Form W 11 PDF Details

Every year, all United States taxpayers are required to file a tax return disclosing their income and financial situation to the Internal Revenue Service (IRS). For most people, this process is straightforward. However, for some taxpayers, particularly those who earn income from self-employment or other sources not subject to withholding, there may be additional steps that need to be taken in order to complete the tax return accurately. One such step is filing Form W-11, which is used by individuals claiming certain tax credits related to their employment. Let's take a closer look at what Form W-11 is and how it can help you file your tax return accurately.

Form NameForm W 11
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other names60-day, certify, w11 form, resulted

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Form W-11


Hiring Incentive to Restore Employment (HIRE) Act

Employee Affidavit

Purdue University

To be completed by new or rehired employee. Affidavit is not valid unless employee signs it.

Your Name ____________________________________________________________

(Please print.)

Social Security Number _________________PUID (if known) ____________________

First date of employment at Purdue University ________/________/________

I certify that I have not been paid for work by anyone for more than 40 hours during the 60-day period preceding the date I began employment at Purdue University. Under penalties of perjury, I declare that I have examined this affidavit and, to the best of my knowledge and belief, it is true, correct, and complete.


I was paid for work in the 60 days prior to my employment at Purdue University

Employee’s Signature ______________________________ Date _______________

Return signed form to:

Purdue University Payroll and Taxes Freehafer Hall of Administrative Services 401 South Grant Street

West Lafayette, IN 47907-2024 or Fax to (765) 494-1728

Information about this affidavit:

This affidavit resulted from the HIRE Act and provides Purdue University information about new hires’ previous employment history. Based on your response on this form, Purdue University may be eligible for a tax credit.

Signing this affidavit will not have any impact on your tax withholding or your Social Security earnings history.

You will not be asked to sign another form nor will you be asked to provide additional information.

This information is confidential and will be used for the sole purpose of requesting potential University tax credits. Your personal information will not be shared.

Form W-11, 7/12/10