Revised May 9, 2016

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 or a current student, do not complete this form but process the payment on a Personnel Action Form, PR40, and submit for approval. The Payroll Office will process the payment. Otherwise, complete this page and the attached form and submit to the Tax Compliance Officer for review and approval, P.O. Box 6923. 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, send the invoice and/or University Services Contractto Accounts Payable to process payment. If the approved form indicates an employee, you must complete a Personnel Action Form, PR 40, and submit for approval.

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 isperformed and on the nature of the relationship between the worker and the University personnelresponsible 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 Officer if the status of the worker changes.

I hereby declare that the information provided in this document is true and correct and that I havesufficient 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.______

______

Depending on your responses to the following questions, additional information may requested. Please complete all of the questions below and on Page 3.

  1. Does RadfordUniversity pay, as employees, others who perform essentially the same duties that are to be performed by this worker? Yes____No_____
  2. Has this worker previously been paid at RadfordUniversity, as an employee, to perform essentially these same tasks? Yes____No____
  3. Is the worker a member of the immediate family[1] of a current employee of RadfordUniversity? Yes___No____
  4. 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 Regulation 26 CFR31.3401(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? ______

b)Does the worker require training as to the methods and procedures used to perform the

required work? ______

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? ______

b) Does the worker receive reimbursement for business/travel expenses incurred? ______

c) Does the worker provide similar services to the general public or other universities? ______

d) Does the worker receive a flat fee for his services? ______

e) Does the worker have the opportunity for personal profit or loss from this activity? ______

3) Perception of worker’s relationship to RadfordUniversity:

a)Is there a written contract setting forth conditions, terms and duties? Attach a copy. ______

b) Is the relationship expected to be a permanent one?

Full-time__ part-time__ temporary__one-time only__(check all that apply). ______

c) Can the worker be discharged at any time by the university? ______

d) Does the university provide tools, materials, equipment, paid assistants and/or office space

used in the performance of the worker duties? ______

e) Are the worker’s responsibilities part of the University’s business activity (education,

e. g., lecturer, speaker, trainer)? ______

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).