WPC  }+Ȭ_xGLC|ڡ(L'?>O 1,Jjr|G6 eVu)+eAwHߏ?'0(Xc[\Խ$E.ρQo0C}NqȌoy?i.Z>S,F[BnU, Ji\8bN/w`uK_S{kmHɂko+ %Z` Bw 0b Cyfafa 0pn 0G #! N w@ 4- A mC C C C C C C C C C U JZ Z Z ^  #'   2  0 .    d(:28 $ =!##   dTable_ATable_B(h!2.$ =!##  HHҀ  0  3|x <6X9`(CourierXx6X@7X@2 Ha`$"Letter Gothicx H@7@2 Ha`$"Letter Gothic?` H@7?@(=$##HP LaserJet 4V,,,,,,0 {U|}D~UED{m(WS\TEMP\WP}0U<MaZ'2Letter Gothic RegularB(  WAB =!##  _HHXX  WESTERNKENTUCKYUNIVERSITY X DETERMINATIONOFCONTRACTORSTATUSFORM #ww#SubmitthisformtotheOfficeofSponsoredPrograms(_OSP_)ifthisposition|willbe||is|fundedbya p grantorcontract.}}~~The_OSP_Ԁwillinformyouofthestatus. ##w#w# b  (THISFORMSHOULDBEAPPROVEDPRIORTOSUBMISSIONOFPAYMENTAUTHORIZATION)   #N#  InternalRevenueServiceregulationsstatethatpaymentsmadetoindividualsforserviceswherean l employer/employeerelationshipexistsaresubjecttoemploymenttaxesandwithholdings.Therefore,onlypaymentstoindependentcontractorswillbeapprovedforpaymentotherthanthroughUniversitypayroll.ThepurposeofthisformistodeterminewhetherthepayeeshouldbedeemedanindependentcontractorasdefinedbytheIRS,oranemployeesubjecttoemploymenttaxesandwithholding.Thefollowingquestionsmustbeansweredbythedepartmentrequestingtheservicestobeprovidedpriortothecommencementoftheservices.Nopaymentwillbeprocessedwithoutthecompletionofthisinformation.###N#Payee'sName(ifknown):________________________________SocialSecurityNumber:________________ 0     DIRECTIONS:PLEASECHECKYESORNOTOTHEFOLLOWINGQUESTIONS:  0 h YESNO  H h$h$ * ddd Xdd Xdd XH$H$,dT ,dT , dT , dd +  M> X  P ?1..?M#N#1. RC8 d   ?1. ? RDoesyourdepartmenthavetherighttorequirecompliancewiththetiming,placeandmethodusedincompletingtheworktobedone? 2#L  2 6# d  6 F7# d  d. P  P.F2. 2#n  2Willyourdepartmentapprentice,trainorinstructinthedetailsofthework,orcorrespondinanywaythemannerormethodinwhichtheworkistobeperformed? 2#  2 6#n  6 F7#n  d. P  P.F3. 2#  2Willtheworkbedonepersonallybythecontractor? 2#  2 6#  6 F7#  d. P  P.F4. 2#B  2Willyourdepartmenthire,supervise,orpayassistantstoaidthoseperformingthework? 2#z" 2 6#B# 6 F7#B$ d. P  P.F5. 2#% 2Willyourdepartmentdictatethehoursduringwhichtheworkwillbeperformed? 2#& 2 6#' 6 F7#( d. P  P.F6. 2#) 2Willtheworkbeperformedonyourpremisesoratalocationrequiredbyyourdepartment? 2#N+ 2 6#, 6 F7#- d. P  P.F7. 2#p. 2Willyourdepartmenthavetherighttorequirethattheworkbeperformedinaspecificorder,routineorsequence? 2#X0 2 6#p1 6 F7#p2 d. P  P.F8. 2#z"3 2Willyourdepartmentrequireregularwrittenreportsfromthoseperformingthework? 2# 5 2 6#z"6 6 F7#z"7 d. P  P.F9. 2#,8 2Willyourdepartmentpaythoseperformingtheworkonanhourly,weeklyormonthlyscheduleotherthanasaconvenientpaymentofanagreeduponlumpsumcostofthework? 2#L; 2 6#,< 6 F7#,= d. P  P.F10. 2#n> 2Willyourdepartmentfurnishthetools,equipment,ormaterialsnecessarytocompletetheworkperformed? 2#@ 2 6#nA 6 F7#nB d. P  P.F11. 2# C 2Dothoseperformingtheworkhavetherighttoterminatetherelationshipatwillpriortocompletionwithoutincurringliability? 2#XE 2 6# F 6 H7# G d. P  P>H12. :'zH :Briefdescriptionofreasonforpayment(Usereverseifmorespaceisnecessary):###N#u6,*!*L d> P  6IfthereistobeacontractorwrittenagreementbetweentheUniversityandtheperson(s)performingthework,pleaseattachacopy.CompletedBy(Signature):   X  X   0   `   Date:X%#P$$ PhoneNumber: P     X     Department: &p$R PLEASESENDCOMPLETEDFORMTO:DirectorofAccounts&FiscalServices,WAB37.-----------------------------------------------------------------#,,#ForBusinessOfficeUseOnly: )P'V *  m d ddT dT  dT  dd  H$H$,dT ,dd +  - "*'W P(-________ 6#+(Y 6Employee.Thispersonmustbepaidonpayroll.SubmitappropriatedocumentstoHumanResources. H7#+([ d( P  P8H________ 6#,(*] 6Independentcontractor.Submitpaymentdocumentstotheappropriatedepartment.3)',)^ d8 P   3{{Approved:______________________________________________________________________________________Date:____________________________________________    (BusinessOffice)##,#,ɟ# /,b   Revised8/1/98