Independent Contractor Analysis
Florida Administrative Code
Effective Date 07/16
Information on this form is provided by:
Attach copies of any supporting documents (e.g., signed contract, agreements, employment applications, invoices,
prior IRS or state agency rulings on worker’s job class). In addition, complete a separate copy of this form for each job
title/class. If you do not know an answer, write ‘do not know’ or NA, if not applicable.
Employing unit/business: Answer all questions, including Section III if it is applicable. If you are completing this
form as required by Form DR-1, note that you do not need to submit this form if you have contracted with a distinct
business, occupation or profession that serves the general public, e.g., a plumber, general contractor, or certified
public accountant. Note: The issuance of a 1099 does not guarantee that a worker is an independent contractor and all
corporate officers who perform services are automatically deemed employees of their corporation pursuant to Section
443.036, Florida Statutes. Submit only one copy of this form per job-class and not for individuals.
Worker: Answer all questions, including Section III if applicable, but not Section IV.
1. Name, address, telephone and fax number(s) of the employing unit/business: _______________________________
2. Type of work done by the employing unit/business: ______________________________________________________
3. Name of the worker: _________________________________________________________________________________
4. Worker’s social security number*: ______________________________________________________________________
5. Worker’s job title or class: _____________________________________________________________________________
6. If worker’s duties were not part of the employing unit’s regular business, how did they differ? _________________
7. Dates worker performed services for the employing unit/business: _________________________________________
8. Did the worker perform the majority of the services in Florida?
9. Was 1099-MISC or W-2 given to the worker?
If yes, attach copy.
• If worker was given both 1099-MISC and W-2, explain what changed and give dates for 1099-MISC vs
W-2 duties: ___________________________________________________________________________________
10. Briefly describe the worker’s job (add additional page if needed): __________________________________________
11. If the worker is still performing services, describe the working arrangements through the current date: _________
12. List the skill(s) required to perform the work: ____________________________________________________________
*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration
of Florida’s taxes. SSNs obtained for tax administration purposes are confidential under sections 213.053 and 119.071,
Florida Statutes, and not subject to disclosure as public records. Collection of your SSN is authorized under state and
federal law. Visit our Internet site at and select “Privacy Notice” for more information regarding
the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions.