Certified Professional Employer Organization Customer Reporting Agreement printable pdf download

Certified Professional Employer Organization Customer Reporting Agreement

8973

Certified Professional Employer Organization/Customer

Form

Reporting Agreement

OMB No. 1545-2266

(May 2017)

Department of the Treasury — Internal Revenue Service

Read the separate instructions before you complete Form 8973.

Part 1:

Why are you filing this form?

A service contract started on

between the customer reported in Part 2 and the CPEO reported in Part 3.

A service contract ended on

between the customer reported in Part 2 and the CPEO reported in Part 3.

Correcting a previously filed Form 8973.

Part 2:

Customer Information

—

Customer’s employer identification number (EIN)

Customer’s name (not your trade name)

Customer’s trade name (if any)

Address

Number

Street

Suite or room number

City

State

ZIP code

Foreign country name

Foreign province/county

Foreign postal code

CPEO reports all wages/

CPEO reports some

Identify forms that the CPEO will file reporting wages or compensation paid to

compensation paid to

wages/compensation

employees performing services for the customer. Check all that apply.

employees

paid to employees

Form 940, 940-PR (Employer’s Annual Federal Unemployment (FUTA) Tax Return)

Form 941, 941-PR, 941-SS (Employer’s QUARTERLY Federal Tax Return)

Form 943, 943-PR (Employer’s Annual Federal Tax Return for Agricultural

Employees)

Form CT-1 (Employer’s Annual Railroad Retirement Tax Return)

Part 3:

CPEO Information

—

CPEO’s employer identification number (EIN)

CPEO’s name (not your trade name)

CPEO’s trade name (if any)

Address

Number

Street

Suite or room number

City

State

ZIP code

8973

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Form

(5-2017)

Cat. No. 37796R

Certified Professional Employer Organization Customer Reporting Agreement

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