Form 8952
(Rev. November 2013)
Department of the Treasury
Internal Revenue Service
Application for Voluntary
Classification Settlement Program (VCSP)
Do not send payment with Form 8952.
Information about Form 8952 and its separate instructions is at www.irs.gov/form8952.
OMB No. 1545-2215
Caution. Taxpayer must make certain representations in order to be eligible to participate in the VCSP. These representations can be found in
Part V on page 2.
Part I Taxpayer Information
1 Taxpayer's name 2 Employer identification number (EIN)
3
Number and street (or P.O. box number if mail is not delivered to a street address) Room/Suite
4
City, town or post office, state, and ZIP code
5
Telephone number 6 Website address (optional)
7
Fax number (optional) 8 Email address (optional)
9 Type of entity.
Check the applicable box:
Sole proprietorship
Joint venture
Partnership
C corporation
S corporation
Cooperative organization described in section 1381 of the Internal Revenue Code
Tax-exempt organization
State or local government (for worker class or position not covered under a section 218 agreement)
Other (specify here)
10 Are you a member of an affiliated group?
Yes
No
If “Yes,” complete the common parent information on lines 11-14.
If “No,” skip to Part II.
11
Name of common parent of the affiliated group 12 EIN of common parent
13
Number and street (or P.O. box number if mail is not delivered to a street address) of common parent
14
City, town or post office, state, and ZIP code of common parent
Part II Contact Person
Attach a properly completed Form 2848, Power of Attorney and Declaration of Representative, if applicable. Also see Special
instructions for Form 2848 in the instructions.
• Name and title of contact person
• Contact person's number and street (or P.O. box number if mail is not delivered to a street address)
• Contact person's city, town or post office, state, and ZIP code
• Contact person's telephone number
• Contact person's fax number (optional)
• Contact person's email address (optional)
Part III General Information About Workers To Be Reclassified
15 Enter the total number of workers from all classes
to be reclassified. A class of workers includes all
workers who perform the same or similar
services.
16
Enter a description of the class or classes of workers to be reclassified. If
more space is needed, attach separate sheets (see instructions).
17 Enter the beginning date of the employment tax
period (calendar year or quarter) for which you
want to begin treating the class or classes of
workers as employees. This date should be at
least 60 days after the date you file Form 8952
(see instructions).
/ /
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 37772H
Form 8952 (Rev. 11-2013)
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Form 8952 (Rev. 11-2013)
Page 2
Taxpayer's name Employer identification number (EIN)
Part IV Payment Calculation Using Section 3509(a) Rates (see instructions)
18
Enter total compensation paid in the most recently completed calendar year to
all workers to be reclassified (see instructions) . . . . . . . . . . .
18
19 Multiply line 18 by 3.24% (.0324) . . . . . . . . . . . . . . . . . . . . . . . . 19
20
Enter any compensation included on line 18 that exceeded the social security
wage base for any worker or workers for the most recently completed calendar
year (see instructions) . . . . . . . . . . . . . . . . . . .
20
21 Subtract line 20 from line 18 . . . . . . . . . . . . . . . . . 21
22 Multiply line 21 by 7.44% (.0744) [7.04% (.0704) for compensation paid prior to 2013] . . . . . . 22
23 Add lines 19 and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24
Multiply line 23 by 10% (.10). This is the VCSP payment you will pay when you submit your signed
closing agreement (see instructions) . . . . . . . . . . . . . . . . . . . . . .
24
Part V Taxpayer Representations
Caution. Since the representations include the penalty of perjury statement, the representations under Part V must be signed by the
taxpayer, not the taxpayer's representative.
A Treatment of Workers
1
Taxpayer wants to voluntarily reclassify certain workers as employees for federal income tax withholding, Federal Insurance
Contributions Act, and Federal Unemployment Tax Act taxes (collectively, federal employment taxes) for future tax periods.
2 Taxpayer is presently treating the workers as nonemployees.
3
Taxpayer has filed all required Forms 1099 for each of the workers to be reclassified for the 3 preceding calendar years ending
before the date of this application.
4
Taxpayer has consistently treated the workers as nonemployees.
5
There is no current dispute between the taxpayer and the IRS as to whether the class or classes of workers are nonemployees or
employees for federal employment tax purposes.
B Examination
1 Taxpayer or, if applicable, any member of the taxpayer's affiliated group, is not under employment tax examination by the IRS.
2
Taxpayer is not under examination by the Department of Labor or any state agency concerning the proper classification of the
class or classes of workers.
3a
Taxpayer has not been examined previously by the IRS or the Department of Labor concerning the proper classification of the
class or classes of workers; or,
b
Taxpayer has been examined previously by the IRS or the Department of Labor concerning the proper classification of the class
or classes of workers and the taxpayer has complied with the results of the prior examination.
Caution. Do not send payment with Form 8952. You will submit payment later with your signed closing agreement. If you submit payment
with Form 8952, it may cause a processing delay.
Sign Here
Under penalties of perjury, I declare that I have examined this submission, including any accompanying documents, and to the best of my knowledge and
belief, all of the facts contained herein are true, correct, and complete.
Taxpayer's signature
Date
Paid
Preparer
Use Only
Print/Type preparer's name Preparer's signature Date
Check if
self-employed
PTIN
Firm's name
Firm's address
Firm's EIN
Phone no.
Form 8952 (Rev. 11-2013)
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click to sign
signature
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signature
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