SS-8 Request for Determination of Worker Status for Purposes

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Form

SS-8

OMB. No. 1545-0004

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

(Rev. December 2023)
Department of the Treasury
Internal Revenue Service

For IRS Use Only:
Case Number:
Earliest Receipt Date:

Go to www.irs.gov/FormSS8 for instructions and the latest information.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
September 11, 2023
DO NOT FILE
Disclosure of Information

The information provided on Form SS-8 may be disclosed to the firm, worker, or payer named below to assist the IRS in the determination process.
For example, if you are a worker, we may disclose the information you provide on Form SS-8 to the firm or payer named below. The information can
only be disclosed to assist with the determination process. See Privacy Act and Paperwork Reduction Act Notice in the separate instructions for more
information. If you do not want this information disclosed to other parties, do not file Form SS-8.

IMPORTANT THINGS YOU SHOULD KNOW

• The Form SS-8 must be fully completed. If you provide incomplete information, we may not be able to process

your request.

• All questions in Parts I through IV must be explained with clear concise answers.

• Part V must be completed if the worker provides a service directly to customers or is a salesperson.
• If you cannot answer a question, enter “Unknown” or “Does not apply.”

• If you need more space for a question, attach another sheet with the part and question number clearly identified. Write

your firm’s name (or worker’s name) and employer identification number (or social security number) at the top of each
additional sheet attached to this form.

• You MUST include copies of the Forms W-2, 1099-MISC, and/or 1099-NEC for each year you are contesting. See instructions.

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

Worker’s name

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

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

Trade name

Worker’s daytime telephone number

Worker’s alternate telephone number
Worker’s social security number

Firm’s fax number

Firm’s website

Worker’s fax number

Firm’s telephone number (include area code)

Firm’s employer identification number

Worker’s employer identification number (if any)

Note: If the worker is paid for services performed for a business or individual not listed above, enter the name, address, and taxpayer identification number
of that business/individual who paid the worker, if known. Explain the relationship between the firm and the business/individual who paid the worker.

Part I
1

General Information

This form is being completed by:
Firm
for services performed from beginning date

Worker
to ending date

.
MM/YYYY

MM/YYYY

Caution: Filing Form SS-8 does not prevent the expiration of the time in which a claim for refund must be filed.
2

Explain your reason(s) for filing this form.
You received a bill from the IRS
You are unable to get workers’ compensation benefits
Other (specify)

You believe you erroneously received a Form 1099 or Form W-2
You were audited or are being audited by the IRS

Don’t complete this form if payment was received for reasons unrelated to Form SS-8. See instructions.

Did you remember to answer all questions and
refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 16106T

Form SS-8 (Rev. 12-2023)

Page 2

Form SS-8 (Rev. 12-2023)

Part I

General Information (continued)

3
4

Total number of workers who performed or are performing the same or similar services:
How did the worker obtain the job? Attach any advertisement.
Application
Bid
Employment agency
Other (specify)

5

Attach copies of all supporting documentation (for example, contracts; invoices; memos; Forms W-2, Forms 1099-MISC, or Forms
1099-NEC issued or received; IRS closing agreements; or IRS rulings).
Inform us of any current or past litigation concerning the worker’s status.

.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
September 11, 2023
DO NOT FILE
a

b

If no income reporting forms (Form 1099-MISC, 1099-NEC, or W-2) were furnished to the worker, enter the amount of income earned for the
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year(s) at issue $

c

If both Form W-2 and Form 1099-MISC, or both Form W-2 and Form 1099-NEC, were issued or received, explain why.

6

Describe the firm’s business.

7

Did the worker receive pay from more than one entity (for example, two or more entities with different taxpayer identification numbers) because
of a business sale, merger, acquisition, or reorganization?
No. Skip to line 8.
Yes. Complete the rest of line 7.
Name of the firm’s previous owner:

Previous owner’s taxpayer identification number:
Other (specify)
Description of above change:

Change was a:

Sale

Merger

Acquisition

Reorganization

Date of change (MM/DD/YY):
What is the worker’s job title?

8

Describe the worker’s duties.

9

Which do you believe the worker is? Check only one.
Explain.

10

Employee

Independent contractor

Did the worker perform any services for the firm before or after the dates entered on line 1 on page 1 of this form?
If “Yes,” what were the dates of service?

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Yes

No

If “Yes,” explain any differences between the services provided.

11a

b

Is the work done under a written agreement between the firm and the worker? .
If “Yes,” attach a copy (preferably signed by both parties).
If “Yes,” describe the terms and conditions of the work arrangement.

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Yes

No

Is the work done under an oral agreement? .
If “Yes,” describe the details of the agreement.

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Yes

No

Part II

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Behavioral Control (Provide names and titles of specific individuals, if applicable.)

1

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

2

Who gives the worker work assignments?

3
4

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In person
Phone
How are the assignments received?
Other (specify)
Who determines the methods by which the assignments are performed?
If problems or complaints arise, who is contacted?
Who is responsible for their resolution?

Email

Text message

Did you remember to answer all questions and
refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?
Form SS-8 (Rev. 12-2023)

Page 3

Form SS-8 (Rev. 12-2023)

Part II
5
6a

Behavioral Control (Provide names and titles of specific individuals, if applicable.) (continued)

Is the worker required to complete reports? . . .
If “Yes,” attach examples.
How frequently does the worker perform services?
Other (specify)
Describe the worker’s primary services.
Sales
Other (specify)

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As scheduled

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As needed

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Yes

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No

As available

TREASURY/IRS
AND OMB USE
ONLY DRAFT
September 11, 2023
DO NOT FILE
b

7

Timesheets

Patient logs

Where are the services performed? If more than one location, what percentage of the worker’s time is spent at each location?
Firm premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Worker’s office or shop . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8a

b

9

Customer’s location . . . . . . .
Other (specify)
Is the worker required to attend meetings? .
If “Yes,” what type of meetings?
Sales

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Yes

No

Staff
Is the worker penalized if unable to attend a meeting? . .
If “Yes,” what is the penalty?

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Other (specify)
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Yes

No

Is the worker required to provide the services personally? .

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Can the worker hire substitutes or helpers? . . . . . . . .
If the worker hires the substitutes or helpers, is approval required? .
If “Yes,” who approves the hiring?
Firm
Other (specify)

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Yes
Yes
Yes

No
No
No

12

Does the worker pay substitutes or helpers? . . . . .
If “Yes,” is the worker reimbursed? . . . . . . . .
If the worker is reimbursed, explain who reimburses them.

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Yes
Yes

No
No

Part III
1a

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Financial Control (Provide names and titles of specific individuals, if applicable.)

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

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Yes

No

2

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

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Yes

No

3

Are expenses incurred by the worker in the performance of services for the firm? .
If “Yes,” explain.

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Yes

No

4a

Are expenses reimbursed by the firm? . . .
If “Yes,” provide the frequency and amount.

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Yes

No

b

Are expenses reimbursed by another party? .
If “Yes,” explain.

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Yes

No

b

5a
b

Are supplies, equipment, materials, or property provided by another party? .
If “Yes,” explain.

What type of pay does the worker receive?

Salary

Commission

Other (specify)
If paid commission, does the firm guarantee a minimum amount of pay? .
If “Yes,” explain.

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Yes

No

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Monthly

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Other (specify)

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Yes

No

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No

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If “No,” explain.

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

8

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

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Lump sum

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7

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Piece work

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Can the worker request advance pay? .
Daily
If “Yes,” how often?

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Weekly

Hourly wage

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Yes

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Firm

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Worker

Yes

No

Did you remember to answer all questions and
refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?
Form SS-8 (Rev. 12-2023)

Page 4

Form SS-8 (Rev. 12-2023)

Part III

Financial Control (Provide names and titles of specific individuals, if applicable.) (continued)

9a

Does the worker take a financial risk by performing services? .
If “Yes,” explain.

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Yes

No

b

Can the worker suffer a financial loss by performing services? .
If “Yes,” explain.

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Yes

No

TREASURY/IRS
AND OMB USE
ONLY DRAFT
September 11, 2023
DO NOT FILE
10a
b

Who sets the rate of pay for the services performed?
If products are sold, who sets the product price?

Part IV
1

Firm
Firm

Relationship of the Worker and Firm

Are benefits made available to the worker?
If “Yes,” which benefits are available?
Personal days

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Paid vacations
Pensions

Worker
Worker

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Sick pay
Insurance benefits

Yes

No

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Yes
Yes

No
No

Yes

No

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Did the worker perform similar services for others during the time period entered in Part I, line 1?
If “Yes,” is the worker required to get approval from the firm? . . . . . . . . . . .
Is there an agreement prohibiting competition between the firm and the worker? . . . . .
If “Yes,” explain or attach available documentation.

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7

Does the worker assemble or process a product at home? . . .
If “Yes,” who provides the materials and instructions or patterns?

Other (specify)
Does the firm introduce the worker to its customers? .
Employee
If “Yes,” how is the worker introduced?
Other (specify)
Under whose name are services performed?
Other (specify)

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Firm

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Partner

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Paid holidays
Bonuses

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Yes

No

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Yes

No

Provide to another party

Sell it

Yes

No

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Yes
Worker ended the work relationship

No

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Representative

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Contractor

Worker

Does the worker still perform services for the firm? . . . . . . . . . . . .
Firm ended the work relationship
If “No,” how did the work relationship end?
Job completed
Contract ended
Firm or worker went out of business

Part V

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Return to the firm

If “Yes,” what does the worker do with the finished product?

9

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Reserved for future use.
Does the worker advertise? . . . . . . . . . . . . . . . . .
If “Yes,” what type of advertising does the worker do? Provide copies, if available.

b

No

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5
6

8a

Yes

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Other (specify)
Can the firm or worker end the work relationship without penalty?
If “No,” explain.

2

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Other (specify)
Other (specify)

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Other (specify)

For Service Providers or Salespersons. You must complete this part if the worker provided a service
directly to customers or is a salesperson.

1

Is the worker responsible for contacting potential new customers?
If “Yes,” what are the worker’s specific responsibilities?

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Yes

No

2

Is the worker provided leads (names and contact information) for potential new customers? .
If “Yes,” who provides the leads?

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Yes

No

3

Is the worker required to report on potential new customers contacted? .
If “Yes,” what are the reporting requirements?

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Yes

No

4

Does the firm set terms and conditions of sale? .
If “Yes,” explain.

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5
6

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

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Yes

No

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Yes

No

Worker

Other (specify)

Did you remember to answer all questions and
refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?
Form SS-8 (Rev. 12-2023)

Page 5

Form SS-8 (Rev. 12-2023)

Part V
7

For Service Providers or Salespersons. You must complete this part if the worker provided a service
directly to customers or is a salesperson. (continued)

Did the worker pay for the privilege of serving customers on the route or in the territory? .
If “Yes,” whom did the worker pay?

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

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Yes

No

TREASURY/IRS
AND OMB USE
ONLY DRAFT
September 11, 2023
DO NOT FILE
8

9

10
11
12

13

Sign
Here

Home
Retail establishment
Online
Where does the worker sell the product?
Other (specify)
List the product and/or services distributed by the worker (for example, 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.

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 . . . . .
Does the worker solicit orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar
establishments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” what percentage of the worker’s time is spent in solicitation? . . . . . . . . .
Is the merchandise purchased by the customers for resale or use in their business operations? . .
Describe the merchandise and state whether it is equipment installed on the customers’ premises.

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Yes
Yes

No
No
%

Yes

No
%

Yes

No

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.

Print your name

Date

Signature

Did you remember to answer all questions and
refer to the Instructions for Form SS-8 at www.irs.gov/pub/irs-pdf/iss8.pdf?

Did you sign Form SS-8?
Did you attach copies of your Form W-2 or Form 1099 for each year contested?

Form SS-8 (Rev. 12-2023)