Independent Contractor Analysis - Florida Department Of Revenue Page 3
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3RTS-6061
R. 07/16
Page 3
Section III - Salespersons Only
1. Did the worker:
A) Solicit orders for business supplies or merchandise for resale? ..............................................
Yes
No
B) Sell consumer products/services directly to buyers on a commission only basis? .................
Yes
No
C) Perform services as an insurance or real estate agent? ...........................................................
Yes
No
If yes, provide license number _________________________________
D) Receive pay solely based on commission? .............................................................................
Yes
No
If no, was the worker paid by time (hourly, weekly, monthly, or salary)? (Circle all that apply)
2. Was the worker required to make a business investment other than travel expenses and
transportation? .......................................................................................................................................
Yes
No
3. Would the worker be penalized for not attending sales meetings? .......................................................
Yes
No
Section IV
To be completed ONLY by the employing unit/business. Attach additional sheets if needed.
1. Reemployment tax (RT)* account number of employing unit (if applicable): __________________________________
2. Federal employer identification number: ________________________________________________________________
3. Type of employing unit:
Sole Proprietorship,
Partnership,
Corporation,
LLC (If LLC, do you file with
the IRS as a corporation?
),
Non-profit (attach 501c3),
Agricultural,
Other (specify): _______
Yes
No
____________________________________________________________________________________________________
4. Total number of workers in this job class considered independent contractors: ______________________________
5. Total number of workers in this job class considered employees: ___________________________________________
6. If numbers were entered for 4 and 5, explain the difference between the independent contractors and the
employees: _________________________________________________________________________________________
____________________________________________________________________________________________________
7. When did a worker in this job class first perform services of any kind for the employing unit/business? _________
____________________________________________________________________________________________________
8. Do all workers in this job class who are considered independent contractors perform services under the same
terms and conditions? ...........................................................................................................................
Yes
No
(Explain any differences): ______________________________________________________________________________
____________________________________________________________________________________________________
* Formerly Unemployment Tax
Section V
Under penalties of perjury, I declare that I have read this completed questionnaire, including any attachments,
and the facts stated in it are true. I understand that knowingly providing false or misleading statements to the
Department of Revenue is punishable as a third-degree felony pursuant to section 443.071, Florida Statutes.
Employing Unit/Business Representative Signature: __________________________________________________________
Print Name of Signer: _____________________________________________________________________________________
Title: ________________________________________
Date: _______________________________________ Telephone Number: _______________________________________
--------------------------------------------------------------------------------------------------------------------------------------
Worker Signature: _____________________________ Title: ____________________________________________________
Date: ________________________________________ Telephone Number: _______________________________________
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