Form 14581 - Fslg Compliance Self-Assessment Page 3

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Department of the Treasury - Internal Revenue Service
FSLG Compliance Self-Assessment
(March 2015)
We suggest marking the boxes, as follows:
• OK – for items that either do not apply, or that apply but you believe that you are in compliance.
• Flag – the item applies but you are uncertain whether you are in compliance.
Flag Item Social Security
Does the entity have a voluntary social security coverage agreement, often referred to as a
Section 218 Agreement or Modification to the State’s Section 218 Agreement?
If not, SKIP to question 4 in this section.
Note: If an entity is uncertain whether it is covered by a Section 218 Agreement or to obtain a copy of its Section
218 Agreement and any related modifications, contact the State Social Security Administrator at
Have there been any Modifications to the 218 Agreement or the original Modification that
provided Section 218 coverage for the entity?
It may be necessary to contact the
State Social Security Administrator
to answer this question. If “yes”, list all
Modification numbers, dates and a description of changes to the Section 218 Agreement made by each
Modification. If there have been no modifications, skip to Question 3.
List the Modifications:
Note: The State Social Security Administrators prepare Section 218 modifications to the states’ agreements to
include additional coverage groups, to correct errors in other modifications, to identify additional political
subdivisions joining a covered retirement system or to obtain Medicare coverage for public employees whose
employment relationship with a public employer has been continuous since March 31, 1986.
To learn more, contact the
State Social Security Administrator
for the state.
If the entity has a Section 218 Agreement, are services performed by any employees
excluded from social security and Medicare coverage?
Note: Federal law requires the exclusion of the following services from voluntary (Section 218) coverage under the
Social Security Act (Section 218(c)(6)):
• Services performed by individuals hired to be relieved from unemployment.
• Services performed in a hospital, home or other institution by a patient or inmate thereof as an employee of a
state or local government.
• Services performed by an employee hired on a temporary basis in case of fire, storm, snow, earthquake, flood or
similar emergency.
• Services performed by a nonresident alien temporarily residing in the U.S., holding an F-1, J-1, M-1 or Q-1 visa,
when the services are performed to carry out the purpose for which the alien was admitted to the U.S.
• Covered transportation service as defined in SSA 210(k)
Note: Federal law allows for the optional exclusion of the following services from voluntary (Section 218) coverage
under the Social Security Act:
• Services in positions compensated solely by fees received directly from the public are subject to SECA (Self-
Employment Contributions Act) taxes.
• Services performed by a student enrolled and regularly attending classes at the school, college or university for
which they are working.
• Services performed by election officials or election workers paid less than the calendar year threshold amount
mandated by law.
• Services that would be excluded if performed for a private employer because they are not work defined as
employment under Section 210(a) of the Social Security Act.
Catalog Number 66247V
(Rev. 3-2015)


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