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Determination Of Employment Work Status For Purposes Of State Of California Employment Taxes DE-1870 - California

Determination Of Employment Work Status For Purposes Of State Of California Employment Taxes Form. This is a California form and can be used in EDD Forms Workers Comp .
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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 businesses who would like to get a determination as to whether a worker is an employee for purposes of California Unemployment Insurance, Employment Training Tax, State Disability Insurance*, and Personal Income Tax withholding. Note If you require any assistance in the completion of this form, contact the nearest Employment Tax Office of the Employment Development Department (EDD) or call (888) 745-3886. Upon completion, return to: STATE OF CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT FACD-Central Operations, MIC 94 P.O. Box 826880 Sacramento, CA 94280-0001 The EDD may need to contact you if additional information is required. * Includes Paid Family Leave (PFL). General Information This form should be completed carefully, and it should be completed for one individual who is representative of the class of workers whose status is in question. If a written determination is desired for any other class of workers, complete a separate DE 1870. A written determination for any worker will apply to other workers of the same class if facts are not different from those of the worker whose status was ruled upon. This form is designed to cover many work activities. Some of the questions may not apply to you. You must answer questions 1-39 or mark them "UNKNOWN" or "DOES NOT APPLY." Answer questions 40-79 only if applicable. If additional space is needed, please attach another sheet. PLEASE TYPE OR PRINT ALL INFORMATION CLEARLY NAME OF FIRM NAME OF OWNER ADDRESS OF FIRM (CITY) (STATE) (ZIP CODE) TELEPHONE NUMBER (INCLUDING AREA CODE) FIRM'S FEDERAL IDENTIFICATION NUMBER FIRM'S EDD EMPLOYER ACCOUNT NUMBER Check the type of firm for which the work relationship is in question: Individual Partnership Corporation Limited Liability Company (LLC) Limited Liability Partnership (LLP) Other (specify): Yes No Yes No If the firm is a corporation, is the worker an officer of the corporation? If the firm is an LLC or LLP, is the worker a member of the LLC or partner in the LLP? DE 1870 Rev. 12 (2-09) (INTERNET) Page 1 of 7 American LegalNet, Inc. CU 1. Provide a brief description of the firm's business (e.g., drug store, farmer, and construction): __________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 2. Has this issue been the subject of a prior or current EDD audit and/or a benefit claim investigation or hearing? 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, telephone numbers, and social security numbers. If 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 worker's occupation and title and give a complete description of the services provided: __________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 7. How did the worker learn of the job (e.g., advertisement in newspapers, and word of mouth): __________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 8. What were the requirements for the worker's position (e.g., previous experience, and education): _______________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 9. Is the worker still performing services for the firm? Yes No If "No," explain why and how the worker was terminated:_______________________________________________ ____________________________________________________________________________________________ 10. Were the services performed under a written agreement or contract? 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 Yes No If "No," please explain:__________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ DE 1870 Rev. 12 (2-09) (INTERNET) Page 2 of 7 CU American LegalNet, Inc. 13a. Does the worker have helpers? Yes No If "Yes," answer questions 13b. through 13g. If "No," go to question 14. b. Were the helpers hired by: c. Who could discharge the helpers: Worker Worker Worker The firm The firm The firm Unknown Unknown Unknown Yes No Unknown d. Who paid the helpers: e. If the worker paid the helpers, did the firm reimburse the worker? f. What services do the helpers perform? __________________________________________________________ g. Are social security (FICA), state disability insurance (SDI), and income taxes withheld from the helpers' wages? Yes No
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