University Of Rochester Independent Contractor Determination And Certification Form Ic (7/1/13) (Page 2 of 3) in pdf

UNIVERSITY OF ROCHESTER

INDEPENDENT CONTRACTOR DETERMINATION AND CERTIFICATION

FORM IC (7/1/13)

C. Individuals not covered under A and B

Yes

Have you provided the same or similar services to other unrelated entities or to the general public as a trade of business

during the last 12 months?

Will your period of service be performed within a finite time frame?

Will the department provide specific instructions regarding performance of the required work rather than relying on your

expertise?

Will the University set the number of hours and/or days of the work week that you are required to work, as opposed to you

setting your own work schedule?

If the answer to question 1 and 2 is “Yes” and 3, and 4 is “No”, treat the individual as an Independent Contractor.

Otherwise the individual should be paid as an employee via payroll.

Yes

D. Other Questions for purposes of assessing independent contractor status:

Have you received other payments from the University of Rochester within the past year? If yes, please specify the type

of payment (e.g., consulting fee, other service fee)? ________________________________________________________

I will receive a flat fee for my services.

Yes

My services are made available to the public on a regular and consistent basis.

Yes

I contract with others to provide similar services.

Yes

I will provide all the equipment required to complete my duties.

Yes

I have the right to retain others to assist me in carrying out my work.

Yes

The retention of other people to assist me in carrying out my work is solely within my discretion and compensation will be

paid by me.

Yes

I will use either a University classroom, office space, or other University facility to perform my work.

Yes

All expenses incidental to the performance of my duties for the University, including travel expenses are to be borne by

me, unless reimbursement is permitted by the express terms of the contract and invoiced with appropriate documentation.

Yes

10. I retain the right to schedule the work to be completed.

Yes

11. If required, I will submit periodic progress reports to the responsible department chair or departmental administrator as to

the status of the project or work being performed.

Yes

12. The right to control the progress of the project or work being performed, is at my discretion.

Yes

13. I contract to provide these services on a project-by-project basis. Nothing in this shall imply that either party has the right

or obligation to receive or provide services for any period other than that covered by the contract.

Yes

14. I am providing additional information which may be relevant to the determination of my status as an independent

contractor (e.g., yellow page advertisements, business cards, copies of invoices to other customers, etc.)

Yes

University Of Rochester Independent Contractor Determination And Certification Form Ic (7/1/13) Page 2

Related Articles

Related forms

Related Categories