ࡱ> ] \bjbjzz 41\1\S  HH8Ww&V:,01L2(vvvvvvv}y3|Tv,2/@,0,2,2vHH\w666,2^HRv6,2v66k4"qjW.?26m>v'w0Wwtm.| 3||qq8|q ,2,26,2,2,2,2,2vv6,2,2,2Ww,2,2,2,2|,2,2,2,2,2,2,2,2,2 > : tv RESEARCH FOUNDATION, INC. Payee (Consultant) Name Initiating Department Contact Name, Email & Telephone  INDEPENDENT CONTRACTOR - CONSULTING & PROFESSIONAL SERVICES WORKSHEET PLEASE READ ALL INSTRUCTIONS BEFORE COMPLETING THIS WORKSHEET. THE PAYEE AND ACCOUNTABLE OFFICER MUST SIGN THIS WORKSHEET. SECTION 1: PAYEE CLASSIFICATION FOR TAX PURPOSES PLACE AN X NEXT TO THE APPROPRIATE CLASSIFICATIONPAYEE CLASSIFICATIONINFORMATION TO SUBMITPayee is a U.S. Governmental Entity, Corporation, Partnership or LLC that is a Corporation or Partnership for tax purposesDo not complete this worksheet. Complete form W-9. Payee is an Individual, a Sole Proprietorship or a Single Member LLC that is a Disregarded Entity for tax purposesComplete this worksheet. Complete form W-9. Payee is a Non-Resident AlienComplete this worksheet Complete form W-8BEN.Payee is classified as Other (describe):Complete this worksheet. Complete form W-9. SECTION 2: INITIAL DETERMINATION THAT THE INDIVIDUAL MAY BE AN EMPLOYEE ANSWER YES OR NO TO THE FOLLOWING (3) QUESTIONS BELOW. A RESPONSE OF YES TO ANY OF THE FOLLOWING (3) QUESTIONS REPRESENTS AN INDIVIDUAL THAT SHOULD BE HIRED AS AN EMPLOYEE (See II. EXAMPLES OF PERSONS THAT ARE EMPLOYEES OF tv FOUND ON THE INSTRUCTIONS PAGE). YES NOIs the payee providing instructional/teaching/workshop services needed to conduct classes or courses offered by tv, tv Continuing Education or a tv department or unit?YES NOWill the payee be supervised by or report directly to a tv employee who has the right to change how the individual does the job?YES NOWill the payee supervise any tv employees or other independent contractors paid by tv?  IF YOU ANSWERED YES TO ANY OF THE ABOVE (3) QUESTIONS. THE INDIVIDUAL YOU ARE HIRING MUST BE HIRED AS AN EMPLOYEE. PLEASE DO NOT COMPLETE THE ADDITONAL SECTIONS OF THIS FORM, FOLLOW THE NORMAL HIRING PROCEDURES. SECTION 3: DETERMINE IF THE INDIVIDUAL CAN BE CLASSIFIED AS AN INDEPENDENT CONTRACTOR (See III. EXAMPLES OF PERSONS THAT MAY BE INDEPENDENT CONTRACTORS FOUND ON THE INSTRUCTIONS PAGE). ANSWER YES OR NO TO QUESTIONS (1-8). IF YOU ARE HIRING AN INDIVIDUAL OR A SOLE PROPRIETORSHIP, IT IS IMPORTANT TO ESTABLISH THAT THE NATURE OF THE SERVICE DOES NOT CONSTITUTE AN EMPLOYEE/EMPLOYER RELATIONSHIP. THE INDEPENDENT CONTRACTOR QUESTIONS ARE IMPORTANT TO BOTH tv/tvRF AND THE PROSPECTIVE PAYEE TO ENABLE PROPER TAX WITHHOLDING AND REPORTING IN ACCORDANCE WITH  HYPERLINK "http://www.irs.gov/individuals/employees/article/0,,id=130504,00.html" IRS RULES AND  HYPERLINK "http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0440/titl0440.htm&StatuteYear=2003&Title=-%3E2003-%3EChapter%20440" FLORIDA STATUTES. PLEASE COMPLETE EACH QUESTION CAREFULLY WITH THE PROSPECTIVE PAYEES COOPERATION AND THEIR UNDERSTANDING OF THE ARRANGEMENT WITH tv/tvRF. YES NOIs the prospective payee/independent contractor using experience or expertise gained doing similar work as a current or former tv employee in providing the service?YES NOIs the individual working exclusively for tv (with respect to the service being performed)? Answer 'no' if the individual has a business where the service is performed for clients other than tv. Provide proof of business as attachment in requisition (i.e. business card, brochure, webpage or client list).YES NOIs the payee a tv employee, a former tv employee (terminated in the last 12 months), or a tv student employed through tv Human Resources?YES NOIs the work performed a key aspect of the regular business of the hiring tv department (job normally performed by tv employee)? See Section III. of the instructions for examples of persons that may be independent contractors.YES NOIs tv providing assistance to the individual such as facilities, personnel support, supplies, equipment, etc.? A yes for a speaker who is not performing training or teaching duties is an acceptable answer for payment as an independent contractor. Note: while tv facilities use may be acceptable, any use of tv facilities, personnel support, supplies, equipment, etc. Should be described in detail in Section 4. YES NOIs tv providing training or education concerning procedures to be followed and methods to be used by the individual in performing the services? YES NOIs there a regular or on-going relationship with the prospective payee/independent contractor (for example, are you paying the individual more than once to perform the same task)? Yes is an acceptable answer for payment as an independent contractor if the individual has a business where the service is performed for clients other than tv. Provide proof of business as attachment to requisition (i.e. business card, brochure, webpage or client list).YES NOIs tv/tvRF required to pay the individual regardless of the quality or completeness of the work? An explanation for all yes answers above must be provided in Section 4. SECTION 4: IF YOU ANSWERED YES TO ANY OF THE QUESTIONS IN SECTION 3, PLEASE PROVIDE AN EXPLANATION FOR EACH YES RESPONSE IN THE SPACE BELOW.  PROVIDE AN EXPLANATION OF THE SERVICES BEING PROVIDED IN THE SPACE BELOW (ATTACH ADDITIONAL PAGES IF NEEDED). EXPLANATION SHOULD INCLUDE A DESCRIPTION OF RATES, DATES AND DELIVERABLES (DRAFT 2-PARTY AGREEMENT MAY BE ATTACHED). EVIDENCE THAT THE INDIVIDUAL PROVIDES THE SERVICE FOR OTHER CUSTOMERS WILL ENHANCE THE EVALUATION (BROCHURES, BUSINESS CARD, WEB PAGE AND/OR LIST OF CLIENTS/CUSTOMERS). DEPARTMENTS MUST PROVIDE SUPPORT FOR ALL PAYMENTS TO BE PROCESSED.  By signing below, I agree that any taxes, interest or penalties assessed by the IRS due to misclassification of an individual as an independent contractor will be paid by the department authorizing this form. The employment taxes, interest and penalties will be approximately equal to the independent contractor payment made to the individual. Further, I certify that the information I provided on this worksheet are true and complete to the best of my knowledge. PRINT NAME & TITLE OF INDIVIDUAL APPROVING PAYMENT FOR tv (ACCOUNTABLE OFFICER)SIGNATURE OF APPROVAL & DATE (ACCOUNTABLE OFFICER) (SIGNATURE REQUIRED)  By signing below, I agree with the statements made on this form by the individual approving payment employed with the University of South Florida. I understand that independent contractors are not covered under the state of Florida Workers Compensation Law ( HYPERLINK "http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0440/titl0440.htm&StatuteYear=2003&Title=-%3E2003-%3EChapter%20440" F.S. CHAPTER 440) and that I meet the independent contractor definition in  HYPERLINK "http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0440/titl0440.htm&StatuteYear=2003&Title=-%3E2003-%3EChapter%20440" F.S. CHAPTER 440. I am a  HYPERLINK "http://www.uscis.gov/portal/site/uscis" US CITIZEN or  HYPERLINK "http://www.uscis.gov/portal/site/uscis" PERMANENT RESIDENT OF THE US or a  HYPERLINK "http://www.uscis.gov/portal/site/uscis" NON-RESIDENT ALIEN and the address and  HYPERLINK "http://www.ssa.gov/ssnumber/" SSN,  HYPERLINK "http://www.irs.gov/individuals/article/0,,id=96287,00.html" ITIN or  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=98350,00.html" FEIN above is correct. I understand that the payment from tv/tvRF is taxable income to me and that I am required to report this income on my  HYPERLINK "http://www.irs.gov/" US TAX RETURN. I understand that Florida law provides that a person who knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in section  HYPERLINK "http://www.myfloridahouse.gov/filestores/web/statutes/fs07/CH0775/Section_0775.082.HTM" 775.082 or  HYPERLINK "http://www.myfloridahouse.gov/filestores/web/statutes/fs07/CH0775/Section_0775.082.HTM" 775.083. PAYEE USE ONLY PAYEE SIGNATURE & DATE (MUST BE PAYEE NAME ABOVE) (SIGNATURE REQUIRED)PAYEE USE ONLY PAYEE TELEPHONE & EMAIL ADDRESS QUESTIONS ABOUT THIS FORM SHOULD BE DIRECTED TO THE  HYPERLINK "http://usfweb2.usf.edu/purchasing/" tv RESEARCH  HYPERLINK "http://www.research.usf.edu/rf/default.asp" FOUNDATION. tv RESEARCH FOUNDATION, INC. INDEPENDENT CONTRACTOR - CONSULTING & PROFESSIONAL SERVICES INSTRUCTIONS THE INSTRUCTIONS BELOW WILL ASSIST IN COMPLETING THE INDEPENDENT CONTRACTOR - CONSULTING & PROFESSIONAL SERVICES WORKSHEET. PLEASE READ ALL THE INSTRUCTIONS. THE PAYEE AND ACCOUNTABLE OFFICER MUST SIGN SECTION 5 OF THE INDEPENDENT CONTRACTOR - CONSULTING & PROFESSIONAL SERVICES WORKSHEET. The purpose of the Independent Contractor Consulting & Professional Services Worksheet is to assist tv departments in classifying individuals providing services to the university as either employees or independent contractors. This determination will be made by tv Research Foundation,  HYPERLINK "http://usfweb2.usf.edu/purchasing/" Purchasing,  HYPERLINK "http://usfweb2.usf.edu/human-resources/services/service-center-info.asp" Human Resources and the  HYPERLINK "http://usfweb2.usf.edu/uco/taxadvisory/" Controllers Office (Tax Advisors) based on IRS guidance (Section IV below), State laws (Section V below), explanation of services (Section 4 of the Worksheet), employment status with the university and responses to questions in Sections 1-3 of the worksheet. The department should complete the worksheet in conjunction with the consultant in order to provide accurate responses to all required questions prior to signing and dating the form. Department may be contacted to provide additional information. INFORMATION FOR SECTION 1 OF tv CONSULTING & PROFESSIONAL SERVICES WORKSHEET AND FORM W-9 HYPERLINK "http://usfweb2.usf.edu/purchasing/Updated%20Sub%20W-9%2002172011.pdf" . Additional information in a) through e) below is for use in completing Form W-9. U.S. PERSON Complete  HYPERLINK "http://www.irs.gov/pub/irs-pdf/fw9.pdf" FORM W-9; includes U.S. Resident Alien who has a green card" issued by  HYPERLINK "http://www.uscis.gov/portal/site/uscis" USCIS (former INS). NONRESIDENT ALIEN: Complete  HYPERLINK "http://usfweb2.usf.edu/purchasing/forms/FNIF%20Fill%20in%20Form.pdf" tv Payroll Foreign National Information Form and provide supporting documents requested therein. If the form is not submitted, 30% tax will be withheld. Complete appropriate Form W-8 (BEN, ECI, or EXP) in lieu of Form W-9. PAYEE NAME: If you are an individual, you must generally provide the name shown on your social security card. If you have changed your last name, for instance, due to marriage, without informing the  HYPERLINK "http://www.ssa.gov/ssnumber/" Social Security Administration, please enter your first name, the last name shown on your social security card, and your new last name. If you are a sole proprietor, you must furnish your individual name and either your  HYPERLINK "http://www.ssa.gov/ssnumber/" SSN or  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=98350,00.html" FEIN. THE PAYEE ADDRESS MUST AGREE WITH THE PURCHASE ORDER/INVOICE. The payee signature and signature of approval must be original signatures. A facsimile will be accepted to begin the approval process, however, original signatures must be provided before payment is made. The signature of approval must be made by an individual who has the authority to approve payroll certifications. DBA (doing business as): Enter your name(s) as shown on your social security card and/or as it was used to apply for your  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=98350,00.html" FEIN on  HYPERLINK "http://www.irs.gov/pub/irs-pdf/fss4.pdf" Form SS-4. You may also enter your business name or DBA name. PAYEE CLASSIFICATION FOR TAX PURPOSES (see  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=98359,00.html" Business Structure information on IRS website) GOVERNMENTAL ENTITY The United States or any of its agencies or instrumentalities. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions. CORPORATION C Corporation reports business income on IRS Form 1120; S Corporation reports business income on IRS Form 1120-S. PARTNERSHIP Reports business income on IRS Form 1065. LLC (ELECTED CORPORATE TAX STATUS) - C Corporation reports business income on IRS Form 1120; S Corporation reports business income on IRS Form 1120-S. LLC (ELECTED PARTNERSHIP TAX STATUS) - Reports business income on IRS Form 1065. INDIVIDUAL Reports business income on his or her individual IRS Form 1040 (may use Schedule C). SOLE PROPRIETOR Unincorporated business; owner reports business income on his or her individual IRS Form 1040 (may use Schedule C). LLC SINGLE MEMBER DISREGARDED FOR TAX PURPOSES Reports business income on his or her individual IRS Form 1040 (may use Schedule C). EXAMPLES OF PERSONS THAT ARE EMPLOYEES OF tv: A person teaching a course for credit (even if the course is only one day long). A sole proprietorship or single member LLC (disregarded entity) is considered an employee. A person teaching a continuing education course not for credit or providing teaching, workshops or training via any tv department or unit (even if the course is only one day long). A sole proprietorship or single member LLC (disregarded entity) is considered an employee. A person employed by tv in any other capacity (including Student Appointments in Human Resources). Approval to pay dual compensation is not approval to pay an individual as an independent contractor. Persons performing services that are a key aspect of regular business performed by the hiring tv unit or department. Examples of this include a computer person for Information Technologies, an accountant for University Controllers Office, an aerobics instructor for Campus Recreation, an attorney for Office of General Counsel, any department providing training to students (whether enrolled or not enrolled) as they are engaging in a business that is a key aspect of tvs educational business. A sole proprietorship or single member LLC (disregarded entity) is considered an employee. Former employees that return on a part time basis to perform duties similar to those performed previously for tv (former employees may be Independent Contractors but their GEMS records require review). Individuals performing services for tv that do not perform those services for other businesses. Individuals performing services as student note takers or hired to assist with disabled students are employees. EXAMPLES OF PERSONS THAT MAY BE INDEPENDENT CONTRACTORS: A person who is not a tv employee that is presenting a brief lecture. A person who is not a tv employee that is in the business of providing a service to the general public and provides the same service to tv (ex. move piano, string tennis racquet, evaluate business practices). Individuals performing services for tv (excluding examples employees described in II above) that perform those services for other businesses. Individual should have business cards, brochures, website, and/or marketing materials for the business. An independent contractor only receives instructions regarding the end result; he/she is not directly supervised by a tv employee and does not receive evaluations or direction regarding how the work is to be performed. If training is for tv employees and is conducted by a business that conducts training for other clients, it may be OK to process as independent contractor. Please provide scope of services description below, if applicable. IV. IRS DETERMINATION (FEDERAL LAW): tv must correctly determine whether individuals providing services are employees or independent contractors - see information on  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=99921,00.html" IRS website. The tv Consulting and Professional Services Worksheet documents the relationship between tv and individuals providing services. tvs decision to hire an employee or independent contractor will be based on the degree of control and independence between the parties, evidence of which will fall within three categories:  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=179111,00.html" Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=179113,00.html" Financial: Are the business aspects of the workers job controlled by the payer? (These include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=179116,00.html" Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business? tv must take into account evidence in all three categories when determining whether a worker is an employee or independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no magic or set number of factors that makes the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors which are relevant in one situation may not be relevant in another. V. FLORIDA STATUTE (STATE LAW): Under  HYPERLINK "http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0440/titl0440.htm&StatuteYear=2003&Title=-%3E2003-%3EChapter%20440" Florida Statute Chapter 440.02(15)(d)1.a.(i)-(vi) an individual must meet at least four of the following criteria: The independent contractor maintains a separate business with his/her own work facility, truck, equipment, materials, or similar accommodations; The independent contractor holds or has applied for a  HYPERLINK "http://www.irs.gov/businesses/small/article/0,,id=98350,00.html" federal employer identification number, unless the independent contractor is a sole proprietor who is not required to obtain a federal employer identification number under state or federal regulations; The independent contractor receives compensation for services rendered or work performed and such compensation is paid to a business rather than to an individual; The independent contractor holds one or more bank accounts in the name of the business entity for purposes of paying business expenses or other expenses related to services rendered or work performed for compensation; The independent contractor performs work or is able to perform work for any entity in addition to or besides the employer at his or her own election without the necessity of completing an employment application or process; or The independent contractor receives compensation for work or services rendered on a competitive-bid basis or completion of a task or a set of tasks as defined by a contractual agreement, unless such contractual agreement expressly states that an employment relationship exists. IF FOUR OF THE CRITERIA LISTED ABOVE IN SECTION IV. DO NOT EXIST, AN  HYPERLINK "http://www.irs.gov/individuals/index.html?navmenu=menu1" INDIVIDUAL MAY STILL BE PRESUMED TO BE AN INDEPENDENT CONTRACTOR AND NOT AN EMPLOYEE BASED ON FULL CONSIDERATION OF THE NATURE OF THE INDIVIDUAL SITUATION WITH REGARD TO SATISFYING ANY OF THE FOLLOWING CONDITIONS (Per  HYPERLINK "http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0440/titl0440.htm&StatuteYear=2003&Title=-%3E2003-%3EChapter%20440" FLORIDA STATUTE CHAPTER 440.02(15)(d)1.b.(I)-(VII): The independent contractor performs or agrees to perform specific services or work for a specific amount of money and controls the means of performing the services or work. The independent contractor incurs the principal expenses related to the service or work that he or she performs or agrees to perform. The independent contractor is responsible for the satisfactory completion of the work or services that he or she performs or agrees to perform. The independent contractor receives compensation for work or services performed for a commission or on a per-job basis and not on any other basis. The independent contractor may realize a profit or suffer a loss in connection with performing work or services. The independent contractor has continuing or recurring business liabilities or obligations. The success or failure of the independent contractor's business depends on the relationship of business receipts to expenditures. Notwithstanding anything to the contrary in this subparagraph, an individual claiming to be an independent contractor has the burden of proving that he or she is an independent contractor for purposes of this chapter. PLEASE KEEP THE INSTRUCTIONS ABOVE FOR YOUR RECORDS. QUESTIONS SHOULD BE DIRECTED TO THE  HYPERLINK "http://www.research.usf.edu/rf/default.asp" tv RESEARCH FOUNDATION.     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