Quarterly Survey

ECIDA Quarterly Survey

Project ID Number (from email):


Section#1: Employment (only for the location that is receiving IDA benefits):

General Job Classifications Number of
Full-Time Employees
(as of 9/30/19)
Number of
Part-Time Employees
(as of 9/30/19)
Average annual/hourly
salary of full-time
Average annual/hourly
salary of part-time
Other Job Classifications
(please describe below)

Only report employees in one category. Please attach your NYS-45 Quarterly Combined Withholding, Wage Reporting & Unemployment Insurance Return Form for the quarter ending 9/30/19. If you do not currently have the form, please forward upon your receipt of the form. Do NOT include Part C (Employee Wage & Withholding Information) or any employee names, social security numbers or wages.

For multi-tenant clients only:

Please provide a copy of your tenant listing and complete the following chart (enclose additional sheets if necessary):

Tenant list and additional sheets:

Tenant Name Number/Estimate of
Full-Time Employees
Number/Estimate of
Part-Time Employees

Section #2: Employment Status:

If you are below your employment goals (which are referenced on your email), please indicate the reasons for the shortfall and explain what efforts you are undertaking to fill those positions. If you are not filling the vacant positions, please indicate why.

Section #3: Certification:





 I certify that the information submitted on this form is correct to the best of my knowledge according to our records as of September 30, 2019.

If any contact information is incorrect, please provide the updated information below:

Additional comments:

Additional attachments:

Please submit your completed survey and the requested documents on or before Friday, November 15, 2019.