ࡱ> ]_\e NbjbjϺ >إڰإڰ<d4$ #b]HHH+[[[ HH[[[b/'"A0q,#I##H[[q#> : Employee vs. Individual Independent Contractor Form Determining whether a worker is an independent contractor or an employee requires several relevant facts to be considered. These relevant facts fall into three main categories: 1) behavioral control, 2) financial control, and 3) relationship of the parties. Therefore, it is important to consider all the facts in making a determination. The following questions will assist determining whether the individual performing the work for Colorado State University-Pueblo should be classified as an employer or independent contractor. Payments to employees are subject to tax withholding, and independent contractors are subject to IRS reporting on Form 1099 and Self-Employment tax. Payee Name: FORMTEXT       PERA Retiree?  FORMCHECKBOX  Yes (See PERA Disclosure of Compensation Info  Next Page)  FORMCHECKBOX  No Department Preparer Name: FORMTEXT       Preparer Phone # FORMTEXT       Has the payee worked as an employee for CSU-СƵ in the last 6 months?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDoes the payee have an FEIN Tax Payer Identification Number which they will be paid for work?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDoes the service provider have a significant investment in his/her business venue (facilities, tools, marketing insurance, etc.) and is the work to be completed significantly different than what a CSU-СƵ employee would perform  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill service provider receive instructions on how, when, and where results are to be achieved?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill service provider receive specific training from the University on how to accomplish the service?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill the service provider set his/her own hours to perform the contracted services?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill service provider provide his/her own equipment, tools, and materials necessary to perform the contracted service?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoMay service provider accept other contracts or projects for other organizations other than the University?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill the service provider be provided with a written contract to complete a specific service? Please describe in detail scope of work below? If additional space is needed, please attach documentation.  FORMTEXT         FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill service provide be required to provide written or oral reports on the project s status?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoWill the service provider be paid a lump sum based on completion of phase, job or project rather than on a weekly or monthly basis?  FORMCHECKBOX  Yes  FORMCHECKBOX  No I certify the above responses are correct to the best of my knowledge. Department Signature Procurement Services Signature Human Resources Signature (if applicable) Procurement Services Use Only W9 Provided  FORMCHECKBOX  Yes  FORMCHECKBOX  No Status:  FORMCHECKBOX  Independent Contractor  FORMCHECKBOX  Employee Revise 02/18 PERA Disclosure of Compensation Instruction and Form to be completed If you are a PERA Retiree and performing services as an Independent Contractor for Colorado State University-СƵ, the university is required by Colorado state law to pay employee contributions. AED and SAED contributions on salary or payments made to you for the services you have provided The University requires you to complete a PERA Disclosure of Compensation form. The form is necessary to report PERA any compensation you have been paid for services rendered. The PERA Disclosure of Compensation form should be completed and submitted to Payroll Services every time you receive compensation. Payroll will report your earnings and submit the appropriate amount of contributions to PERA. Pleased note, as per the PERA Disclosure of Compensation form, if you fail to complete the PERA Disclosure of Compensation form to PERA and the PERA employer, you will be required to pay the employer contribution amount plus interest, as well as the working retiree contribution at PERAs actuarial investment assumption rate. Steps to complete the Disclosure of Compensation form: Provide your full SSN in the spaces provided. Your SSN is required so PERA can allocate your compensation and contributions to your PERA account. Complete the entire section titled, To be Completed by Retiree, sign and date. 45    A B , . 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(~$0^`0a$gd29 $^a$gdlgdt$a$gdtgd/$d%d&d'd-DM NOPQgd*.`alnPQqr23LZL[LLLôôôôôôôôôÖ{h8:5CJOJQJaJh8:CJOJQJaJUhlhACJOJQJaJhlhlCJOJQJaJhlh29CJOJQJaJhlh$m%CJOJQJaJhvNht5CJOJQJaJh%[D5CJOJQJaJhvNhvN5CJOJQJaJ-LLLLLLL $$Ifa$gd@$a$gdA $h^ha$gdA $ & Fa$gdA$0^`0a$gd29 $^a$gdl On page 2 of the form you must put the exact Dates Worked, Type of Services Provided, and Compensation Received for that specific time period. Example Date(s) WorkedType of Service ProvidedCompensation Received by Retiree07/01/17- 09/30/2017Consulting $900NOTE: The compensation you report should not include any reimbursements for travel, materials, and other expenses. After completing the form, please forward to Payroll for completion of the Employer section and for processing. PERA Disclosure of Compensation form can be found on the PERA website below on page 19-20 of document.  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