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       DETERMINATION OF EMPLOYMENT WORK STATUS FOR PURPOSES OF STATE OF  
       CALIFORNIA EMPLOYMENT TAXES                   AND PERSONAL INCOME             TAX WITHHOLDING 
 
 Purpose                                                         
                                                                 
 This form is to be used by business entities who would         This form should be completed carefully, and it should be 
 like to receive a determination as to whether a worker is      completed for one individual who is a representative of the 
 an employee for purposes of California Unemployment            class of workers whose status is in question. If a written 
 Insurance, Employment Training Tax, State Disability           determination is desired for another class of workers, 
 Insurance (SDI)*, and Personal Income Tax (PIT)                complete a separate DE 1870. A written determination for 
 withholding.                                                   any worker will apply to other workers of the same class if 
                                                                facts are the same as those of the worker whose status is 
 General Information                                            the subject of the written determination. 
                                                                 
 For assistance in completing this form, contact your local     This form is designed to cover many work activities. Some 
 Employment Tax Office of the Employment Development            of the questions may not apply to you. You must answer 
 Department (EDD) or call the Taxpayer Assistance Center        questions 1-39 or mark them “UNKNOWN” or “DOES 
 at 1-888-745-3886. Upon completion, return to:                 NOT APPLY.” Answer questions 40-79 only if applicable.  
                                                                If additional space is needed, please attach another sheet 
 State of California                                            with the question number clearly identified. Write your 
 Employment Development Department                              business name, federal identification number, and the EDD 
 FACD-Central Operations, MIC 94                                employer payroll tax account number at the top of each 
 PO Box 826880                                                  additional sheet attached to this form.  
 Sacramento, CA 94280-0001                                       
                                                                PLEASE TYPE OR PRINT ALL INFORMATION CLEARLY. 
 The EDD may need to contact you if additional 
 information is required. 
  
 * Includes Paid Family Leave (PFL). 
                                   
 NAME OF ENTITY                                                                             

 NAME OF OWNER                                                            

 ADDRESS OF ENTITY                                  (CITY)                         (STATE)        (ZIP CODE)  

 PHONE NUMBER (INCLUDING AREA CODE)                  

 ENTITY’S FEDERAL EMPLOYER IDENTIFICATION NUMBER                         

 ENTITY’S EDD EMPLOYER PAYROLL TAX ACCOUNT NUMBER                   
                                 
Check the type of entity for which the work relationship is in question: 
     Individual           Partnership       Corporation           Limited Liability Company (LLC) 
 
     Limited Liability Partnership (LLP)      Other (specify):                                                              
 
If the entity is a corporation, is the worker an officer of the corporation?    Yes    No 
 
If the entity is an LLC, is the worker a member of the LLC?       Yes          No 
 
If the entity is an LLC, how is the LLC treated for federal income tax reporting purposes? 
     Sole Proprietorship             Partnership       Corporation 
 
DE 1870 Rev. 14 (12-18) (INTERNET)                          Page 1 of 7                                       CU

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1. Provide a brief description of the entity’s business operation (e.g., drug store, farmer, construction, etc.): ____________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

2. Has this issue been the subject of a prior or current EDD audit, benefit claim investigation, hearing, or prior DE 1870
determination? Yes No Unknown

If “Yes,” please explain and provide any applicable dates: ___________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

3. Has any other governmental agency ruled on the status of services performed by the worker or another person
performing the same or similar services? Yes No Unknown If “Yes,” please attach a copy.

4. Total number of workers in this class: __________
Attach names, addresses, and phone numbers of the workers in this class. If there are more than 10 workers, attach the
information for only 10.

5. This information is about services performed by the worker from________________ to _________________.
(Date) (Date)
6. State the worker’s occupation, title, and give a complete description of the services provided: _____________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

7. How did the worker learn of the job (e.g., advertisement, online, in a newspaper, word of mouth, etc. If there was a job
announcement, please attach a copy.): ____________________________________________________________________
_____________________________________________________________________________________________________

8. What were the requirements for the worker’s position (e.g., previous experience, education, etc.): __________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

9. Is the worker still performing services for the entity? Yes No

If “No,” explain why and how the worker was terminated, laid off, or quit: _____________________________________
_____________________________________________________________________________________________________

10. Were the services performed under a written agreement or contract? Yes No
If “Yes,” please attach a copy.

11. If the agreement was not in writing, or the terms of the written agreement were not complied with in practice, describe
the actual terms and conditions of the arrangement: ________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________

12. Was it agreed or understood that the worker would perform the services personally? Yes No

If “No,” please explain: ________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

DE 1870 Rev. 14 (12-18) (INTERNET) Page 2 of 7

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13a. Does the worker have helpers? Yes No

If “Yes,” answer questions 13b through 13g.
If “No,” go to question 14.

b. Who hired the helpers? Worker The entity Unknown

c. Who could discharge the helpers? Worker The entity Unknown

d. Who paid the helpers? Worker The entity Unknown

e. If the worker paid the helpers, did the entity reimburse the worker? Yes No Unknown

f. What services do the helpers perform? __________________________________________________________________

g. Are Social Security/Medicare (FICA), SDI, and PIT withheld from the helpers’ wages?

Yes No Unknown

If “Yes,” who reports and pays these taxes? ______________________________________________________________
14a. Was the worker permitted to provide services for others during the same time periods services were performed for the
entity? Yes No Unknown

If “Yes,” answer questions 14b through 14f.
If “No” or “Unknown,” go to question 15.

b. What percent of the worker’s total working time was spent working for others? ________________________________

c. What percent of the worker’s total income was earned from others? _________________________________________

d. Describe services the worker performed for others: _______________________________________________________

___________________________________________________________________________________________________
e. Did the entity have first call on the worker’s time and efforts? Yes No Unknown

f. Who owned or rented the premises where the services were performed? _____________________________________
15a. List the kind and value of tools, equipment, and/or facilities furnished by the entity: ____________________________

___________________________________________________________________________________________________

b. Was the worker required to wear a uniform or badge? Yes No
If “Yes,” describe what the worker was required to wear: __________________________________________________
Who paid for the items? ______________________________________________________________________________

16. List the kind and value of tools, equipment, and/or facilities furnished by the worker? ___________________________

___________________________________________________________________________________________________

17a. List any expenses connected with the services of the worker: _______________________________________________

___________________________________________________________________________________________________

b. Who was responsible for paying these expenses? _________________________________________________________

c. Was the worker reimbursed by the enitity for any of these expenses? Yes No

18. Did the worker perform under: His/her business name The entity’s name

19. Did the worker advertise or maintain a business listing in the phone directory, a trade journal, Internet, etc.?
Yes No Unknown If “Yes,” please attach a copy.

DE 1870 Rev. 14 (12-18) (INTERNET) Page 3 of 7

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20a. Did the worker hold himself/herself out to the public as available to provide services of this nature?

Yes No Unknown
If “Yes,” please explain: ______________________________________________________________________________
___________________________________________________________________________________________________

b. Or any other nature? Yes No Unknown
If “Yes,” please explain: ______________________________________________________________________________
___________________________________________________________________________________________________

21. Did the worker have an office or shop of his/her own? Yes No Unknown
If “Yes,” where (e.g., was the office in the worker’s home or was it rented office space?): ________________________
___________________________________________________________________________________________________

22a. Was a license or certificate required to perform the services? Yes No Unknown

If “Yes,” does the entity possess such a valid license or certificate? Yes No

If “Yes,” does the worker possess such a valid license or certificate? Yes No Unknown
b. Who issued the license or certificate to the entity and/or worker? State type and number for the entity and/or worker:
___________________________________________________________________________________________________
c. Who paid the worker’s license or certificate fee? __________________________________________________________
23. How did the entity engage the worker? Full-time Part-time Particular Job Indefinite Period

Other, please explain: ____________________________________________________________________________

24. Did the entity require the worker to perform during a scheduled time? Yes No

If “Yes,” please explain: ______________________________________________________________________________

25a. Was the worker provided training by the entity? Yes No
If “Yes,” what kind and how often? _____________________________________________________________________
___________________________________________________________________________________________________

b. Who paid for the worker’s training expenses? ____________________________________________________________

c. Was the worker provided an orientation by the entity? Yes No

If “Yes,” please describe: ______________________________________________________________________________

26. Was the worker required to follow a work schedule by the entity specifying days and hours in which work had to be
performed? Yes No
If “Yes,” please provide work schedule: _________________________________________________________________
Who established the work schedule? ___________________________________________________________________

27. Was the worker given instructions about the way the service was to be performed? Yes No
If “Yes,” explain the nature of the instructions: ____________________________________________________________
___________________________________________________________________________________________________
28. Could the entity change the methods used by the worker in performing the services or otherwise direct him/her as to
how to perform the work? Yes No

Explain your answer: _________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

DE 1870 Rev. 14 (12-18) (INTERNET) Page 4 of 7

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29a. Does the worker report to the entity or its representatives? Yes No
If “Yes,” how often? __________________________________________________________________________________
b. For what purpose? ___________________________________________________________________________________
c. In what manner (in person, in writing, by phone, time record, etc.)? _________________________________________
Attach copies of report forms used in reporting to the entity.
30. Was the worker required to produce a certain amount of work regularly or achieve certain performance goals if
services were to continue? Yes No

31a. Check the type of pay the worker received? Salary Commission Hourly Other
If “Other,” please explain: ____________________________________________________________________________
31b. Who set the pay rate? Worker Business Entity Negotiated Other
If “Other,” please explain: _____________________________________________________________________________
31c. Was the worker paid in regular intervals? Yes No
If “Yes,” what was the frequency? Daily Weekly Monthly Other
If “Other,” please explain: _____________________________________________________________________________
32. Was the worker guaranteed a minimum pay? Yes No
33. Was the worker eligible for a pension, bonuses, paid vacations, sick pay, etc.? Yes No
If “Yes,” please explain: ______________________________________________________________________________
___________________________________________________________________________________________________
34. Did the entity carry workers’ compensation insurance on the worker? Yes No
35. Could the entity discharge or layoff the worker without notice? Yes No
36. Could the worker quit at any time? Yes No
37. Would a liability be incurred if the worker quit or was discharged before the job was complete? Yes No
If "Yes," please explain: _______________________________________________________________________________
38. Please explain why you believe the worker is/was an employee of the entity or an independent contractor:
___________________________________________________________________________________________________
___________________________________________________________________________________________________

39. How did the worker report earnings for income tax purposes? Wages Self-employment Income Unknown

ANSWER QUESTIONS 40 THROUGH 45 ONLY IF THE WORKER IS AN AGENT DRIVER OR
COMMISSION DRIVER
An agent driver or commission driver is a person who operates his/her own truck or the truck of the entity and
serves the customers of the entity as well as soliciting his/her own customers.

40. State the products and/or services the driver distributes (for example: bakery products and laundry services):
___________________________________________________________________________________________________
41. If the driver distributes more than one product or service, which is considered the principal or main product?
Explain: ____________________________________________________________________________________________
42. Who does the driver serve? Customers or routes designated by the entity His/her own customers Both
43. Was the driver required to perform the services personally? Yes No
44. Were the driver’s services part of a continuing relationship with the entity and not in the nature of a single transaction?
Yes No
45. What investment, other than for transportation, does the driver have in his/her business?
___________________________________________________________________________________________________
___________________________________________________________________________________________________

DE 1870 Rev. 14 (12-18) (INTERNET) Page 5 of 7

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ANSWER QUESTIONS 46 THROUGH 58 ONLY IF THE WORKER WAS A
TRAVELING OR CITY SALESPERSON

46. What type of product is sold? _________________________________________________________________________
47. To whom are sales made? ____________________________________________________________________________
48. What typical type of business is the buyer in? ___________________________________________________________
49. Does the buyer resell the product or use it in its business? _________________________________________________
50. Did the worker have an exclusive territory? Yes No
51. Did the entity specify when and how often to work the territory? Yes No
If “Yes,” please explain: _____________________________________________________________________________
__________________________________________________________________________________________________

52. What percent of total sales that the worker made for the entity were made to wholesalers, retailers, contractors, or
operators of hotels, restaurants, or other similar establishments? ____________________________________________
53. What was the percent of working time that the worker spent in selling to organizations other than those specified in
#52, such as manufacturers, schools, churches, and homeowners? _________________________________________
54. What was the approximate number of hours worked per day for the entity? __________________________________
55. Was the worker required to perform the services personally? Yes No
56. Was the worker required to forward the orders to the entity? Yes No
57. Were the worker’s services part of a continuing relationship with the entity? Yes No
58. What investment, other than transportation, does the worker have in the business? ____________________________
__________________________________________________________________________________________________

ANSWER QUESTIONS 59 THROUGH 67 ONLY IF THE INDIVIDUAL WORKED AT HOME

59. Who furnished materials or goods used by the worker? Individual Entity
60. Was the worker furnished a pattern or given instructions to follow in making the product? Yes No
If “Yes,” please explain: _____________________________________________________________________________

__________________________________________________________________________________________________

61. Was the worker required to return the finished product either to the entity or to someone designated by the entity?
Yes No
62. Was the worker required to perform the services personally? Yes No
63. Were the worker’s services part of a continuing relationship with the entity? Yes No
64. Is the entity licensed by the California Division of Labor Standards Enforcement? Yes No Unknown
65. Does the worker have a valid permit from the California Division of Labor Standards Enforcement?
Yes No Unknown
66. Who bears the cost of material damaged by the worker? Worker Entity
67. Explain the nature of any substantial investment in facilities used in connection with performance of the worker’s
services: __________________________________________________________________________________________
__________________________________________________________________________________________________

__________________________________________________________________________________________________

DE 1870 Rev. 14 (12-18) (INTERNET) Page 6 of 7

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ANSWER QUESTIONS 68 THROUGH 72 ONLY IF THE INDIVIDUAL IS A
REAL ESTATE SALESPERSON OR BROKER

68. Does the entity provide advances against unearned commissions, expense accounts, or reimbursements of expenses
incurred by the worker? Yes No
Please explain: ____________________________________________________________________________________

__________________________________________________________________________________________________

69. Does the entity approve the sales before they are placed in escrow? Yes No
70. Does the worker have any other duties with the entity besides selling real estate? Yes No
If “Yes,” please explain the nature of such duties and the method of payment: _______________________________

__________________________________________________________________________________________________

71. Does the entity allow the worker to have exclusive listings? Yes No

72. Does the worker have a valid license to sell real properties? Yes No

ANSWER QUESTIONS 73 THROUGH 79 ONLY IF THE ENTITY IS A
TEMPORARY SERVICES EMPLOYER OR LEASING EMPLOYER

73. Does the entity negotiate with clients or customers for such matters as time, place, type of work, working conditions,
quality, and price of the services? Yes No
74. Does the entity determine the assignments or reassignments of the workers, even though workers retain the right to
refuse specific assignments? Yes No
75. Does the entity retain the authority to assign or reassign a worker to other clients or customers when a worker is
determined unacceptable by a specific client or customer? Yes No
76. Does the entity assign or reassign the worker to perform services for a client or customer? Yes No
77. Does the entity set the rate of pay of the worker, whether or not through negotiation? Yes No
78. Does the entity pay the worker from its own account(s)? Yes No
79. Does the entity retain the right to hire and terminate workers? Yes No

I declare that all copies of contracts and all statements submitted are true, correct, and complete to the best of
my knowledge and belief. If any misrepresentation has been made or facts have been omitted, I understand that
the determination will not be valid and will not be binding upon the EDD.

(NAME PRINTED) (DATE)

(SIGNATURE) (PHONE NUMBER)

(TITLE)

DE 1870 Rev. 14 (12-18) (INTERNET) Page 7 of 7

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