OMB. No. 1545-0004
Form SS-8                       Determination of Worker Status for Purposes                                                                    For IRS Use Only: 
(Rev. December 2023)                                                                                                                           Case Number:  
                                             of Federal Employment Taxes and  
Department of the Treasury                        Income Tax Withholding                                                                       Earliest Receipt Date:
Internal Revenue Service                    Go to www.irs.gov/FormSS8 for instructions and the latest information.

                                                  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

Firm’s fax number                           Firm’s website                                    Worker’s fax number                             Worker’s social security 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       General Information
1     This form is being completed by:            Firm               Worker 
      for services performed from beginning date                                              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 believe you erroneously received a Form 1099 or Form W-2
           You are unable to get workers’ compensation benefits                               You were audited or are being audited by the IRS
           Other (specify)

                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)

Form SS-8 (Rev. 12-2023)                                                                                                             Page 2
Part I  General Information (continued)
3   Total number of workers who performed or are performing the same or similar services:                     .
4   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). 
a   Inform us of any current or past litigation concerning the worker’s status.

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 
    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:                    Change was a:     Sale   Merger        Acquisition       Reorganization
        Other (specify)
    Description of above change:

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

9   Which do you believe the worker is? Check only one.         Employee          Independent contractor
    Explain.

10  Did the worker perform any services for the firm before or after the dates entered on line 1 on page 1 of this form?  . .    Yes No
    If “Yes,” what were the dates of service?
    If “Yes,” explain any differences between the services provided.

11a Is the work done under a written agreement between the firm and the worker?  .    . . . .  . .      . . .  . .          .    Yes No
    If “Yes,” attach a copy (preferably signed by both parties).
    If “Yes,” describe the terms and conditions of the work arrangement.

b   Is the work done under an oral agreement? .     . . .       . . .   .     . . .   . . . .  . .      . . .  . .          .    Yes No
    If “Yes,” describe the details of the agreement.

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

                                      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)

Form SS-8 (Rev. 12-2023)                                                                                                           Page 3
Part II  Behavioral Control (Provide names and titles of specific individuals, if applicable.) (continued)
5  Is the worker required to complete reports? .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” attach examples.
6a How frequently does the worker perform services?    As scheduled              As needed            As available
         Other (specify)
b  Describe the worker’s primary services.     Sales         Timesheets            Patient logs
         Other (specify)
7  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  . . .  . .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .                  %
         Customer’s location  .  .  . .  . .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .                  %
         Other (specify)                                                                                                               %
8a Is the worker required to attend meetings?  .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” what type of meetings?      Sales         Staff             Other (specify)
b  Is the worker penalized if unable to attend a meeting? .  .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” what is the penalty?
9  Is the worker required to provide the services personally?  . .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
10 Can the worker hire substitutes or helpers?  . .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
11 If the worker hires the substitutes or helpers, is approval required? . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” who approves the hiring?    Firm          Other (specify)
12 Does the worker pay substitutes or helpers?  . .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” is the worker reimbursed? . . .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If the worker is reimbursed, explain who reimburses them.
Part III Financial Control (Provide names and titles of specific individuals, if applicable.)
1a List the supplies, equipment, materials, and property provided by
   The firm:
   The worker:
b  Are supplies, equipment, materials, or property provided by another party?  . . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” explain.

2  Does the worker lease equipment, space, or a facility?  . .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” what are the terms of the lease? (Attach a copy or explanatory statement.)

3  Are expenses incurred by the worker in the performance of services for the firm?  .  . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” explain.

4a Are expenses reimbursed by the firm? .  .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” provide the frequency and amount.

b  Are expenses reimbursed by another party?  .   .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” explain.

5a What type of pay does the worker receive?      Salary           Commission           Hourly wage          Piece work        Lump sum
         Other (specify)
b  If paid commission, does the firm guarantee a minimum amount of pay? .    .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” explain.

6  Can the worker request advance pay? .   .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .  . .          Yes     No
   If “Yes,” how often?         Daily         Weekly             Monthly           Other (specify)
7  Whom does the customer pay? .      .  . .   .  .  . .     .   .  .    . . .   . .    . . .  .    . .    . . .        Firm       Worker
   If worker, does the worker pay the total amount to the firm?     Yes          No       If “No,” explain.

8  Does the firm carry workers’ compensation insurance on the 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)

Form SS-8 (Rev. 12-2023)                                                                                                           Page 4
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? .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” explain.

b   Can the worker suffer a financial loss by performing services? .   . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” explain.

10a Who sets the rate of pay for the services performed?        Firm         Worker         Other (specify)
b   If products are sold, who sets the product price?           Firm         Worker         Other (specify)
Part IV  Relationship of the Worker and Firm
1   Are benefits made available to the worker?   . .    .     . . .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” which benefits are available?       Paid vacations           Sick pay                            Paid holidays
         Personal days                            Pensions                 Insurance benefits                  Bonuses
         Other (specify)
2   Can the firm or worker end the work relationship without penalty?    . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “No,” explain.

3   Did the worker perform similar services for others during the time period entered in Part I, line 1? . . . . . .     .  Yes    No
    If “Yes,” is the worker required to get approval from the firm?  . . . .   . .      . . . . .        . . . . . .     .  Yes    No
4   Is there an agreement prohibiting competition between the firm and the worker?  .     . . . .        . . . . . .     .  Yes    No
    If “Yes,” explain or attach available documentation.

5   Reserved for future use. 
6   Does the worker advertise?  . .  .      . .  . .    .     . . .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” what type of advertising does the worker do? Provide copies, if available.
7   Does the worker assemble or process a product at home? .      .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” who provides the materials and instructions or patterns?
    If “Yes,” what does the worker do with the finished product?         Return to the firm   Provide to another party      Sell it
         Other (specify)
8a  Does the firm introduce the worker to its customers?      . . .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” how is the worker introduced?      Employee                Partner        Representative         Contractor
         Other (specify)
b   Under whose name are services performed?            Firm             Worker
         Other (specify)
9   Does the worker still perform services for the firm? .    . . .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “No,” how did the work relationship end?         Firm ended the work relationship      Worker ended the work relationship
         Job completed       Contract ended             Firm or worker went out of business
         Other (specify)
Part V   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?    . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” what are the worker’s specific responsibilities?

2   Is the worker provided leads (names and contact information) for potential new customers? . .        . . . . . .     .  Yes    No
    If “Yes,” who provides the leads?
3   Is the worker required to report on potential new customers contacted? .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” what are the reporting requirements?

4   Does the firm set terms and conditions of sale? .   .     . . .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
    If “Yes,” explain.

5   Are orders submitted and subject to the firm’s approval?  .   .    . . .   . .      . . . . .        . . . . . .     .  Yes    No
6   Who determines the worker’s sales territory?        Firm             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)

Form SS-8 (Rev. 12-2023)                                                                                                                 Page 5
Part V For Service Providers or Salespersons. You must complete this part if the worker provided a service 
       directly to customers or is a salesperson. (continued)
7    Did the worker pay for the privilege of serving customers on the route or in the territory?  . . .   . . .     .  . . .        Yes  No
     If “Yes,” whom did the worker pay?
     If “Yes,” how much did the worker pay?  .         . . .  . .   . . .     . . . .    . .        . .   . . .       $
8    Where does the worker sell the product?             Home       Retail establishment            Online
       Other (specify)
9    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.

10   Does the worker sell life insurance full time?  .   . .  . .   . . .     . . . .    . .        . .   . . .     .  . . .        Yes  No
11   Does the worker sell other types of insurance for the firm?  . . . .     . . . .    . .        . .   . . .     .  . . .        Yes  No
     If “Yes,” enter the percentage of the worker’s total working time spent in selling other types of insurance  . .  . . .                                      %
12   Does the worker solicit orders from wholesalers, retailers, contractors, or operators of hotels, restaurants, or other similar 
     establishments?     . . . . .     .   . .         . . .  . .   . . .     . . . .    . .        . .   . . .     .  . . .        Yes  No
     If “Yes,” what percentage of the worker’s time is spent in solicitation? . . . .    . .        . .   . . .     .  . . .                                      %
13   Is the merchandise purchased by the customers for resale or use in their business operations?  .     . . .     .  . . .        Yes  No
     Describe the merchandise and state whether it is equipment installed on the customers’ premises.

       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.
Sign 
Here                       Print your name                                               Signature                                  Date 

                                       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)