Physical Damage to Business Property

If your business also suffered property damage, please answer the following questions:

Estimated dollar loss to:

Real Property (Building), if owned: Contents *:

* – includes machinery and equipment, furniture and fixtures, inventory, leasehold

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.