Revised December 12, 2002
RADFORDUNIVERSITY
INDEPENDENT CONTRACTOR/EMPLOYEE STATUS
CERTIFICATION FORM
The information provided below will assist the University in determining whether the individual performing the services will be classified for Federal, State and FICA tax purposes as an employee of the University or as an independent contractor. If the individual is a current employee (including student employees) or a dependent of a current employee, do not complete this form but process payment through the Personnel and Payroll Offices. Otherwise, complete the following and the attached form and submit to the Materiel Management & Contracts Office for review and approval, P.O. Box 6885, UniversityServiceCenter. A copy of the approved form will be returned to you. If the approved form indicates an independent contractor, you must enter a purchase requisition to initiate the procurement action. Once a purchase order number is assigned, notify Accounts Payable to process payment. If the approved form indicates an employee, complete a Personnel Action Form (PR40) and submit for approval. The Payroll Office will process payment.
I have attached the Independent Contractor/Employee Status Determination Form and any supplemental information, such as the individual’s business card, advertising or business letterhead, that supports the independence of the worker.
I understand that the proper status of the worker depends on the manner in which the work is
performed and on the nature of the relationship between the worker and the University personnel
responsible for the work being performed. Therefore, the status of the worker for federal employee tax withholding and related reporting purposes will be redetermined when the manner in which the work is performed or the relationship between the worker and the University changes sufficiently to alter the validity of this certification. I agree to notify the Tax Compliance Office if the status of the worker changes.
I hereby declare that the information provided in this document is true and correct and that I have
sufficient knowledge of, authority and responsibility for the work to be performed under this contract to effectively complete the attached form.
Department for whom services are to be performed ______
______
Signature Title
______
DateTelephone number
REVIEWED BY UNIVERSITY TAX COMPLIANCE OFFICE
I certify that I have reviewed the attached Determination Form completed by the department and based on the results of the completed form; the individual (______) to be engaged under this contract appears, for federal employment tax withholding and related reporting purposes, to be:
An Independent Contractor an Employee
______
Signature Title Date
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INDEPENDENT CONTRACTOR/EMPLOYEE STATUS
DETERMINATION FORM
Common Law Direction and Control Test
Department seeking to contract for services: ______
Department P.O. Box and telephone number: ______
Name of worker: ______
Business address of worker: ______
Permanent home address (if different from above):______
Social Security Number______or Employer Identification number______
Identify services required and date(s) to be performed. Other pertinent information should be provided including class/conference information such as speaking date, instructor of record, course number and title and a copy of the conference brochure. If a written contract is available, attach a copy.______
______
If the answer to any of the following questions is yes, the worker is considered an employee and must be paid through the payroll process. Stop, do not continue to complete this form, a Personnel Action Form (PR40) must be submitted for approval.
- Does RadfordUniversity pay, as employees, others who perform essentially the same duties that are to be performed by this worker? Yes____No_____
- Has this worker previously been paid at RadfordUniversity, as an employee, to perform essentially these same tasks? Yes____No____
- Is the worker a member of the immediate family[1] of a current employee of RadfordUniversity? Yes___No____
- Is the worker a current employee of another VirginiaState agency? Yes____No____
Definitions:
Independent contractor: an individual over whom the employer has the right to control or direct only the result of the work and not the means and methods of accomplishing the result.
Employee: a worker is an employee if the person from whom the services are performed has the right to direct and control the worker, not only as to the result to be accomplished by the work, but also as to the details by which the work is accomplished [Ref: Treasury Regulations ' 31.3401(c)-l(b)].
The common law direction and control test is used as a primary vehicle in making employee/independent contractor determination. Evidence of the worker’s classification must be documented in order to support the final determination. Please answer the following questions truthfully and to the best of your knowledge. The final determination will be based on the majority of answers, not on one or two answers only. The three categories that must be evaluated are as follows:
1) Behavior Control - training and instructions: Yes No
a)Does the worker require instruction as to methods and procedures necessary to perform
the required work? (If yes, then the worker is most likely to be classified an employee.) ______
b)Does the worker require training as to the methods and procedures used to perform the
required work? (If yes, then the worker is most likely to be classified an employee.)______
2) Financial Control - relates to RadfordUniversity’s right to direct and control business-related
means and details of the worker’s performance:
a)Has the worker made a significant financial investment in his/her independent business
activity, e. g., investment in training, equipment and/or facilities? (If yes, then the worker
is most likely to be an independent contractor.)______
b)Does the worker receive reimbursement for business/travel expenses incurred? (In yes,
then the worker is most likely to be classified an employee).______
c)Does the worker provide similar services to the general public (or other universities)?
(If yes, then the worker is most likely to be an independent contractor.) ______
d)Does the worker receive a flat fee for his services? (If yes, then the worker is most
likely to be an independent contractor.)______
e)Does the worker have the opportunity for personal profit or loss from this activity?
(If yes, then the worker is most likely to be an independent contractor.)______
3) Perception of worker’s relationship to RadfordUniversity:
a)Is there a written contract setting forth conditions, terms and duties? (Attach a copy.
Could indicate either employee or independent contractor.)______
b) Is the relationship expected to be a permanent one?
Full-time__ part-time__ temporary__one-time only__(check all that apply).
(If yes, then the worker is most likely to be classified an employee.) ______
c) Can the worker be discharged at any time by the university (an independent contractor
cannot be fired so long as he meets contractual specifications)? (In yes, then the worker
is most likely to be classified an employee.)______
d) Does the university provide tools, materials, equipment, paid assistants and/or office space
used in the performance of the worker duties? (In yes, then the worker is most likely to
be classified an employee.)______
e) Are the worker’s responsibilities part of the University’s business activity (education,
e. g., lecturer, speaker, trainer)? (In yes, then the worker is most likely to be classified
an employee.)______
Acknowledgments:Susan Brooks, Controller, University of Vermont.
Bertrand M. Harding, Jr., The Tax Law of Colleges and Universities, (New York, John Wiley & Sons, Inc., 1997).
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[1]The immediate family includes a spouse and any other person residing in the same household as the employee who is a dependent of the employee or of whom the employee is a dependent (e.g., son, daughter, mother, father, brother, sister).