Internal Revenue Service regulations state that payments made to individuals for services where an employer/employee relationship exists are subject to employment taxes and withholdings. Therefore, only payments to independent contractors will be approved for payment other than through University payroll. The purpose of this form is to determine whether the payee should be deemed an independent contractor as defined by the IRS, or an employee subject to employment taxes and withholding. The following questions must be answered by the department requesting the services to be provided prior to the commencement of the services. No payment will be processed without the completion of this information.

Payee's Name (if known): _______________________ Social Security Number: __________________

DIRECTIONS:    PLEASE CHECK YES OR NO TO THE FOLLOWING QUESTIONS:         YES or NO

1.	Does your department have the right to require compliance with the timing, place and method used in completing the work to be done?	Yes	No
2.	Will your department apprentice, train or instruct in the details of the work, or correspond in any way the manner or method in which the work is to be performed?	Yes	No
3.	Will the work be done personally by the contractor?	Yes	No
4.	Will your department hire, supervise, or pay assistants to aid those performing the work?	Yes	No
5.	Will your department dictate the hours during which the work will be performed?	Yes	No
6.	Will the work be performed on your premises or at a location required by your department?	Yes	No
7.	Will your department have the right to require that the work be performed in a specific order, routine or sequence?	Yes	No
8.	Will your department require regular written reports from those performing the work?	Yes	No
9.	Will your department pay those performing the work on an hourly, weekly or monthly schedule other than as a convenient payment of an agreed-upon lump sum cost of the work?	Yes	No
10.	Will your department furnish the tools, equipment, or materials necessary to complete the work performed?	Yes	No
11.	Do those performing the work have the right to terminate the relationship at will prior to completion without incurring liability?	Yes	No
12.	Brief description of reason for payment (Use reverse if more space is necessary):

If there is to be a contract or written agreement between the University and the person(s) performing the work, please attach a copy.

Completed By (Signature):                                                                                                  Date:

Phone Number:                                               Department:

PLEASE SEND COMPLETED FORM TO: Director of Accounts & Fiscal Services, WAB 37.

For Business Office Use Only:

	Employee. This person must be paid on payroll. Submit appropriate documents to Human Resources.
	Independent contractor. Submit payment documents to the appropriate department.

Approved: __________________________________________________ Date: _______________________________
                           (Business Office)

Revised 8/1/98