Form Ss-8 - Determination Of Worker Status For Purposes Of Federal Employment Taxes And Income Tax Withholding Page 3

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Form SS-8 (Rev. 5-2014)
Page
Financial Control (Provide names and titles of specific individuals, if applicable.)
Part III
1
List the supplies, equipment, materials, and property provided by each party:
The firm:
The worker:
Other party:
2
Does the worker lease equipment, space, or a facility? .
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Yes
No
If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.)
3
What expenses are incurred by the worker in the performance of services for the firm?
4
Specify which, if any, expenses are reimbursed by:
The firm:
Other party:
5
Type of pay the worker receives:
Salary
Commission
Hourly Wage
Piece Work
Lump Sum
Other (specify)
$
If type of pay is commission, and the firm guarantees a minimum amount of pay, specify amount.
6
Yes
No
Is the worker allowed a drawing account for advances?
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If “Yes,” how often?
Specify any restrictions.
Firm
Worker
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Whom does the customer pay? .
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If worker, does the worker pay the total amount to the firm?
Yes
No
If “No,” explain.
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Yes
No
Does the firm carry workers' compensation insurance on the worker?
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9
What economic loss or financial risk, if any, can the worker incur beyond the normal loss of salary (for example, loss or damage of equipment,
material)?
10
Does the worker establish the level of payment for the services provided or the products sold? .
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Yes
No
If “No,” who does?
Relationship of the Worker and Firm
Part IV
1
Please check the benefits available to the worker:
Paid vacations
Sick pay
Paid holidays
Personal days
Pensions
Insurance benefits
Bonuses
Other (specify)
2
Yes
No
Can the relationship be terminated by either party without incurring liability or penalty?
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If “No,” explain your answer.
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Yes
No
Did the worker perform similar services for others during the time period entered in Part I, line 1?
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If “Yes,” is the worker required to get approval from the firm? .
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Yes
No
Describe any agreements prohibiting competition between the worker and the firm while the worker is performing services or during any later
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period. Attach any available documentation.
5
Is the worker a member of a union?
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Yes
No
What type of advertising, if any, does the worker do (for example, a business listing in a directory or business cards)? Provide copies, if
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applicable.
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If the worker assembles or processes a product at home, who provides the materials and instructions or pattern?
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What does the worker do with the finished product (for example, return it to the firm, provide it to another party, or sell it)?
How does the firm represent the worker to its customers (for example, employee, partner, representative, or contractor), and under whose
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business name does the worker perform these services?
If the worker no longer performs services for the firm, how did the relationship end (for example, worker quit or was fired, job completed,
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contract ended, firm or worker went out of business)?
SS-8
Form
(Rev. 5-2014)

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