Student Social Security Exemption Form (Page 2 of 2) in pdf

University Corporation, San Francisco State

P.O. Box 320160, San Francisco, CA 94132-0160

(415)338-2246 / fax (415)338-7938

Application For Exemption From Social Security Taxes

(For SFSU Students Employed by the University Corporation, San Francisco State)

Amendments to the Social Security Act and subsequent IRS revenue rulings have excluded the service

performed by some San Francisco State University students employed by the University Corporation, San

Francisco State from Social Security Taxes (FICA). The exclusion is generally restricted to full-time SFSU

students who are enrolled and regularly attending classes and who work 50% time or less for the Corporation,

(regarding Fall, Spring and Summer sessions). Please see reverse side before signing this form.

Since the FICA exclusions are subject to IRS audit, you must sign the certification below if you desire

exclusion from Social Security Taxes.

____ I am currently enrolled as a full-time student (12 units or more for undergraduate, 9 units or more for

graduate) and I regularly attend classes at SFSU for the purpose of pursuing a course of study. My

employment with the Corporation does not exceed 50% time.* I shall immediately inform the San

Francisco State University Corporation’s Personnel Department, in writing, should any of the above

change.

____ I do not meet the requirements above, but I have attached a narrative explanation of my particular

circumstances which I request the Corporation review to determine if my situation complies with IRS

intent of FICA exemption.

Semester Applied For: ___________________________________________

Year: ___________________

(Fall Spring, Summer)

Name (Please Print): ____________________________________________

Student I.D.#: _________________________________________________

Signature: _____________________________________________________

Date: ___________________

Note:

A new form must be filled out at the start of each semester. In addition, during the period between Graduation

Day and the start of Fall Semester Classes, it will be assumed that all Corporation employees are subject to

Social Security Taxes, unless we receive one of these forms indicating SFSU Summer Session enrollment.

Full-time students who work less than 20 hours per week and who are FICA exempt are not eligible for

unemployment or disability insurance.

*During academic holiday or inter-session, the student may work more than 50% time without jeopardizing

his/her eligibility.

Student Social Security Exemption Form Page 2