Ss 8 Form 2009

SS-8 Form Rev. December 2009 Department of the Treasury Internal Revenue Service Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding OMB No. 1545-0004 Name of firm or person for whom the worker performed services Worker s name Firm s address include street address apt. Cat. No. 16106T Rev. 12-2009 Form SS-8 Rev. 12-2009 Page Behavioral Control What specific training and/or instruction is the worker given by the firm How does the worker receive work assignments Who determines the methods by which the assignments are performed Who is the worker required to contact if problems or complaints arise and who is responsible for their resolution What types of reports are required from the worker Attach examples. or suite no. city state and ZIP code Worker s address include street address apt. or suite no. city state and ZIP code Trade name Daytime telephone number Telephone number include area code Firm s employer identification number Worker s social security number Worker s employer identification number if any Note. If the worker is paid by a firm other than the one listed on this form for these services enter the name address and employer identification number of the payer. Disclosure of Information The information provided on Form SS-8 may be disclosed to the firm worker or payer named above to assist the IRS in the determination process. For example if you are a worker we may disclose the information you provide on Form SS-8 to the firm or payer named above. The information can only be disclosed to assist with the determination process. If you provide incomplete information we may not be able to process your request. See Privacy Act and Paperwork Reduction Act Notice on page 5 for more information* If you do not want this information disclosed to other parties do not file Form SS-8. Parts I V. All filers of Form SS-8 must complete all questions in Parts I IV. Part V must be completed if the worker provides a service directly to customers or is a salesperson* If you cannot answer a question enter Unknown or Does not apply. If you need more space for a question attach another sheet with the part and question number clearly identified* Part I General Information This form is being completed by Firm Worker for services performed to. beginning date ending date Explain your reason s for filing this form for example you received a bill from the IRS you believe you erroneously received a Form 1099 or Form W-2 you are unable to get worker s compensation benefits or you were audited or are being audited by the IRS. Total number of workers who performed or are performing the same or similar services How did the worker obtain the job Attach copies of all supporting documentation contracts invoices memos Forms W-2 or Forms 1099-MISC issued or received IRS closing agreements IRS rulings etc*. In addition please inform us of any current or past litigation concerning the worker s status. If no income reporting forms Form 1099-MISC or W-2 were furnished to the worker enter the amount of income earned for the year s at issue Application Bid Employment Agency Other specify If both Form W-2 and Form 1099-MISC were issued or received explain why.