Form 8952 Application for Voluntary Classification Settlement Prog

Form

8952

Application for Voluntary
Classification Settlement Program (VCSP)

(Rev. November 2011)
Department of the Treasury
Internal Revenue Service

▶

OMB No. 1545-2215

▶ See www.irs.gov/form8952.
Do not send payment with Form 8952.
▶ See separate instructions.

Caution. Taxpayer must make certain representations in order to be eligible to participate in the VCSP. These representations can be found in
Part V, below.

Part I

Taxpayer Information

1 Employer Identification Number (EIN)

2 Taxpayer Name

3 Number and street (If a P.O. box, see instructions)

Room/Suite

4 City, town, state, and ZIP code
5 Telephone Number

6 Taxpayer's website address (optional)

7 Fax Number (optional)

8 Email address (optional)

9 Type of Entity.
Check the applicable box
Sole proprietorship
Cooperative organization described in section 1381 of the Internal Revenue Code
Joint venture
Tax exempt organization
State or local government (for worker class or position not covered under a section 218 agreement )
Partnership
C corporation
Other (specify here)
S corporation
10 Are you a member of an affiliated group filing consolidated returns for income tax purposes?
No
Yes
If “Yes,” complete the common parent information on lines 11-14.
If “No,” skip to Part II.
11 Name of common parent of the affiliated group
12 Employer Identification Number (EIN) of common parent
13 Number and Street (or P.O. box no. if mail is not delivered to a street address) of common parent
14 City, town, state, and ZIP code of common parent

Part II Contact Person
Attach a properly completed Form 2848, Power of Attorney and Declaration of Representative, if applicable.
a Name and title of contact person
b Contact person address: Number and street (or P.O. box no. if mail is not delivered to a street address)
c Contact person address: City, town, or P.O. box, state, and ZIP code
d Contact person telephone number
e Contact person fax number (optional)
f Contact person email address (optional)

Part III General Information About Workers to be Reclassified
15 Enter the number of workers from all classes to

be reclassified

16 Description of the class or classes of workers to be reclassified. If more

space is needed, attach separate sheets (see instructions).

17 Enter the beginning date of the tax period (year or

quarter) for which you want to begin treating the
class or classes of workers as employees. This
date should be at least 60 days from the date you
file Form 8952 (see instructions).
/

/

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 37772H

Form 8952 (Rev. 11-2011)

Page 2

Form 8952 (Rev. 11-2011)
Taxpayer's Employer Identification Number (EIN)

Taxpayer's Name

Part IV Payment Calculation using Section 3509(a) rates (see instructions)

18

Compensation paid to all classes of workers
to be reclassified for the most recently
completed tax year
. . . . . . . .

19

Multiply line 18, Column A by the
percentage (10.68% for compensation paid
in 2010 or 10.28% for compensation paid in
2011) (see instructions) . . . . . . .
Multiply line 18, Column B by the
percentage (3.24% for 2010 and for 2011) .
Total of line 19, Column A and line 20,
Column B . . . . . . . . . . . .
Multiply the amount on line 21, Column C by
10%. This will be your VCSP payment . .

20
21
22

Column A

Column B

Column C

Compensation paid to all
classes of workers at or below
the social security wage base
(see instructions)

Compensation paid to all
classes of workers above the
social security wage base
(see instructions)

Totals

Caution. Do not send payment with Form 8952. You will submit payment later with your signed closing agreement. If you submit payment
with Form 8952, it may cause processing delay.

Part V Taxpayer's Representations
(Note: Since the representations include the penalty of perjury statement, the representations under Part V must be signed by the
Taxpayer, not the Taxpayer's representative.)
A Treatment of Workers
1 Taxpayer wants to voluntarily reclassify certain workers as employees for federal income tax withholding, Federal Insurance
Contributions Act, and Federal Unemployment Tax Act taxes (collectively, federal employment taxes) for future tax periods.
2 Taxpayer is presently treating the workers as nonemployees.
3 Taxpayer has satisfied any Form 1099 requirements for each of the workers for the 3 preceding calendar years ending before the
date of this application.
4 Taxpayer has consistently treated the workers as nonemployees.
5 There is no dispute between Taxpayer and the Internal Revenue Service as to whether the workers are nonemployees or
employees for federal employment tax purposes.
B Examination
1 Taxpayer is not under examination by the Internal Revenue Service.
2 Taxpayer is not under examination by the Department of Labor or any state agency for the proper classification of the workers.
3a Taxpayer has not been examined previously by the Internal Revenue Service or the Department of Labor concerning the
classification of the workers; or,
b Taxpayer has been examined previously by the Internal Revenue Service or the Department of Labor concerning the
classification of workers and Taxpayer has complied with the results of the prior examination.
C

Extension of Period of Limitations
The Taxpayer understands that by participating in the VCSP, Taxpayer agrees to extend the period of limitations on assessment
of employment taxes for 3 years for the first, second, and third calendar years beginning after the date Taxpayer elects to begin
treating the workers as employees under the VCSP closing agreement. Taxpayer has the right to refuse to extend the period of
limitations on assessment or to limit the extension to particular issues or to a particular period of time. However, if Taxpayer
refuses to extend the period of limitations on assessment or provides only a limited extension, the IRS will not execute the
VCSP closing agreement.

Sign Here

Under penalties of perjury, I declare that I have examined this submission, including any accompanying documents, and to the best of my knowledge and
belief, all of the facts contained herein are true, correct, and complete.
Date

Your signature
▲

Paid
Preparer
Use Only

Print/Type preparer's name

Preparer's signature

Date

Firm's name ▶

Firm's EIN ▶

Firm's address ▶

Phone no.

Check
if
self-employed

PTIN

Form 8952 (Rev. 11-2011)