Form De 1870 - Determination Of Employment Work Status For Purposes Of State Of California Employment Taxes And Personal Income Tax Withholding

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Determination of Employment Work Status
for Purposes of State of California Employment Taxes
and Personal Income Tax Withholding
Purpose
General Information
This form is to be used by businesses who would like to
This form should be completed carefully, and it should be
get a determination as to whether a worker is an
completed for one individual who is representative of the
employee for purposes of California Unemployment
class of workers whose status is in question. If a written
Insurance, Employment Training Tax, State Disability
determination is desired for any other class of workers,
Insurance, and Personal Income Tax withholding.
complete a separate DE 1870. A written determination
for any worker will apply to other workers of the same
Note
class if facts are not different from those of the worker
whose status was ruled upon.
If you require any assistance in the completion of this
form, contact the nearest Employment Tax Customer
This form is designed to cover many work activities.
Service Office of the Employment Development
Some of the questions may not apply to you. You
Department (EDD) or call (916) 464-2500. Upon
must answer questions 1-39 or mark them
completion, return to:
“UNKNOWN” or “DOES NOT APPLY.” Answer
questions 40-78 only if applicable. If additional
STATE OF CALIFORNIA
space is needed, please attach another sheet.
EMPLOYMENT DEVELOPMENT DEPARTMENT
FACD-Central Operations, MIC 94
PLEASE TYPE OR PRINT ALL INFORMATION
10969 Trade Center Drive, Ste. 203
CLEARLY
Rancho Cordova CA 95670-6140
The EDD may need to contact you if additional
information is required.
NAME OF FIRM
NAME OF OWNER
ADDRESS OF FIRM
(CITY)
(STATE)
(ZIP CODE)
TELEPHONE NUMBER (INCLUDING AREA CODE)
FIRM’S FEDERAL IDENTIFICATION NUMBER
FIRM’S EDD EMPLOYER ACCOUNT NUMBER
Check the type of firm for which the work relationship is in question:
Individual
Partnership
Corporation
Other (specify): ________________________________
If the firm is a corporation, is the worker an officer of the corporation?
Yes
No
DE 1870 Rev. 9 (9-99) (INTERNET)
Page 1 of 7
CU

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