Form 8952 - Application For Voluntary Classification Settlement Program (Vcsp)
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28952
Application for Voluntary
Form
Classification Settlement Program (VCSP)
OMB No. 1545-2215
(Rev. December 2012)
Do not send payment with Form 8952.
▶
Department of the Treasury
Information about Form 8952 and its separate instructions is at
Internal Revenue Service
▶
Caution. Taxpayer must make certain representations in order to be eligible to participate in the VCSP. These representations can be found in
Part V on page 2.
Part I
Taxpayer Information
1 Taxpayer's name
2 Employer identification number (EIN)
3 Number and street (or P.O. box number if mail is not delivered to a street address)
Room/Suite
4 City, town or post office, state, and ZIP code
5 Telephone number
6 Website address (optional)
7 Fax number (optional)
8 Email address (optional)
9 Type of entity. Check the applicable box:
Sole proprietorship
Cooperative organization described in section 1381 of the Internal Revenue Code
Joint venture
Tax-exempt organization
Partnership
State or local government (for worker class or position not covered under a section 218 agreement)
C corporation
Other (specify here)
S corporation
10 Are you a member of an affiliated group?
No
Yes
If “Yes,” complete the common parent information on lines 11-14.
If “No,” skip to Part II.
11 Name of common parent of the affiliated group
12 EIN of common parent
13 Number and street (or P.O. box number if mail is not delivered to a street address) of common parent
14 City, town or post office, state, and ZIP code of common parent
Part II
Contact Person
Attach a properly completed Form 2848, Power of Attorney and Declaration of Representative, if applicable.
• Name and title of contact person
• Contact person's number and street (or P.O. box number if mail is not delivered to a street address)
• Contact person's city, town or post office, state, and ZIP code
• Contact person's telephone number
• Contact person's fax number (optional)
• Contact person's email address (optional)
Part III
General Information About Workers To Be Reclassified
15 Enter the total number of workers from all classes
16 Enter a description of the class or classes of workers to be reclassified. If
to be reclassified. A class of workers includes all
more space is needed, attach separate sheets (see instructions).
workers who perform the same or similar
services.
17 Enter the beginning date of the employment tax
period (calendar year or quarter) for which you
want to begin treating the class or classes of
workers as employees. This date should be at
least 60 days after the date you file Form 8952
(see instructions).
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8952
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 12-2012)
Cat. No. 37772H
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