Service Provider Questionnaire The information on this form is used to determine whether an individual providing services is an independent contractor under IRS guidelines. This form must be completed and signed by the individual performing the services, and reviewed and signed by the individual responsible for contracting for the services, prior to the rendering of any services. No payment for any services will be made otherwise. This form is not intended for enrolled Penn students or for UPHS or Penn employees.Scope of Work*Please provide a brief description of the services that will be provided. Description should include duration, estimated cost, location of activity/services, etc.Applicant* First Last Email* Name of Business*(If a business, specify if Business is a sole partnership, LLC, Corporation, etc.)Business address for tax purposes* Street Address (No P.O. Boxes) Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email for purchase orders:* Please answer all of the following questionsAre you a U.S. Citizen?*YesNoAre you a Resident Alien (Green Card Holder)?Yes - If yes, you will be required to provide a photocopy of your greencardNoIf no, Country of Citizenship:*Please refer to Financial Policy No. 2319.4Are you an enrolled student of the University of Pennsylvania?YesNoAre you an employee of the University of Pennsylvannia, HUP or CPUP?*YesNoIf yes, please check all that apply: Part-time Full-time Faculty Staff or other (specify) Other specificationHave you received wages or any other payments from the University of Pennsylvania, the Health System or any of its affiliate institutions?*YesNoCheck the appropriate box:Salary or Wages/Taxes withheld through payroll systemOther (specify)Other wage arrangementSpecify time period worked (date/date range):*Will you receive a flat fee for your services?*YesNoAre your services made available to the public on a regular and consistent basis?*YesNoDo you contract with others to provide similar services?*YesNoWill you provide all the required equipment to complete your duties?*YesNoWill you retain others to assist you in carrying out your services?*YesNoIf yes, will the retention of any such individuals be solely within your discretion, with their compensation to be paid by you?*YesNoWill you use a University classroom or office space to perform your duties?*YesNoWill expenses incidental to the performance of your duties for the University including travel expenses, be borne by you, unless reimbursement is permitted in the terms of the contract and invoiced with appropriate documentation?*YesNoWill you have the right to schedule the work to be completed?*YesNoIf required, will you submit periodic progress reports to the responsible department chairman or business administrator as to the status of the project or work being performed?*YesNoWill you control the progress of the project or work being performed?*YesNoDo you contract to provide these services on a project-by-project basis?*YesNoWill the services be provided outside of Pennsylvania?*YesNoIf yes, provide location (U.S. state or foreign country)If services are being provided outside of the U.S., do you have the appropriate visas and/or work authorizations to provide the services in the country?YesNoApplicant Acceptance Check* Yes, I undertand that the University will make the determination as to whether I will be treated as an independent contractor or an employee. By signing below (Applicant E-Signature), I hereby certify that I am entitled to claim independent contractor status. I have complied with all business licensing requirements. I certify that I pay all applicable taxes in accordance with relevant tax laws. I acknowledge that, as an independent contractor, I am not eligible for workers compensation, unemployment compensation or other University employee benefits. I understand that the University will issue the required tax document as it relates to my tax status. I acknowledge that providing false information will result in my not being eligible to contract with the University in the future, and may result in further penalties.Applicant E-Signature*Please make sure to answer questions in Section 1 and D. Be sure to answer questions in Section II A, II B or II C depending on your situation. If you are sure you will be hiring as an employee make sure to make that selection in each drop box that presents that option.IRS Common Law Test for determination and classification as employee vs. independent contractor is organized into three major categories: Behavioral Control: Who controls how the work is done? BEHAVIORAL CONTROL EMPLOYEE INDEPENDENT CONTRACTOR Instructions An employer has the right to give an employee instructions regarding how, when and where the work is performed The client has a right to specify the parameters of the deliverables; not the details of how, when and where the work is performed Training Employees are often trained to do their jobs Independent Contractors are hired for their expertise and should receive no internal training Financial Control: Who controls the business aspects of the worker’s assignment? FINANCIAL CONTROL EMPLOYEE INDEPENDENT CONTRACTOR Significant Investment Employers provide the tools and equipment necessary for their employees Independent Contractors provide their own tools and equipment Unreimbursed Expenses Employees are reimbursed for any out-of-pocket business expenses they might incur Independent Contractors pay their own business expenses Marketing Employees do not market their services to public Independent Contractors market their services to the public Method of Payment Employees are paid based upon the passage of time—guaranteed return for his/her labor Independent Contractors are generally to be paid upon the completion of specific deliverables Opportunity for Profit/Loss Employees generally have no opportunity for suffering a loss Independen Contractors make business decisions that allow them to not only make a profit but also have the opportunity to suffer a loss Relationship of Parties: Worker's and employer's/purchaser's type of relationship RELATIONSHIP OF PARTIES EMPLOYEE INDEPENDENT CONTRACTOR Intent of Parties Expressed via employment contract; extent of direction and control the employer requires over the employee Expressed in a contract between the two parties; Independent Contractor expresses his/her intent by fulfilling local and state requirements for business (i.e. securing business license, etc) Employee Benefits Employees are entitled to benefits such as vacation or sick time, health care benefits and ability to attend company sponsored events Independent Contractor provides his/her own benefits Termination Within the confines of legal or contractual requirements employees can be discharged at will by the employer Contracts can only be terminated according to the specifications of the contract. Non-performance on the part of the contractor or client can lead to legal recourse Permanency of Relationship Employer engages for indefinite period of time Specific services are for limited period of time Regular Business Activity Employees perform services which are key aspects of employer’s regular business activities Independent contractors perform services which do not affect client’s bottom line. (limited exceptions) DOL Economic Realities Test: Determination and classification of an employee vs. independent contractor is based on these six factors: ECONOMIC REALITIES TEST FACTOR EMPLOYEE INDEPENDENT CONTRACTOR Whether the work is an integral part of the employer’s business. This factor is “compelling” per the DOL. Integral work includes: Any work that is part of the mission of the University (e.g. education, research, and health care) Work that is already performed by University employees in the normal course of business Work that is regular and ongoing If the work is integral, it is more likely that the worker is economically dependent on the employer If the work is not integral, it is less likely that the worker is economically dependent on the employer Whether the worker’s managerial skills affect the opportunity for profit or loss. Worker has no opportunity to increase profit except by increasing hours Worker hires others; purchases materials and equipment for the job; advertises; rents spaces; manages timetables The relative investment of the worker and the employer Worker is economically dependent on payments from the University Worker is NOT economically dependent on payments from the University Whether the work performed requires special skills and initiative. The DOL does not consider specialized skills unless they indicate that a worker is in business for himself/herself The DOL only considers business skills, business judgment and business initiative as relevant to independent contractor status Whether a working relationship is permanent or indefinite. Permanency or indefiniteness suggests the worker is an employee Independent contractors are not permanent and should not have an indefinite term The nature and degree of the employer’s control This factor should be analyzed in light of the ultimate determination of whether the worker is economically dependent on the employer Controlling one’s hours, working at home, and having little supervision are common for employees An independent contractor controls meaningful aspects of the work performed, and must conduct his or her own business Section I: Select a response Current relationship with the University of Pennsylvania. Show instructions in new window* If the answer to Question 8 is Yes, please complete sections B, C and D. Do not check the box for classification determination, but send the completed SPE and SPQ to GLobal Support Services (GSS), or submit a ticket to Tax and International Operations (TIO). GSS or TIO will assist in making the classification determination.Section II: Select a response Classification Guidelines: Complete only ONE sub-section, A, B, or C, depending on the services to be performed by the individual PLEASE NOTE: These are factors in considering whether to hire an individual as an employee. Consult with your Human Resources Manager for further guidance.Section A - Guest Lecturer/Speaker Show instructions in new windowSection B: Researchers hired to perform services for a University department or unit are initially presumed to be employees of the University. Show instructions in new windowSection C: Other individuals not covered under section A or B Show instructions in new windowSection D: Economics realities test Show instructions in new windowIRS Section Comments/QuestionsUse this space to ask any questions you have for HR about any of the questions in the IRS section. For example, these might pertain to specific case examples, or clarification based on what you are hiring the applicant for. University Employees Cannot Be Paid As Independent Contractors In almost every circumstance, University employees are not allowed to receive independent contractor type payments. Based on the Common Law Test, the following categories of workers will be considered employees not Independent Contractors while performing services for the University: University of Pennsylvania faculty, students, and/or staff performing services for the University, regardless of the source of payment (i.e. departmental accounts, government grants, foundation funds). Any individual working as a tutor. Instructors employed by any department of the University, conducting workshops, classes, or seminars on University premises for any University department, with the exception of one-time payments to guest speakers/guest lecturers as defined above. NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.