Form 14581 - Fslg Compliance Self-Assessment Page 10
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Flag Item International
1.
Did the entity make payments of any item of income to a foreign person that is subject to
Yes
No
withholding?
If not, indicate “OK” and skip the International Issues section.
Note: Employees or independent contractors who are not U.S. citizens may be required to furnish their employer
with a Form I-9, Employment Eligibility Verification, Form W-4, Employee’s Withholding Allowance Certificate, or a
W-8 series form. P.O. Boxes from a foreign country are acceptable.
The Form W-8 series includes:
• W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding;
• W-8ECI, Certificate of Foreign Person’s Claim That Income Is Effectively Connected With the Conduct of a Trade
or Business in the United States;
• W-8EXPC, Certificate of Foreign Government or Other Foreign Organization for United States Tax Withholding;
and
• W-8IMY, Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United
States Tax Withholding
2.
Did the entity employ resident aliens?
Yes
No
If yes, were withholding income, social security and Medicare taxes followed in the same way as for U.S. citizens?
Yes
No
3.
Did the entity employ nonresident aliens?
If no, indicate “OK” and skip the rest of “International” and continue with “Other Issues” below
Note: For information on determining who is a nonresident or resident alien, see
Publication
519.
Yes
No
A. Did any of the nonresident aliens holding an F-1, J-1, M-1 or Q-1 Visa provide
documentation, including copies of the Visa and Form I-9 with supporting documents to
support exemption from social security and Medicare taxes?
Note: If this documentation was not provided, social security and Medicare taxes should be withheld from the
wages paid to these nonresident aliens. However, a nonresident alien student may be eligible for the student FICA
exception under IRC §3121(b)(10).
Yes
No
B. Did any nonresident aliens have a visa status other than F-1, J-1, M-1 or Q-1?
If yes, were social security and Medicare taxes withheld as required?
Yes
No
Note: Nonresident aliens holding other visas, such as an H-1 or any secondary visa are subject to social security
and Medicare withholding.
C. Is federal income tax withheld as required?
Yes
No
Note: Nonresident aliens should compete a Form W-4, using Notice 1392 and Form 8233 to claim tax treaty
benefits The employer should include procedures for completing Form W-4 and use of Form 8233, Exemption From
Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien
Individual, to claim a treaty exemption. See
Publication 15
for the rules for completing Form W-4 and claiming a tax
treaty exemption on Form 8233.
D. Do any nonresident aliens claim a treaty exemption using Form 8233?
Yes
No
If yes, were federal income taxes withheld using the current treaty provisions? See
Publication 901
for treaty
information.
E. For nonresident aliens who did not claim a treaty exemption, were federal income taxes
Yes
No
withheld using the presumption rules described in Publication 515?
Note: If the nonresident alien did not claim a treaty exemption, Federal withholding taxes must be computed based
on the completed Form W-4 for the nonresident alien and also by following the steps outlined in Chapter 9 of
Publication
15.
14581
Catalog Number 66247V
Form
(Rev. 3-2015)
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