Appendix C

FORM T-27 REQUEST FOR SPECIAL PAYMENT The University of Tennessee Request for Special Payment _____Independent Contractor _____Employee _____Company Name ___________________________________Date__________ (Last, First, MI or Company Name) Address _________________________________________________ ________________________________________________________ ________________________________________________________ Note: Checks and other information will be mailed to this address. Page 14 of 21 pages SSN/FED ID:_____________________________ Citizen _____ 1 US Citizen POLICIES AND PROCEDURE FOR PERSONAL CHAPTER 1720-1-4 SERVICE, PROFESSIONAL SERVICE, AND CONSULTANT SERVICE CONTRACTS Status _____ 2 Resident Alien _____ 3 Non-Resident Alien Visa Type: ______________________________ Visa Expiration Date: _______________________ Country of Citizenship: _______________________ For Employees Only: Sex ___ 1 Male ___ 2 Female Marital Status ___ M Married ___ S Single Birthdate_____/_____/_____ Mo Day Year Race ___ 1 Caucasian ___ 2 American Indian or Alaskan Native ___ 3 Black ___ 4 Hispanic ___ 5 Asian or Pacific Islander Description of Services Performed ______________________________ __________________________________________________________ __________________________________________________________ Dates of Service____________________________________________ Contract Date From__________________ To_____________________ Contract Tracking No.:_______________________________________ Hour/Day/Week _______xRate _______=Amount to Pay_________ Check Stub Information Description of Services_______________________________________ Amount___________________________________________________ Account No. to be Charged____________________________________ Object Code:_______________________________________________ Amount:__________________________________________________ APPROVALS: I hereby certify that, to the best of my knowledge, the above described services have been rendered and it is proper for the University to make payment. Signature__________________________________________________ Date______________________________________________________ Department Head’s Certification: I hereby certify that the individual identified on the front of this form meets all the conditions stated above and is properly classified as an independent contractor. ______________________________________ _______________ Authorization Signature Date (1) Employee or Independent Contractor? POLICIES AND PROCEDURE FOR PERSONAL CHAPTER 1720-1-4 SERVICE, PROFESSIONAL SERVICE, AND CONSULTANT SERVICE CONTRACTS (a) The T-27 form will continue to be used to request special payments for goods or services that fall within the guidelines of Fiscal Policy Statement 05, Section 130, Part 03(C). (b) Individuals who provide a service to the University must be classified as either an Independent Contractor or an Employee. To determine if a worker is an employee or independent contractor, the University must apply the Internal Revenue common law test of control. Under this test, if the University has the right to control and direct what a worker does and how he/she does it, an employee relationship exists. If there is no control, the worker can be classified as an independent contractor. (2) Individuals Classified as Independent Contractors: (a) If an individual meets all of the following conditions, he/she may be classified as an independent contractor: 1. The University controls only the results of the work, not how it gets done. 2. The individual assumes a business risk (assumes all expenses for personnel, equipment and materials) as a result of this association with the University. 3. The individual is responsible for paying and reporting applicable self-employment tax. 4. The individual is free to complete the assigned task without control or direction from the University. 5. The individual’s association with the University normally ceases upon completion of a specified project. 6. The individual is free to work for other entities. 7. The individual has declared himself/herself to be an independent contractor when providing similar services to the general public. (b) Department Head’s Certification: 1. I hereby certify that the individual identified on the front of this form meets all the conditions stated above and is properly classified as an independent contractor. ____________________________ ____________ Authorization Signature Date (c) If an independent contractor is not a U.S. citizen, a copy (front and back) of his/her I-94 or I-20 form must be obtained and attached to the T-27 form. Non-U.S. citizens are required by the U.S. Federal government to have these documents in their possession. (3) Individuals Classified as Employees (a) If the individual does not meet the guidelines shown above, he/she must be classified as an employee. The W-4 form provided on the T-27 form must be completed and signed by the individual. Additionally, an I-9 form must be completed and submitted with the T-27 form. If the individual is a non-resident alien, a copy (front and back) of his/her I-94 or I-20 form must accompany the T-27 form. If a non-resident alien qualifies for exemption under a tax treaty, an IRS form 8233 must accompany the T-27 form. Non-resident aliens claiming "resident" POLICIES AND PROCEDURE FOR PERSONAL CHAPTER 1720-1-4 SERVICE, PROFESSIONAL SERVICE, AND CONSULTANT SERVICE CONTRACTS status must complete an IRS form 1078. Forms and further explanation regarding non- residents are available at the Payroll Office.