Independent Contractor Tax Rate

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					                        REQUEST FOR INDEPENDENT CONTRACTOR (IC) STATUS
                                                                    INPUT SCREEN
Use this form to obtain approval from the Tax Manager in Financial Accounting PRIOR TO entering into
an agreement for services to be performed as an independent contractor.

                        ***Click on the INSTRUCTIONS tab at bottom for guidance***

                                                               VENDOR INFORMATION
Click here to clear work                        area
              and start a new form.                    Enter requested information in the fields below:
Individual Name
Business Name (if applicable)                                                                                         Enter complete
Home Address (Street, City, State, Zip)                                                                               address on one line
Social Security Number
Federal Tax ID Number (if applicable)
Click on buttons to answer the following questions. Where applicable, enter requested info in the fields below:
University Employee (or former employee within the last 18 months?)

Related to University Employee?
   If YES, employee's name/relationship:

U.S. Citizen or Permanent Resident (green-card holder)?
   If NO, country of citizenship:

                                                       DATES AND DURATION OF SERVICE
Indicate the beginning and ending dates of the time frame for which you are requesting IC approval (maximum 12 months).
   Dates of service to be rendered         FROM:                                                                          ( m/d/yy )
                                                 TO:                                                                      ( m/d/yy )
Indicate how often services will be rendered by clicking on one of the following choice buttons.
For "Ongoing" or "Other", indicate the requested information in the fields below:




                    (indicate # hrs per week)


                    ( explain)



                                                               METHOD OF PAYMENT
Click on one of the following choices. For "Installments" or "Other", input explanation in appropriate field below:



                (specify # & frequency)


                (explain)

                                                DESCRIPTION AND LOCATION OF SERVICES

Describe the services to be performed: Enter below.                  (Tab to Leftmost Column)       Do not type more than 3 lines of text.




Where will the work be done? Enter below.                 (Tab to Leftmost Column)       Do not type more than 3 lines of text.




                                    ALL OF THE FOLLOWING QUESTIONS MUST BE ANSWERED
                                                 Click on the answer for each of the following six questions:
1. Will the IC provide his/her own tools, materials, equipment, etc.?                                                                        1

2. Will the IC be working on a fixed schedule specified by UA?                                                                               2

3. Will the IC receive training from UA in order to do the work?                                                                             3

4. Will the details of the work be directed or supervised by UA personnel?                                                                   4

5. Will the IC supervise UA personnel?                                                                                                       5

6. Does the IC perform this type of service for others besides UA?                                                                           6


                                                           DEPARTMENT INFORMATION
                                                       Enter requested information in the fields below:
Department Name:
FOAPAL:
Department Official:
Department Contact for Questions:
Contact Phone Number:
Fax Number:
Campus Mail Box Number:
                           REQUEST FOR INDEPENDENT CONTRACTOR STATUS
                        Form must be approved prior to engaging the services of an independent contractor (IC).

                                                                                               Date       August 1, 2010
I.    VENDOR INFORMATION
      Individual Name
      Business Name
      Home Address
      Social Security #                                                                   Federal Tax ID#
      University employee (or former employee within the last 18 months?)
      Related to University employee?                     If YES, explain:
      U. S. Citizen or Permanent Resident (green-card holder)?
           If NO, country of citizenship:

II.   DESCRIPTION OF SERVICE
      Date(s) of service to be rendered: From                                             to
      Duration of service:
      Method of payment:
      Describe the services to be performed:




      Where will the work be done?




      1.   Will the IC provide his/her own tools, materials, equipment, etc. to do the work?
      2.   Will the IC be working on a fixed schedule specified by UA?
      3.   Will the IC receive training from UA in order to do the work?
      4.   Will the details of the work be directed or supervised by UA personnel?
      5.   Will the IC supervise UA personnel?
      6.   Does the IC perform this type of service for others besides UA?

III. DEPARTMENT INFORMATION
Department Name:
Department Official Requesting Approval:                                                              FOAPAL:
                        DEPARTMENT CONTACT FOR QUESTIONS CONCERNING THIS REQUEST:
Name                                              Phone                       FAX                       Box

IV. FINANCIAL ACCOUNTING USE

             APPROVED
                                                    Tax Manager or designee                                                 Date

              Not Approved - This position does not qualify for independent contractor status. The securing of services
                             for this individual must follow University hiring procedures. Please contact your Human Resource
                             Partner for assistance.
              Not Approved - The above individual is currently on University payroll. Payment to this individual must be
                             processed on a supplemental Personnel Action form.




                                                                                                                Form IC (revised 7/06)
INSTRUCTIONS FOR INDEPENDENT CONTRACTOR (IC) APPROVAL:

Complete the IC form when you anticipate obtaining services from someone to be paid outside the payroll
system.

Click on the INPUT tab at bottom and enter all requested information on the INPUT page. Then click on the
PRINT tab at bottom to switch to the PRINT page. Here you can review your completed form and use the Print
icon to print a hard copy.

If input does not transfer correctly to the PRINT page, be sure your Macro Security Level is set on Medium. (Go
into "Tools", "Macro", "Security" and select "Medium" security level.)  When opening worksheets, you should
get a choice box and select "Enable Macros". This will allow the macros to run to transfer the data from INPUT
to PRINT page.

Forward the completed form to Michelle L'Etang, Tax Manager, Financial Accounting.
You may send by any of the following options:
    Fax the form to 8-7282 (direct line in the Tax Office)
    Send as an e-mail attachment to mletang@fa.ua.edu
    Send by campus mail to Box 870136
    Deliver to Room 326 Rose front desk

When you receive the signed form back, keep copies to attach to EACH Miscellaneous Disbursement Voucher
(MDV) for payment. This is the department's responsibility. Do not attach an unsigned IC form to an MDV that
you are submitting to be paid. Get the approval signature first.

Once IC approval has been received, you may proceed with the Professional Service Agreement (PSA).

NOTE: While we are allowed to use faxes/copies on the IC form, the MDV and PSA forms must have
ORIGINAL signatures.

For questions regarding the completion of this form or the approval process, contact Michelle L'Etang, Tax
Manager, at 8-2963 or mletang@fa.ua.edu.

				
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