Independent Contractor Classification Request

Complete this form

Warning: This determination must be made before services are rendered or the individual will be classified and paid as an employee. This will require further review and completion of entire Classification Checklist.
Length of Service: * Required
- Less than 12 months
- 12 months or more, please provide a brief explanation in the field below
brief explanation of 12 or more months of service * Required
Anticipated renewal of contract? * Required
- Yes, please provide a brief explanation in the field below
- No
Brief explanation of renewal of contract * Required
Total cost of service: * Required
- Less than $10,000
- $10,000 or more Please Contact Procurement
Location where service is performed: * Required
Note: If location of service is out-of-state, review may take additional time for approval.
- In-State
- Out-of-State
- Both - please provide the states and approximate % of work performed in each state in the field below
If Out-of-State, please specify location * Required
Both In-State and Out-of-State explanation * Required

Save and Continue Later