Form Ss-8 - Determination Of Worker Status For Purposes Of Federal Employment Taxes And Income Tax Withholding Page 2

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Form SS-8 (Rev. 8-2011)
Page
Part I
General Information (continued)
If the worker received pay from more than one entity because of an event such as the sale, merger, acquisition, or reorganization of the firm for
7
whom the services are performed, provide the following: Name of the firm's previous owner:
Previous owner's taxpayer identification number:
Change was a:
Sale
Merger
Acquisition
Reorganization
Other (specify)
Description of above change:
Date of change (MM/DD/YY):
8
Describe the work done by the worker and provide the worker’s job title.
9
Explain why you believe the worker is an employee or an independent contractor.
10
Did the worker perform services for the firm in any capacity before providing the services that are the subject of this determination request?
Yes
No
N/A
If “Yes,” what were the dates of the prior service?
If “Yes,” explain the differences, if any, between the current and prior service.
11
If the work is done under a written agreement between the firm and the worker, attach a copy (preferably signed by both parties). Describe the
terms and conditions of the work arrangement.
Behavioral Control (Provide names and titles of specific individuals, if applicable.)
Part II
1
What specific training and/or instruction is the worker given by the firm?
2
How does the worker receive work assignments?
3
Who determines the methods by which the assignments are performed?
4
Who is the worker required to contact if problems or complaints arise and who is responsible for their resolution?
5
What types of reports are required from the worker? Attach examples.
6
Describe the worker’s daily routine such as his or her schedule or hours.
At what location(s) does the worker perform services (for example, firm’s premises, own shop or office, home, customer’s location)? Indicate
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the appropriate percentage of time the worker spends in each location, if more than one.
Describe any meetings the worker is required to attend and any penalties for not attending (for example, sales meetings, monthly meetings,
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staff meetings).
9
Yes
No
Is the worker required to provide the services personally? .
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If substitutes or helpers are needed, who hires them?
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If the worker hires the substitutes or helpers, is approval required?
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Yes
No
If “Yes,” by whom?
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Who pays the substitutes or helpers?
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Is the worker reimbursed if the worker pays the substitutes or helpers? .
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Yes
No
If “Yes,” by whom?
SS-8
Form
(Rev. 8-2011)

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