Form 8952 - Application For Voluntary Classification Settlement Program printable pdf download

8952

Application for Voluntary

Form

Classification Settlement Program (VCSP)

OMB No. 1545-2215

(Rev. November 2013)

Do not send payment with Form 8952.

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Department of the Treasury

Information about Form 8952 and its separate instructions is at

Internal Revenue Service

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Caution. Taxpayer must make certain representations in order to be eligible to participate in the VCSP. These representations can be found in

Part V on page 2.

Part I

Taxpayer Information

1 Taxpayer's name

2 Employer identification number (EIN)

3 Number and street (or P.O. box number if mail is not delivered to a street address)

Room/Suite

4 City, town or post office, state, and ZIP code

5 Telephone number

6 Website address (optional)

7 Fax number (optional)

8 Email address (optional)

9 Type of entity. Check the applicable box:

Sole proprietorship

Cooperative organization described in section 1381 of the Internal Revenue Code

Joint venture

Tax-exempt organization

Partnership

State or local government (for worker class or position not covered under a section 218 agreement)

C corporation

Other (specify here)

S corporation

10 Are you a member of an affiliated group?

Yes

If “Yes,” complete the common parent information on lines 11-14.

If “No,” skip to Part II.

11 Name of common parent of the affiliated group

12 EIN of common parent

13 Number and street (or P.O. box number if mail is not delivered to a street address) of common parent

14 City, town or post office, state, and ZIP code of common parent

Part II

Contact Person

Attach a properly completed Form 2848, Power of Attorney and Declaration of Representative, if applicable. Also see Special

instructions for Form 2848 in the instructions.

• Name and title of contact person

• Contact person's number and street (or P.O. box number if mail is not delivered to a street address)

• Contact person's city, town or post office, state, and ZIP code

• Contact person's telephone number

• Contact person's fax number (optional)

• Contact person's email address (optional)

Part III

General Information About Workers To Be Reclassified

15 Enter the total number of workers from all classes

16 Enter a description of the class or classes of workers to be reclassified. If

to be reclassified. A class of workers includes all

more space is needed, attach separate sheets (see instructions).

workers who perform the same or similar

services.

17 Enter the beginning date of the employment tax

period (calendar year or quarter) for which you

want to begin treating the class or classes of

workers as employees. This date should be at

least 60 days after the date you file Form 8952

(see instructions).

8952

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Form

(Rev. 11-2013)

Cat. No. 37772H

Form 8952 - Application For Voluntary Classification Settlement Program

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