Michigan Workers Independent Contractor Worksheet PDF Details

If you are a Michigan worker who is designated as an independent contractor, it is important to understand the tax and reporting requirements associated with that designation. The Michigan Workers Independent Contractor Worksheet Form can help you to do just that. This worksheet will allow you to report your business income and expenses, as well as your estimated tax payments. By understanding your responsibilities as an independent contractor, you can be sure that you are meeting all of the necessary requirements.

You may find info about the type of form you need to prepare in the table. It will show you how much time it will take to fill out michigan workers independent contractor worksheet, exactly what parts you will need to fill in and several other specific details.

QuestionAnswer
Form NameMichigan Workers Independent Contractor Worksheet
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform michigan placement, compensation certificate michigan, michigan workers compensation placement facility independent contractor worksheet, michigan workers compensation independent contractor worksheet

Form Preview Example

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY

P.O. Box 3337 Livonia, MI 48151-3337

(734) 462-9600 Fax (734) 462-9721

Internet WEB Site: www.caom.com E-Mail: caom@caom.com

October 3, 2008

CIRCULAR LETTER #222

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY (MWCPF)

INDEPENDENT CONTRACTOR WORKSHEET

It has been an accepted practice in the residual market to consider a sole proprietor without employees as an independent contractor, if a Certificate of Insurance (COI) for the individual is presented. Effective July, 1, 2009, this practice will cease in the residual market (on new and renewal policies as of that date). In order for a sole proprietor without employees to be considered for independent contractor status, the MWCPF Independent Contractor Worksheet must be completely filled out and supplied to the entity undergoing a workers compensation audit.

Attached is a copy of the worksheet. As indicated on the worksheet, additional information may be requested to determine independent contractor status.

Sincerely,

Gary L. Thompson

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY

INDEPENDENT CONTRACTOR WORKSHEET

TO BE COMPLETED BY THE INDEPENDENT CONTRACTOR

Policyholder Name form is being filled out for:

Subcontractor Name:

Doing Business As (DBA):

 

 

If DBA is filed, attach a copy.

 

1. I operate as a :

Sole Proprietor

Partnership

Corporation

Limited Liability Company

Note: If indicating

Partnership, Corporation or Limited Liability Company, a Certificate of Workers’

Compensation Insurance or a properly filed Form BWC-337 must be submitted.

 

2.The type of work I perform can be described as:

3.I hire employees or casual laborers to complete work for the named policyholder:

Yes

 

Number hired (Attach Certificate of Workers’ Compensation Insurance)

No

Form 1040 SCHEDULE C (Profit or Loss from Business) may be provided as verification.

4. I hire subcontractors to complete work for the named policyholder: Yes No If yes, additional information may be required.

5. I have General Liability coverage: Yes No

If yes, a Certificate of General Liability Insurance is required.

6.To validate my standing as an independent contractor, I state that I do not exclusively depend upon the payments of the named policyholder and have worked for the following general contractors or clients during the past twelve months.

NAME

CITY

TELEPHONE

1.

2.

3.

I acknowledge that as a sole proprietor, I am by law not covered by or subject to the Workers’ Disability Compensation Act.

I certify the above represents a true and complete statement of my status as an Independent Contractor. I understand a company representative may verify this statement at any time. If requested, I agree to provide documentation to verify my status as a sole proprietor.

Signed:

 

 

 

 

Date:

 

 

 

(Independent Contractor)

Phone Number:

 

Email Address :

 

(Required)

This form is utilized as a test of the above individual’s independent status. By completing this form, it does not automatically remove the above individual’s exposure from the audit of the policy period in question. Additional information may be required. If independent status is proven, the exposure will not be charged.

ICW08

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