Form 8952 - Application For Voluntary Classification Settlement Program (Vcsp) - Department Of Treasury
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1
28952
Application for Voluntary
Form
Classification Settlement Program (VCSP)
OMB No. 1545-2215
(Rev. November 2011)
Do not send payment with Form 8952.
See
▶
▶
Department of the Treasury
See separate instructions.
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, below.
Part I
Taxpayer Information
1 Employer Identification Number (EIN)
2 Taxpayer Name
3 Number and street (If a P.O. box, see instructions)
Room/Suite
4 City, town, state, and ZIP code
5 Telephone Number
6 Taxpayer's 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 filing consolidated returns for income tax purposes?
Yes
No
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 Employer Identification Number (EIN) of common parent
13 Number and Street (or P.O. box no. if mail is not delivered to a street address) of common parent
14 City, town, 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.
a Name and title of contact person
b Contact person address: Number and street (or P.O. box no. if mail is not delivered to a street address)
c Contact person address: City, town, or P.O. box, state, and ZIP code
d Contact person telephone number
e Contact person fax number (optional)
f Contact person email address (optional)
Part III
General Information About Workers to be Reclassified
15
Enter the number of workers from all classes to
16
Description of the class or classes of workers to be reclassified. If more
be reclassified
space is needed, attach separate sheets (see instructions).
17
Enter the beginning date of the tax period (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 from the date you
file Form 8952 (see instructions).
/
/
8952
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 11-2011)
Cat. No. 37772H
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