Form 14581 - Fslg Compliance Self-Assessment Page 2

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For Assistance and Further Information After Completing the Form:
An FSLG Specialist can help you interpret the results of the self-assessment and ensure that you know what, if any, steps you need to
take to be fully compliant with all applicable federal tax laws, rules and regulations. The names and contact information for FSLG staff
are available at
local FSLG Contact
Information.
The FSLG Specialist may recommend that you contact your State Social Security Administrator for clarifications and information about
a Section 218 Agreement or Modification, how to obtain Medicare-only coverage for Medicare-exempt employees or other similar
information. Each state has unique laws governing voluntary social security and Medicare coverage. Agreements for state and local
governments can be obtained through the NCSSSA. You may also contact SSA for additional information about coverage and benefits
under social security and Medicare.
FSLG offers a process by which a government employer can voluntarily disclose an identified error and solicit resolution via a walk-in
closing agreement. Employers interested in such a resolution may contact an FSLG Specialist or submit a detailed letter disclosing the
specific nature of the tax error, the employees affected and their proposed resolution. The letter should be submitted to the following
address:
Internal Revenue Service
T:GE:FSLG:CPM
1111 Constitution Avenue NW
Washington, DC 20224
ATTN: Closing Agreement Coordinator
Compliance Categories:
The self-assessment tool consists of the following seven categories.
1) Social Security (Section 218 Agreement and Mandatory Social Security)
2) Medicare
3) Retirement Plan Coverage
4) Worker Classification: Employee versus Independent Contractor
5) Fringe Benefits
6) International Issues
7) Other Tax Issues: Information Returns, Independent Contractor Vendors, Payments, Back-up Withholding, and Timely Filing of
Returns
14581
Catalog Number 66247V
Form
(Rev. 3-2015)

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