DETERMINATION OF EMPLOYMENT WORK STATUS FOR PURPOSES OF STATE OF CALIFORNIA EMPLOYMENT TAXES AND PERSONAL INCOME TAX WITHHOLDING Purpose This form is to be used by business entities who would like to receive a determination as to whether a worker is an employee for purposes of California Unemployment Insurance, Employment Training Tax, State Disability Insurance (SDI)*, and Personal Income Tax (PIT) withholding. General Information For assistance in completing this form, contact your local Employment Tax Office of the Employment Development Department (EDD) or call the Taxpayer Assistance Center at 1-888-745-3886. Upon completion, return to: State of California Employment Development Department FACD-Central Operations, MIC 94 PO Box 826880 Sacramento, CA 94280-0001 The EDD may need to contact you if additional information is required. * Includes Paid Family Leave (PFL). This form should be completed carefully, and it should be completed for one individual who is a representative of the class of workers whose status is in question. If a written determination is desired for another class of workers, complete a separate DE 1870. A written determination for any worker will apply to other workers of the same class if facts are the same as those of the worker whose status is the subject of the written determination. This form is designed to cover many work activities. Some of the questions may not apply to you. You must answer questions 1-39 or mark them 223UNKNOWN224 or 223DOES NOT APPLY.224 Answer questions 40-79 only if applicable. If additional space is needed, please attach another sheet with the question number clearly identified. Write your business name, federal identification number, and the EDD employer payroll tax account number at the top of each additional sheet attached to this form. PLEASE TYPE OR PRINT ALL INFORMATION CLEARLY. NAME OF ENTITY NAME OF OWNER ADDRESS OF ENTITY (CITY) (STATE) (ZIP CODE) PHONE NUMBER (INCLUDING AREA CODE) ENTITY222S FEDERAL EMPLOYER IDENTIFICATION NUMBER ENTITY222S EDD EMPLOYER PAYROLL TAX ACCOUNT NUMBER Check the type of entity for which the work relationship is in question: Individual Partnership Corporation Limited Liability Company (LLC) Limited Liability Partnership (LLP) Other (specify): If the entity is a corporation, is the worker an officer of the corporation? Yes No If the entity is an LLC, is the worker a member of the LLC? Yes No If the entity is an LLC, how is the LLC treated for federal income tax reporting purposes? Sole Proprietorship Partnership Corporation DE 1870 Rev. 14 (12-18) (INTERNET) Page 1 of 7 CU American LegalNet, Inc. www.FormsWorkFlow.com 1. Provide a brief description of the entity 222s busi ness operation (e.g., drug store, farmer, construction , etc. ): 2. Has this issue been the subject of a prior or current EDD audit, benefit claim investigation, hearing, or prior DE 1870 determination? Yes No Unknown If 223Yes,224 please explain and provide any applicable dates: 3. Has any other governmental agency ruled on the status of services performed by the worker or another person performing the same or similar services? Yes No Unknown If 223Yes,224 please attach a copy. 4. Total number of workers in this class: Attach names, addresses, and phone numbers of the workers in this class. If there are more than 10 workers, attach the information for only 10. 5. This information is about services performed by the worker from to . (Date) (Date) 6. State the worker222s occupation, title, and give a complete description of the services provided: 7. How did the worker learn of the job (e.g., advertisement, online, in a newspaper, word of mouth, etc. If there was a job announcement, please attach a copy.): 8. What were the requirements for the worker222s position (e.g., previous experience, education, etc.): 9. Is the worker still performing services for the entity? Yes No If 223No,224 explain why and how the worker was terminated, laid off, or quit: 10. Were the services performed under a written agreement or contract? Yes No If 223Yes,224 please attach a copy. 11. If the agreement was not in writing, or the terms of the written agreement were not complied with in practice, describe the actual terms and conditions of the arrangement: 12. Was it agreed or understood that the worker would perform the services personally? Yes No If 223No,224 please explain: DE 1870 Rev. 14 (12-18) (INTERNET) Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 13a. Does the worker have helpers? Yes No If 223Yes,224 answer questions 13b through 13g. If 223No,224 go to question 14. b. Who hired the helpers? Worker The entity Unknown c. Who could discharge the helpers? Worker The entity Unknown d. Who paid the helpers? Worker The entity Unknown e. If the worker paid the helpers, did the entity reimburse the worker? Yes No Unknown f. What services do the helpers perform? g. Are Social Security/Medicare (FICA), SDI, and PIT withheld from the helpers222 wages? Yes No Unknown If 223Yes,224 who reports and pays these taxes? 14a. Was the worker permitted to provide services for others during the same time periods services were performed for the entity? Yes No Unknown If 223Yes,224 answer questions 14b through 14f. If 223No224 or 223Unknown,224 go to question 15. b. What percent of the worker222s total working time was spent working for others? c. What percent of the worker222s total income was earned from others? d. Describe services the worker performed for others: e. Did the entity have first call on the worker222s time and efforts? Yes No Unknown f. Who owned or rented the premises where the services were performed? 15a. List the kind and value of tools, equipment, and/or facilities furnished by the entity: b. Was the worker required to wear a uniform or badge? Yes No If 223Yes,224 describe what the worker was required to wear: Who paid for the items? 16. List the kind and value of tools, equipment, and/or facilities furnished by the worker? 17a. List any expenses connected with the services of the worker: b. Who was responsible for paying these expenses? c. Was the worker reimbursed by the enitity for any of these expenses? Yes No 18. Did the worker perform under: His/her business name The entity222s name 19. Did the worker advertise or maintain a business listing in the phone directory, a trade journal, Internet, etc.? Yes No Unknown If 223Yes,224 please attach a copy. DE 1870 Rev. 14 (12-18) (INTERNET) Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 20a. Did the worker hold himself/herself out to the public as available to provide services of this nature? Yes No Unknown If 223Yes,224 please explain: b. Or any other nature? Yes No Unknown If 223Yes,224 please explain: 21. Did the worker have an office or shop of his/her own? Yes No Unknown If 223Yes,224 where (e.g., was the office in the worker222s home or was it rented office space?): 22a. Was a license or certificate required to perform the services? Yes No Unknown If 223Yes,224 does the entity possess such a valid license or certificate? Yes No If 223Yes,224 does the worker possess such a valid license or certificate? Yes No Unknown b. Who issued the license or certificate to the entity and/or worker? State type and number for the entity and/or worker: c. Who paid the worker222s license or certificate fee? 23. How did the entity engage the worker? Full-time Part-time Particular Job Indefinite Period Other, please explain: 24. Did the entity require the worker to perform during a scheduled time? Yes No If 223Yes,224 please explain: 25a. Was the worker provided training by the entity? Yes No If 223Yes,224 what kind and how often? b. Who paid for the worker222s training expenses? c. Was the worker provided an orientation by the entity? Yes No If 223Yes,224 please describe: 26. Was the worker required to follow a work schedule by the entity specifying days and hours in which work had to be performed? Yes No If 223Yes,224 please provide work schedule: Who established the work schedule? 27. Was the worker given instructions about the way the service was to be performed? Yes No If 223Yes,224 explain the nature of the instructions: 28. Could the e