Maine Predetermination Form PDF Details

The Maine Predetermination Form is a crucial instrument for individuals seeking to establish themselves as independent contractors within the state's legal framework, offering both an affirmation of status and a protective guide against inadvertent misclassification. This meticulous form, officially recognized under Title 39-A M.R.S.A. §13-A, serves as a foundational element in the differentiation between an employee and an independent contractor, a distinction that carries significant implications for both parties in terms of responsibilities, rights, and benefits. The application process is designed to be comprehensive yet accessible, demanding from applicants detailed information regarding the nature of their work, the extent of their autonomy in it, the structure of their business, and their financial engagement in the success or failure of their endeavors. The repercussions for the submission of a fraudulent or intentionally misleading form are severe, encompassing fines of up to $1,000 for individuals and up to $10,000 for corporations, partnerships, or other legal entities. Remarkably, the form's approval does not only hinge on the potential contractor's claimed independence but also on the sustainable demonstration of such autonomy through the fulfillment of specific criteria. These include the necessity for the applicant to possess an essential right to control the progression of the work, to be engaged in an independently established business, and to exhibit an opportunity for profit and loss, among others. Moreover, the form delineates additional qualifications that further solidify the applicant's status as an independent contractor, ensuring a thorough vetting process

.

QuestionAnswer
Form NameMaine Predetermination Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesmaine wcb 266, predetermination form maine, maine independent form, predetermination independent

Form Preview Example

IMPORTANT: PLEASE READ BEFORE COMPLETING APPLICATION

NOTICE TO APPLICANT: Predetermination of independent contractor status is based upon the information provided in this application. Participation in the submission of a fraudulent or intentionally misleading form can result in fines of up to $1,000 for an individual and up to $10,000 for a corporation, partnership or other legal entity.

The predetermination WILL NOT apply if you do not perform work consistent with the information provided in this application.

Title 39-A M.R.S.A. §13-A establishes that: A person who performs services for remuneration is presumed to be an employee unless the employing unit proves that the person is free from the essential direction and control of the employing unit, both under the person's contract of service and in fact and the person meets specific criteria. In order for a person to be an independent contractor:

A.The following criteria must be met:

(1)The person has the essential right to control the means and progress of the work except as to final results;

(2)The person is customarily engaged in an independently established trade, occupation, profession or business;

(3)The person has the opportunity for profit and loss as a result of the services being performed for the other individual or entity;

(4)The person hires and pays the person's assistants, if any, and, to the extent such assistants are employees, supervises the details of the assistants' work; and

(5)The person makes the person's services available to some client or customer community even if the person's right to do so is voluntarily not exercised or is temporarily restricted; and

B.At least 3 of the following criteria must be met:

(1)The person has a substantive investment in the facilities, tools, instruments, materials and knowledge used by the person to complete the work;

(2)The person is not required to work exclusively for the other individual or entity;

(3)The person is responsible for satisfactory completion of the work and may be held contractually responsible for failure to complete the work;

(4)The parties have a contract that defines the relationship and gives contractual rights in the event the contract is terminated by the other individual or entity prior to completion of the work;

(5)Payment to the person is based on factors directly related to the work performed and not solely on the amount of time expended by the person;

(6)The work is outside the usual course of business for which the service is performed; or

(7)The person has been determined to be an independent contractor by the federal Internal Revenue Service.

1

WCB-266 (eff. 08/01/2013)

STATE OF MAINE

WORKERS’ COMPENSATION BOARD

27 STATE HOUSE STATION

AUGUSTA, ME 04333-0027

Tel. 207-287-7071 / Fax 207-287-5413

APPLICATION FOR PREDETERMINATION OF INDEPENDENT CONTRACTOR STATUS

TO ESTABLISH A REBUTTABLE PRESUMPTION

NOTICE

The predetermination process is voluntary under the Maine Workers’ Compensation Act. The Act DOES NOT require an individual to receive an approved predetermination before working as an independent contractor.

If you file this application, it may be: Granted or denied (you will receive a letter to this effect); or, instead of denying it, the Board may return your application and request additional information.

By submitting this Application you are not relinquishing your rights to be covered under the Maine Workers’ Compensation Act—if you are injured you may still file a claim with the Board.

Approved predeterminations are “portable” (may be submitted to any employing unit) and are valid for one year from the date of approval.

The predetermination is only valid with respect to an employing unit if you work consistent with the answers on this application

A predetermination from the Board is not binding on the Department of Labor.

You must retain a copy of this application for your records. You may be required to produce this application along with the decision that you receive from the Board.

Pursuant to 39-A M.R.S.A. § 105, ______________________________________(Applicant Name (and d/b/a if

you use one)) hereby requests a predetermination by the Maine Workers’ Compensation Board that the Applicant is an independent contractor.

APPLICANT

Name: _______________________________________________________________________________

Doing Business As (d/b/a) (if applicable): ___________________________________________________

Complete Mailing address: ______________________________________________________________

STREET/P.O. BOXAPT. NO.

______________________________________________________________

CITY

STATE

ZIP CODE

Telephone: ___________________________________________________________________________

E-mail address: ________________________________________________________________________

Type of work you do: ___________________________________________________________________

Note: Information provided on this form, not otherwise confidential, may be shared with other state and federal agencies.

2

WCB-266 (eff. 08/01/2013)

SECTION I

THIS APPLICATION IS NOT COMPLETE UNLESS YOU ANSWER ALL OF THE QUESTIONS IN THIS SECTION AND PROVIDE ALL REQUIRED INFORMATION.

INCOMPLETE APPLICATIONS WILL BE RETURNED.

(1)The person has the essential right to control the means and progress of the work except as to final results.

(a)

Do you have the right to decide how to perform your work?

Yes

No

(b)

Other than the completion date for the work, do you have the right to determine when

 

you will perform your work?

Yes

No

(2)The person is customarily engaged in an independently established trade, occupation, profession or business.

(a)Please state your trade, occupation, profession or business.

___________________________________________________________________

(b)Please indicate how your business is organized:

sole proprietor

corporation

limited liability company

partnership

professional corporation

(c)How long have you been considered independent in your trade, occupation, profession or business?

____________________________________________________________________

(d)Have you worked for or searched for work from more than one source during the 12

months prior to the date of this application?

Yes No

(e)Did you file a corporate or partnership income tax return last year for the trade, occupation, profession or business listed in Question 2(a)?

Yes No

(f)Did you file Schedule C, Schedule E or Schedule F with your personal income tax return last year for the trade, occupation, profession or business listed in Question

2(a)?

Yes No

(g)Did you pay self-employment tax and file Schedule SE with the I.R.S. last year for the trade, occupation, profession or business listed in Question 2(a)?

Yes No

3

WCB-266 (eff. 08/01/2013)

(h) If you answered “No” to Questions 2 (e), (f) and (g), please explain:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(3)The person has the opportunity for profit and loss as a result of the services being performed for the other individual or entity.

(a)Check each of the following expenses you paid in the last 12 months in order to perform your work:

rent and utilities

tools and equipment

training

advertising

payments to business managers and agents

wages or salaries of assistants

licensing/certification/ professional dues

insurance

postage and delivery

repairs and maintenance

supplies

travel

leasing of equipment

depreciation

inventory/cost of goods sold

other

(b) Do you ever provide the materials necessary to complete your work? Yes No

(c)Do you ever provide the tools and/or equipment necessary to complete your work?

Yes No

(d)Can you make more money based on how you do your work? For example, if material costs are lower than expected, or the job does not take as long as expected.

Yes No

(e)Can you lose money doing your work? For example, if material costs are higher than expected, the job takes longer than expected, or re-work must be done due to a

 

mistake or flaw, etc.

Yes

No

(f)

Are you responsible for completing the work you agree to do?

Yes

No

(g)

If you fail to do quality work, do you have to redo the work or fix the mistake at no

 

additional cost to the people or businesses who hired you?

Yes

No

4

WCB-266 (eff. 08/01/2013)

(4)The person hires and pays the person's assistants, if any, and, to the extent such assistants are employees, supervises the details of the assistants' work.

(a)

Can you, if you want, use assistants and/or subcontractors to perform, or help

 

 

perform, your work?

Yes

No

 

If “No” please explain:

 

 

 

_____________________________________________________________________

 

_____________________________________________________________________

 

_____________________________________________________________________

(b)

Do you use assistants to perform your work?

Yes

No

 

(If “Yes,” answer questions (c), (d) and (e). If “No,” proceed to question (5).)

 

(c)

Are you responsible for paying your assistants?

Yes

No

(d)Are you personally responsible for supervising the details of your assistants’ work?

Yes No

(e)Do you provide Workers’ Compensation coverage for any individuals who work

with you?

Yes No

(5)The person makes the person's services available to some client or customer community even if the person's right to do so is voluntarily not exercised or is temporarily restricted.

(a) Do you advertise?

Yes No

(b)Do you have the right to work for more than one person or business at a time?

Yes No

(c)Other than the completion date for the work, do you determine what you work on,

how you will perform the work and when you will work on it?

Yes No

5

WCB-266 (eff. 08/01/2013)

SECTION II

YOU MUST ANSWER ALL QUESTIONS IN THIS SECTION. SATISFACTORY ANSWERS TO AT LEAST THREE (3) QUESTIONS ARE REQUIRED TO QUALIFY. INCOMPLETE APPLICATIONS WILL BE RETURNED.

(6)The person has a substantive investment in the facilities, tools, instruments, materials and knowledge used by the person to complete the work.

(a)

Have you made a substantive investment in the facilities, tools, instruments, materials

 

or knowledge you use to complete your work?

Yes

No

(b)

Do you provide the essential equipment or knowledge that is used to complete your

 

work?

Yes

No

(c)

Are you required to lease essential equipment from the people or businesses who

 

hired you?

Yes

No

(d)

If the answer to (6)(c) is “Yes,” are you paying fair market value for the equipment

 

that you are leasing?

Yes

No

(7) The person is not required to work exclusively for the other individual or entity.

(a) Are you required to work exclusively for one person or business?

Yes No

(b)Have you worked for more than one person or business during the past 12 months?

Yes No

(c)Do you have the right to refuse work offered by the people or businesses hiring you?

Yes No

(8)The person is responsible for satisfactory completion of the work and may be held contractually responsible for failure to complete the work.

(a)If you do not complete the work you agree to do in your contracts (verbal or written),

are you potentially liable to pay the people for the damages they suffer as a result of

this failure?

Yes No

(b)If you fail to do quality work, do you have to redo the work or fix the mistake at no additional cost to the people who hired you, or potentially pay them money damages

so they can have the work redone or fixed?

Yes No

(9)The parties have a contract that defines the relationship and gives contractual rights in the event the contract is terminated by the other individual or entity prior to completion of the work.

(a) Do you have agreements (verbal or written) with the people or businesses who hire

you?

Yes No

6

WCB-266 (eff. 08/01/2013)

(b)If the people or businesses that hire you cancel your contracts (verbal or written) before you have an opportunity to complete the work, are they potentially liable to pay you the money you would have received if you had completed the work?

Yes No

(10)Payment to the person is based on factors directly related to the work performed and not solely on the amount of time expended by the person.

(a)

Are you paid by the hour for your work?

Yes

No

(b)

If paid by the hour, do you negotiate your rates?

Yes

No

(c)

Are your contracts (verbal or written) for specific work at a set price?

Yes

No

(d)If the answers to 10 (a),(b) or (c) are “No,” please explain.

___________________________________________________________________

___________________________________________________________________

(11)The work is outside the usual course of business for which the service is performed.

(a)Is the work you do different than the work performed by the people or businesses that

hire you?Yes No

(b) Have you worked as an employee for any of the people or businesses for which you

currently work?Yes No If yes, please provide the most recent date of your employment: _________________

(12)The person has been determined to be an independent contractor by the federal Internal Revenue Service.

The Internal Revenue Service allows businesses or workers to a request a determination as to whether or not a worker is an independent contractor. These determinations can be requested by filing Form SS-8, Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding with the I.R.S.

(a)

Have you filed Form SS-8 with the I.R.S.?

 

Yes

No

(b)

If you filed Form SS-8, have you received a determination?

Yes

No

(c)

If you received a determination, please check the appropriate box:

 

 

 

Approved

Denied

Other

 

 

Please provide the date the I.R.S. issued its determination: __________________.

7

WCB-266 (eff. 08/01/2013)

APPLICANT

THIS APPLICATION MUST BE SIGNED.

UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.

Read carefully and sign below:

I hereby certify the foregoing information is truthful and accurate. I understand if any information contained in this application is found to be intentionally misleading or fraudulent, the predetermination of independent contractor status shall be nullified and I may be subject to fines as described on page 1.

I further understand this predetermination of independent contractor status is based upon the information provided in this application. I understand changes in these circumstances may nullify the predetermination of independent contractor status. I agree to notify the Workers’ Compensation Board of any changes to the information in this application or the circumstances described herein.

You must retain a copy of this application for your records. You may be required to produce this application along with the decision that you receive from the Board.

______________

________________________________

Date

Signature of Applicant

8

WCB-266 (eff. 08/01/2013)

How to Edit Maine Predetermination Form Online for Free

Whenever you want to fill out maine predetermination, you won't have to install any kind of applications - simply try our PDF tool. To have our tool on the cutting edge of practicality, we aim to implement user-oriented features and enhancements regularly. We're routinely glad to receive feedback - assist us with remolding PDF editing. To start your journey, consider these basic steps:

Step 1: First, access the pdf editor by pressing the "Get Form Button" at the top of this webpage.

Step 2: When you launch the editor, there'll be the form all set to be completed. Other than filling in various fields, you may as well do other sorts of things with the form, such as putting on custom text, changing the initial text, inserting illustrations or photos, signing the document, and more.

It is actually an easy task to complete the pdf with our practical guide! Here is what you should do:

1. To begin with, when completing the maine predetermination, begin with the area that has the next blanks:

Completing section 1 of maine independent form

2. Once the previous array of fields is completed, you're ready include the essential particulars in The person has the essential, a Do you have the right to decide, Yes No, b Other than the completion date, you will perform your work, The person is customarily engaged, a Please state your trade, b Please indicate how your, sole proprietor corporation, c How long have you been, and profession or business allowing you to move forward further.

Best ways to fill in maine independent form stage 2

3. In this specific step, look at d Have you worked for or searched, months prior to the date of this, e Did you file a corporate or, occupation profession or business, Yes No, f Did you file Schedule C Schedule, Yes No, g Did you pay selfemployment tax, the trade occupation profession or, Yes No, and WCB eff. All of these will need to be filled in with greatest focus on detail.

Step # 3 of filling out maine independent form

4. Filling out h If you answered No to Questions, The person has the opportunity, a Check each of the following, perform your work, rent and utilities tools and, assistants, and insurance postage and delivery is paramount in the fourth part - make sure you don't rush and take a close look at every single empty field!

How one can fill in maine independent form stage 4

5. As a final point, the following last section is precisely what you have to finish before finalizing the document. The blanks in this instance are the next: assistants, licensingcertification, professional dues, insurance postage and delivery, b Do you ever provide the, c Do you ever provide the tools, Yes No, d Can you make more money based on, material costs are lower than, e Can you lose money doing your, expected the job takes longer than, Yes No, f Are you responsible for, Yes No, and g If you fail to do quality work.

How one can fill in maine independent form part 5

It's simple to get it wrong while filling out your d Can you make more money based on, so be sure to look again before you send it in.

Step 3: Once you have looked over the information you filled in, click on "Done" to complete your FormsPal process. Right after starting afree trial account at FormsPal, it will be possible to download maine predetermination or email it directly. The file will also be accessible via your personal account with your every single modification. FormsPal ensures your data confidentiality by using a protected method that in no way records or distributes any kind of sensitive information typed in. You can relax knowing your docs are kept confidential every time you work with our editor!