Independent Contractor Analysis Form
INSTRUCTIONS
This form is required before processing payment for services to an individual using a Social Security Number. It should be completed prior to the beginning of services. If the University is contracting with an individual as an independent contractor, it is important to establish that the nature of the service does not constitute an employee/employer relationship. The following questions are necessary to enable proper tax withholding and reporting. Please complete the following with the prospective payee's cooperation.
GENERAL INFORMATION
Name of Individual or Service Provider:
Soc Sec # (last 4 digits):	xxx-xx-	Banner ID (if applicable):	Taxpayer ID (if applicable):
Department:	Form Preparer:	Phone:
SERVICE INFORMATION
Start Date:	End Date:	Location of services to be provided:
Method of Payment:
Lump Sum
Hourly Rate
Other (explain):
Purpose of Work:
determination of status analysis
Check “YES” or “NO” to the following questions. In the space provided, give a description as to why yes or no was checked. If more space is needed, use the back of the form or attach a separate sheet. In addition, below each question is an explanation of the reasoning behind each question.
*Independent Contractor status is determined by the level of control the University has over the individual. There are two major types of control when referring to independent contractor status, BEHAVIORAL and FINANCIAL. It is important to understand the difference between the “parameters of an assignment” and “controlling the means and methods of accomplishing an assignment”. The parameters of an assignment may include instructions over laws, policies, or guidelines or quality assessments that relate to the acceptance or rejection of the end work product. On the other hand, the controlling of means and methods may include ongoing supervision, training given that suggests the work be performed in specific manner, and the submission of regular or written reports.
1.	YES
NO
Once the individual receives the assignment, does the University have the right to further supervise or control how the individual must go about completing the work?

BEHAVIORAL CONTROL
Explanation: Supervision or control can consist of when and where to do the work, what tools/equipment to use, what workers to hire to assist with the work, where to purchase supplies/services, what work must be performed by a specified individual, what routines/patterns must be used, and what order the sequence must follow? The right to control how the individual must complete the work after the assignment is given would make it difficult to prove Independent Contractor status.
2.	YES
NO
Does the University have control over the expenses or business activities related to the work assignment?
FINANCIAL CONTROL
Explanation: If the University has no control over the expenses in which the individual should incur to complete the work, then the individual is most likely an independent contractor. If the University requires the individual to make a significant investment (ex. requiring the individual to use equipment, tools, services, etc. of high value) in order to do the work, then this represents an independent contractor.
3.	YES
NO
May the individual cease providing services prior to completion of the work without incurring any legal liability?
FINANCIAL CONTROL
Explanation: If the individual has the right to end his/her relationship with the University at any time without incurring liability, this indicates an employer-employee relationship. The University’s ability to withhold payment(s) for unsatisfactory or incomplete work is characteristic of a liability.
4.	YES
NO
Does the individual provide services exclusively for SIUE? (The individual does not provide services to the general public.)
FINANCIAL CONTROL
Explanation: Providing services as a part of his or her business to the general public resembles independent contractor status.
5.	YES
NO
Will SIUE provide long-term assistance to the individual such as additional personnel, support, supplies or equipment?
FINANCIAL CONTROL
Explanation: If the University furnishes significant tools, materials, and other equipment, then the relationship tends to show the existence of an employer-employee relationship, whereas personal investment shows a lack of financial control of the University and represents independent contractor status.
6.	YES
NO
Is there a regular or on-going relationship with the individual? (The University is contracting with the individual for more than a one-time task.)
RELATIONSHIP STATUS
Explanation: Back-to-back, recurring contracts could be considered a continuing relationship rather than a separate, finite relationship. Also, any expectations or guarantees for a new contract after the current request would resemble an employer-employee relationship.

7.	YES
NO
Does the individual currently perform similar work for the University as an employee?
RELATIONSHIP STATUS
Explanation: If an employee is to perform similar duties to that of their current job, they should be hired as an employee. Different duties may qualify the individual as an independent contractor; however, this alone does not constitute justification for independent contractor status.
*Upon completion, forward this form along with the Purchase Requisition and/or AP Invoice, to the Offices of Human Resources, Box 1040. If the appropriate classification is in question, you will be contacted by a representative from the Office of Human Resources.
I attest that all information on this form is true and correct to the best of my knowledge. I understand that the services will be performed as an independent contractor and not as an employee. The University will not withhold any taxes from the payments made under this contract. The payments of the services will constitute self-employment income for income tax purposes and may be subject to reporting to the Internal Revenue Service on Form 1099. If I also certify that I am eligible to perform services based on the following status: US. Citizen Permanent Resident Foreign National with proper work authorization
PROSPECTIVE PAYEE SIGNATURE:
DATE:
*I certify that the information on this form is true and correct to the best of my knowledge. I understand the responses to this questionnaire may serve as evidence or support in an accurate reflection of services provided, and that I may be held accountable for any willful misrepresentation of the services provided in the event of an IRS audit.
FISCAL OFFICER SIGNATURE:
DATE:
OFFICE USE ONLY:	Reviewed by:
DATE:
STATUS:	Regular
Adjunct Term
Civil Service Extra Help
Student Worker
Independent Contractor
*Southern Illinois University Edwardsville acknowledges the Internal Revenue Service for the use of information presented in this form.

**Ref., “www.irs.gov/
5/7/12 - previous versions obsolete

07/21/11

Windows User

2012-05-15

Joyree Chura

SIUE