Spreadsheet: 0d291337-e4b9-430f-ae77-505063a4ca77
Sheet: Sheet1

Employee/Independent Contract Classification Checklist | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9
The Internal Revenue Service requires the University to classify each worker as an employee or an independent contractor (IC) for purposes of income tax, Social Security , and Medicare withholding.  Please read each question and answer Yes or No.  Use the instruction to decide whether to check the IC indicator box.  Total the number of IC boxes checked.  No single factor determines an individual's status as an independent contractor.  When the form is complete, attach a position description and return it to:
I. General Information
Individual's name |  | _____________________________________________________________________________________
Social Security No. or Individual Taxpayer Identification No. |  |  |  |  | _____________________________________________________
Department | ________________________________________________________________________________________________
Residency Status |  |  |  |  |  | Yes | No | IC | Instructions
U.S. Citizen
Lawful Permanent Resident
Nonresident Alien
II. Relationship with the University
1. Has the individual worked as an employee of the university at any time during the last 12 months? |  |  |  |  |  |  |  |  | If yes, consult with legal as to status
2. Will the university expect to hire the individual as an employee immediately following termination of independent contractor status? |  |  |  |  |  |  |  |  | If yes, consult with legal as to status
3. At any time during the 12 months prior to the individual's independent contractor services, did the individual have an official university appointment or position and provide the same or similar services? |  |  |  |  |  |  |  |  | If yes, consult with legal as to status
4. Does/did the university pay others who perform essentially the same or similar services as employees? |  |  |  |  |  |  |  |  | If yes, consult with legal as to status
III. Behavior Control
A. Degree of Instruction
1. Will a current university employee instruct the individual on how to do the work, rather than rely on the individual's expertise? |  |  |  |  |  |  |  |  | If no, check IC
2. Will the university supply the individual with the necessary tools, materials, and equipment to perform the work? |  |  |  |  |  |  |  |  | If no, check IC
3. Will the university provide personnel to help perform the work? |  |  |  |  |  |  |  |  | If no, check IC
4. Will the university provide the facility to the individual to perform the work? |  |  |  |  |  |  |  |  | If no, check IC
[NAME]
1. Will the university provide training (periodic or on-going) to the individual on the procedures to follow to perform the work? |  |  |  |  |  |  |  |  | If no, check IC
2. Will the individual be required to follow the schedule set by the university? |  |  |  |  |  |  |  |  | If no, check IC
IV. Financial Control
1. Will the university reimburse the individual for out-of-pocket expenses? |  |  |  |  |  |  |  |  | If no, check IC
2. Will the individual receive a payment at regular payroll-like intervals? |  |  |  |  |  |  |  |  | If no, check IC
3. Is the payment to the individual based on an hourly, daily or weekly basis? |  |  |  |  |  |  |  |  | If No, check IC
4. Will the individual receive a flat fee or payment on a periodic basis? |  |  |  |  |  |  |  |  | If No, check IC
5. Will the individual realize a profit (or loss) from the work? |  |  |  |  |  |  |  |  | If No, check IC
6. Does the university have the right to withhold payment if it determines the work is unsatisfactory? |  |  |  |  |  |  |  |  | If No, check IC
7. Can the university or the worker terminate at any point without incurring liability? |  |  |  |  |  |  |  |  | If Yes, check IC
Employee-Independent Contractor Checklist (continued)
 |  |  |  |  |  | Yes | No | IC | Instructions
V. Relationship between the Parties
1. Is there a written agreement between the individual and the university describing the scope of the project and identifying the individual as am independent contractor? |  |  |  |  |  |  |  |  | If Yes, check IC
2. Does the individual receive vacation or sick leave or other similar benefits? |  |  |  |  |  |  |  |  | If No, check IC
3. Is the duration of the position more than six months? |  |  |  |  |  |  |  |  | If No, check IC
4. Is the work performed by the individual part of the regular business of the university? |  |  |  |  |  |  |  |  | If No, check IC
VI. Specific Classifications
1. Is the individual a guest lecturer who will conduct only a few sessions of a class and is not otherwise working at the university in a different capacity? |  |  |  |  |  |  |  |  | If Yes, check IC
2. Will the individual affect the grade or certification the student receives? |  |  |  |  |  |  |  |  | If No, Check IC
3. Will the individual set the curriculum and select the class materials? |  |  |  |  |  |  |  |  | If Yes, check IC
4. Is the course offered by the university for credit? |  |  |  |  |  |  |  |  | If No, check IC
5. Is the course a degree prerequisite? |  |  |  |  |  |  |  |  | If No, check IC
6. Does the individual teach or present similar courses at other colleges, universities, or educational institutions or to the general public as part of a trade or business? |  |  |  |  |  |  |  |  | If Yes, check IC
B. Researcher
1.Will the individual perform research for the university under a grant or other funding? |  |  |  |  |  |  |  |  | If No, check IC
2. Will the individual perform research for a university professor or employee who determines how the work is performed and the work schedule? |  |  |  |  |  |  |  |  | In No, check IC
3. Will the individual collaborate with a university professor or employee or serve as an advisor or consultant? |  |  |  |  |  |  |  |  | If Yes, check IC
Total Checks in IC Indicator Column
Dept. business contact completing form |  |  | ____________________________________ |  |  |  | Date | _________________________________
Signature |  | ________________________________________________________________________________________
Contact Phone |  | ________________________________________________________________________________________
Determination:
Hire as employee |  |  |  |  | Hire as Independent Contractor
Name of Tax Approving Official: |  |  | _______________________________ |  |  |  | Date | ____________________________
Signature |  |  | __________________________________________________________________
Contact phone |  |  | __________________________________________________________________