2555EZ Foreign Earned Income Exclusion

SS-8

Form
(Rev. June 2003)

Department of the Treasury
Internal Revenue Service

Determination of Worker Status
for Purposes of Federal Employment Taxes
and Income Tax Withholding

OMB No. 1545-0004

Name of firm (or person) for whom the worker performed services

Worker’s name

Firm’s address (include street address, apt. or suite no., city, state, and ZIP code)

Worker’s address (include street address, apt. or suite no., city, state,
and ZIP code)

Trade name

Telephone number (include area code)

(
Telephone number (include area code)

(

Firm’s employer identification number

Worker’s social security number

)

Worker’s employer identification number (if any)

)

If the worker is paid by a firm other than the one listed on this form for these services, enter the name, address, and employer identification number
of the payer.

Important Information Needed To Process Your Request
We must have your permission to disclose your name and the information on this form and any attachments to other
Yes
parties involved with this request. Do we have your permission to disclose this information?
If you answered “No” or did not mark a box, we will not process your request and will not issue a determination.
You must answer ALL items OR mark them “Unknown” or “Does not apply.” If you need more space, attach another sheet.
A This form is being completed by:

Firm

Worker; for services performed

No

to

.

(beginning date)

(ending date)

B Explain your reason(s) for filing this form (e.g., you received a bill from the IRS, you believe you received a Form 1099 or Form W-2 erroneously,
you are unable to get worker’s compensation benefits, you were audited or are being audited by the IRS).

C Total number of workers who performed or are performing the same or similar services
D How did the worker obtain the job?

Application

Bid

Employment Agency

.
Other (specify)

.

E

Attach copies of all supporting documentation (contracts, invoices, memos, Forms W-2, Forms 1099, IRS closing agreements, IRS rulings, etc.).
In addition, please inform us of any current or past litigation concerning the worker’s status. If no income reporting forms (Form 1099-MISC or
W-2) were furnished to the worker, enter the amount of income earned for the year(s) at issue $
.

F

Describe the firm’s business.

G Describe the work done by the worker and provide the worker’s job title.

H Explain why you believe the worker is an employee or an independent contractor.

I

Did the worker perform services for the firm before getting this position?

Yes

No

N/A

If “Yes,” what were the dates of the prior service?
If “Yes,” explain the differences, if any, between the current and prior service.

J If the work is done under a written agreement between the firm and the worker, attach a copy (preferably signed by both parties). Describe
the terms and conditions of the work arrangement.

For Privacy Act and Paperwork Reduction Act Notice, see page 5.

Cat. No. 16106T

Form

SS-8

(Rev. 6-2003)

Form SS-8 (Rev. 6-2003)

Part I

Page

2

Behavioral Control

1

What specific training and/or instruction is the worker given by the firm?

2

How does the worker receive work assignments?

3

Who determines the methods by which the assignments are performed?

4

Who is the worker required to contact if problems or complaints arise and who is responsible for their resolution?

5

What types of reports are required from the worker? Attach examples.

6

Describe the worker’s daily routine (i.e., schedule, hours, etc.).

7

At what location(s) does the worker perform services (e.g., firm’s premises, own shop or office, home, customer’s location, etc.)?

8

Describe any meetings the worker is required to attend and any penalties for not attending (e.g., sales meetings, monthly meetings, staff
meetings, etc.).

9

Is the worker required to provide the services personally?

10

If substitutes or helpers are needed, who hires them?

11

If the worker hires the substitutes or helpers, is approval required?

Yes

No

Yes

No

Yes

No

Yes

No

If “Yes,” by whom?
12
13

Who pays the substitutes or helpers?
Is the worker reimbursed if the worker pays the substitutes or helpers?
If “Yes,” by whom?

Part II
1

Financial Control

List the supplies, equipment, materials, and property provided by each party:
The firm
The worker
Other party

2

Does the worker lease equipment?
If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.)

3

What expenses are incurred by the worker in the performance of services for the firm?

4

Specify which, if any, expenses are reimbursed by:
The firm

5

Other party
Type of pay the worker receives:
Lump Sum

Salary

Commission

Hourly Wage

Piece Work

Other (specify)

If type of pay is commission, and the firm guarantees a minimum amount of pay, specify amount $
6

.
No

Yes

Is the worker allowed a drawing account for advances?
If “Yes,” how often?
Specify any restrictions.

7

Whom does the customer pay?
If worker, does the worker pay the total amount to the firm?

Firm
Yes

No

Worker

If “No,” explain.

8

Does the firm carry worker’s compensation insurance on the worker?

9

What economic loss or financial risk, if any, can the worker incur beyond the normal loss of salary (e.g., loss or damage of equipment,
material, etc.)?

Yes

Form

SS-8

No

(Rev. 6-2003)

Form SS-8 (Rev. 6-2003)

Part III

3

Page

Relationship of the Worker and Firm

1

List the benefits available to the worker (e.g., paid vacations, sick pay, pensions, bonuses).

2

Can the relationship be terminated by either party without incurring liability or penalty?

Yes

No

Does the worker perform similar services for others?

Yes

No

If “Yes,” is the worker required to get approval from the firm?

Yes

No

If “No,” explain your answer.
3
4

Describe any agreements prohibiting competition between the worker and the firm while the worker is performing services or during any later
period. Attach any available documentation.

5

Is the worker a member of a union?

6

What type of advertising, if any, does the worker do (e.g., a business listing in a directory, business cards, etc.)? Provide copies, if applicable.

7

If the worker assembles or processes a product at home, who provides the materials and instructions or pattern?

8

What does the worker do with the finished product (e.g., return it to the firm, provide it to another party, or sell it)?

9

How does the firm represent the worker to its customers (e.g., employee, partner, representative, or contractor)?

10

Yes

No

If the worker no longer performs services for the firm, how did the relationship end?

Part IV

For Service Providers or Salespersons—Complete this part if the worker provided a service directly to
customers or is a salesperson.

1

What are the worker’s responsibilities in soliciting new customers?

2

Who provides the worker with leads to prospective customers?

3

Describe any reporting requirements pertaining to the leads.

4

What terms and conditions of sale, if any, are required by the firm?

5

Are orders submitted to and subject to approval by the firm?
Who determines the worker’s territory?

Yes

No

6
7

Did the worker pay for the privilege of serving customers on the route or in the territory?

Yes

No

If “Yes,” whom did the worker pay?
If “Yes,” how much did the worker pay?

$

.

8

Where does the worker sell the product (e.g., in a home, retail establishment, etc.)?

9

List the product and/or services distributed by the worker (e.g., meat, vegetables, fruit, bakery products, beverages, or laundry or dry cleaning
services). If more than one type of product and/or service is distributed, specify the principal one.

10
11

Does the worker sell life insurance full time?
Does the worker sell other types of insurance for the firm?
If “Yes,” enter the percentage of the worker’s total working time spent in selling other types of insurance.

Yes

No

Yes

No
%

12

If the worker solicits orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar
establishments, enter the percentage of the worker’s time spent in the solicitation.

13

Is the merchandise purchased by the customers for resale or use in their business operations?

%
Yes

No

Describe the merchandise and state whether it is equipment installed on the customers’ premises.

Signature (see page 4)

Part V

Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and to the best of my knowledge and belief, the facts
presented are true, correct, and complete.
Signature

䊳

Title

䊳

Date

䊳

(Type or print name below)

Form

SS-8

(Rev. 6-2003)

Form SS-8 (Rev. 6-2003)

General Instructions
Section references are to the Inter nal Revenue Code unless
otherwise noted.

Page

Additional copies of this form may be obtained by calling
1-800-829-4933 or from the IRS website at www.irs.gov.

Fee

Purpose

There is no fee for requesting an SS-8 determination letter.

Firms and workers file Form SS-8 to request a determination
of the status of a worker for purposes of Federal
employment taxes and income tax withholding.
A Form SS-8 determination may be requested only in
order to resolve Federal tax matters. If Form SS-8 is
submitted for a tax year for which the statute of limitations
on the tax return has expired, a determination letter will not
be issued. The statute of limitations expires 3 years from the
due date of the tax return or the date filed, whichever is later.
The IRS does not issue a determination letter for proposed
transactions or on hypothetical situations. We may, however,
issue an information letter when it is considered appropriate.

Signature

Definition
Firm. For the purposes of this form, the term “firm” means
any individual, business enterprise, organization, state, or
other entity for which a worker has performed services. The
firm may or may not have paid the worker directly for these
services. If the firm was not responsible for payment for
services, be sure to enter the name, address, and
employer identification number of the payer on the first
page of Form SS-8 below the identifying information for
the firm and the worker.

The SS-8 Determination Process
The IRS will acknowledge the receipt of your Form SS-8.
Because there are usually two (or more) parties who could be
affected by a determination of employment status, the IRS
attempts to get information from all parties involved by
sending those parties blank Forms SS-8 for completion. The
case will be assigned to a technician who will review the
facts, apply the law, and render a decision. The technician
may ask for additional information from the requestor, from
other involved parties, or from third parties that could help
clarify the work relationship before rendering a decision. The
IRS will generally issue a formal determination to the firm or
payer (if that is a different entity), and will send a copy to the
worker. A determination letter applies only to a worker (or a
class of workers) requesting it, and the decision is binding on
the IRS. In certain cases, a formal determination will not be
issued. Instead, an information letter may be issued.
Although an information letter is advisory only and is not
binding on the IRS, it may be used to assist the worker to
fulfill his or her Federal tax obligations.
Neither the SS-8 determination process nor the review of
any records in connection with the determination constitutes
an examination (audit) of any Federal tax return. If the
periods under consideration have previously been examined,
the SS-8 determination process will not constitute a
reexamination under IRS reopening procedures. Because this
is not an examination of any Federal tax return, the appeal
rights available in connection with an examination do not
apply to an SS-8 determination. However, if you disagree
with a determination and you have additional information
concerning the work relationship that you believe was not
previously considered, you may request that the determining
office reconsider the determination.

Completing Form SS-8
Answer all questions as completely as possible. Attach
additional sheets if you need more space. Provide
information for all years the worker provided services for the
firm. Determinations are based on the entire relationship
between the firm and the worker.

4

Form SS-8 must be signed and dated by the taxpayer.
A stamped signature will not be accepted.
The person who signs for a corporation must be an officer
of the corporation who has personal knowledge of the facts.
If the corporation is a member of an affiliated group filing a
consolidated return, it must be signed by an officer of the
common parent of the group.
The person signing for a trust, partnership, or limited
liability company must be, respectively, a trustee, general
partner, or member-manager who has personal knowledge of
the facts.

Where To File
Send the completed Form SS-8 to the address listed below
for the firm’s location. However, for cases involving Federal
agencies, send Form SS-8 to the Internal Revenue Service,
Attn: CC:CORP:T:C, Ben Franklin Station, P.O. Box 7604,
Washington, DC 20044.

Firm’s location:

Send to:

Alaska, Arizona, Arkansas,
California, Colorado, Hawaii,
Idaho, Illinois, Iowa, Kansas,
Minnesota, Missouri, Montana,
Nebraska, Nevada, New
Mexico, North Dakota,
Oklahoma, Oregon, South
Dakota, Texas, Utah,
Washington, Wisconsin,
Wyoming, American Samoa,
Guam, Puerto Rico, U.S. Virgin
Islands

Internal Revenue Service
SS-8 Determinations
P.O. Box 630
Stop 631
Holtsville, NY 11742-0630

Alabama, Connecticut,
Delaware, District of Columbia,
Florida, Georgia, Indiana,
Kentucky, Louisiana, Maine,
Maryland, Massachusetts,
Michigan, Mississippi, New
Hampshire, New Jersey, New
York, North Carolina, Ohio,
Pennsylvania, Rhode Island,
South Carolina, Tennessee,
Vermont, Virginia, West Virginia,
all other locations not listed

Internal Revenue Service
SS-8 Determinations
40 Lakemont Road
Newport, VT 05855-1555

Instructions for Workers
If you are requesting a determination for more than one firm,
complete a separate Form SS-8 for each firm.
Form SS-8 is not a claim for refund of social security
and Medicare taxes or Federal income tax
withholding.
If the IRS determines that you are an employee, you are
responsible for filing an amended return for any corrections
related to this decision. A determination that a worker is an
employee does not necessarily reduce any current or prior
tax liability. For more information, call 1-800-829-1040.

Form SS-8 (Rev. 6-2003)

Time for filing a claim for refund. Generally, you must file
your claim for a credit or refund within 3 years from the date
your original return was filed or within 2 years from the date
the tax was paid, whichever is later.
Filing Form SS-8 does not prevent the expiration of the
time in which a claim for a refund must be filed. If you are
concerned about a refund, and the statute of limitations for
filing a claim for refund for the year(s) at issue has not yet
expired, you should file Form 1040X, Amended U.S.
Individual Income Tax Return, to protect your statute of
limitations. File a separate Form 1040X for each year.
On the Form 1040X you file, do not complete lines 1
through 24 on the form. Write “Protective Claim” at the top
of the form, sign and date it. In addition, you should enter
the following statement in Part II, Explanation of Changes to
Income, Deductions, and Credits: “Filed Form SS-8 with the
Internal Revenue Service Office in (Holtsville, NY; Newport,
VT; or Washington, DC; as appropriate). By filing this
protective claim, I reserve the right to file a claim for any
refund that may be due after a determination of my
employment tax status has been completed.”
Filing Form SS-8 does not alter the requirement to timely
file an income tax return. Do not delay filing your tax return
in anticipation of an answer to your SS-8 request. In
addition, if applicable, do not delay in responding to a
request for payment while waiting for a determination of your
worker status.

Instructions for Firms
If a worker has requested a determination of his or her
status while working for you, you will receive a request from
the IRS to complete a Form SS-8. In cases of this type, the
IRS usually gives each party an opportunity to present a
statement of the facts because any decision will affect the
employment tax status of the parties. Failure to respond to
this request will not prevent the IRS from issuing a
determination letter based on the information he or she has
made available so that the worker may fulfill his or her
Federal tax obligations. However, the information that you
provide is extremely valuable in determining the status of the
worker.
If you are requesting a determination for a particular class
of worker, complete the form for one individual who is
representative of the class of workers whose status is in
question. If you want a written determination for more than
one class of workers, complete a separate Form SS-8 for
one worker from each class whose status is typical of that
class. A written determination for any worker will apply to
other workers of the same class if the facts are not materially
different for these workers. Please provide a list of names
and addresses of all workers potentially affected by this
determination.
If you have a reasonable basis for not treating a worker as
an employee, you may be relieved from having to pay
employment taxes for that worker under section 530 of the
1978 Revenue Act. However, this relief provision cannot be

Page

5

considered in conjunction with a Form SS-8 determination
because the determination does not constitute an
examination of any tax return. For more information regarding
section 530 of the 1978 Revenue Act and to determine if you
qualify for relief under this section, you may visit the IRS
website at www.irs.gov.
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to carry out the Internal
Revenue laws of the United States. This information will be
used to determine the employment status of the worker(s)
described on the form. Subtitle C, Employment Taxes, of the
Internal Revenue Code imposes employment taxes on
wages. Sections 3121(d), 3306(a), and 3401(c) and (d) and
the related regulations define employee and employer for
purposes of employment taxes imposed under Subtitle C.
Section 6001 authorizes the IRS to request information
needed to determine if a worker(s) or firm is subject to these
taxes. Section 6109 requires you to provide your taxpayer
identification number. Neither workers nor firms are required
to request a status determination, but if you choose to do
so, you must provide the information requested on this form.
Failure to provide the requested information may prevent us
from making a status determination. If any worker or the firm
has requested a status determination and you are being
asked to provide information for use in that determination,
you are not required to provide the requested information.
However, failure to provide such information will prevent the
IRS from considering it in making the status determination.
Providing false or fraudulent information may subject you to
penalties. Routine uses of this information include providing
it to the Department of Justice for use in civil and criminal
litigation, to the Social Security Administration for the
administration of social security programs, and to cities,
states, and the District of Columbia for the administration of
their tax laws. We may also disclose this information to
Federal and state agencies to enforce Federal nontax
criminal laws and to combat terrorism. We may provide this
information to the affected worker(s) or the firm as part of
the status determination process.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is: Recordkeeping, 22 hrs.; Learning about
the law or the form, 47 min.; and Preparing and sending
the form to the IRS, 1 hr., 11 min. If you have comments
concerning the accuracy of these time estimates or
suggestions for making this form simpler, we would be happy
to hear from you. You can write to the Tax Products
Coordinating Committee, Western Area Distribution Center,
Rancho Cordova, CA 95743-0001. Do not send the tax form
to this address. Instead, see Where To File on page 4.