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The Maine Predetermination form is a crucial document for individuals seeking to establish their status as independent contractors under the state's Workers' Compensation Act. This form serves as a means to clarify the relationship between the worker and the employing unit, determining whether the individual is classified as an independent contractor or an employee. Applicants must provide detailed information regarding their work arrangements and must meet specific criteria outlined in Title 39-A M.R.S.A. §13-A. This includes demonstrating the right to control their work processes, being engaged in an independently established trade, and having the opportunity for profit and loss. The form also outlines additional criteria that must be satisfied, such as having a substantive investment in tools and materials, and not being required to work exclusively for one entity. It is important to note that the predetermination process is voluntary; individuals are not mandated to obtain approval before working as independent contractors. However, submitting the application can provide a rebuttable presumption of independent contractor status, which is valid for one year upon approval. The form emphasizes the importance of accuracy, as any fraudulent information can lead to significant fines. Retaining a copy of the application is also advised, as it may be required for future reference or verification.
Dos and Don'ts
Things You Should Do:
- Read the entire application carefully before filling it out.
- Provide accurate and truthful information to avoid penalties.
- Answer all questions completely; incomplete applications will be returned.
- Keep a copy of the completed application for your records.
- Submit the application even if you do not need an approved predetermination to work.
Things You Shouldn't Do:
- Do not submit false or misleading information.
- Avoid leaving any questions unanswered; this can delay the process.
- Do not assume the predetermination applies if your work does not match the information provided.
- Do not forget to check if you need to provide additional information if requested.
- Do not ignore the importance of retaining the decision letter from the Board.
Key takeaways
Understand the Purpose: The Maine Predetermination form is essential for determining if you qualify as an independent contractor. It helps clarify your work status based on the information you provide.
Be Honest and Accurate: Providing false information can lead to significant fines. It's crucial to answer all questions truthfully to avoid complications.
Know the Criteria: Familiarize yourself with the specific criteria that define an independent contractor. You must meet both primary and additional criteria to be classified as such.
Keep Records: Retain a copy of your application and the Board's decision. You may need to present these documents in the future to verify your independent contractor status.
Understand the Process: The predetermination process is voluntary. While you can file for predetermination, it’s not mandatory before starting work as an independent contractor.
Instructions on Filling in Maine Predetermination
Filling out the Maine Predetermination form is a crucial step in establishing your status as an independent contractor. After completing this form, you will submit it to the Maine Workers’ Compensation Board. They will review your application and determine whether to grant or deny your request for predetermination. You may receive a letter informing you of their decision, or they may ask for additional information if needed.
- Gather your personal information: Write down your full name, any doing business as (d/b/a) name, complete mailing address, telephone number, and email address.
- Describe your work: Clearly state the type of work you do.
- Complete Section I: Answer all questions in this section thoroughly. Incomplete applications will be returned.
- Control of Work: Indicate whether you have the right to control how and when you perform your work by answering the Yes/No questions.
- Trade and Business Information: Provide details about your trade, how your business is organized, how long you have been independent, and whether you have worked for multiple sources in the past year.
- Tax Information: Answer questions regarding your tax filings related to your business, including whether you filed a corporate or partnership income tax return.
- Profit and Loss: Check all relevant expenses you incurred in the last 12 months, and answer questions about your responsibility for materials, tools, and financial outcomes.
- Assistants and Subcontractors: Indicate whether you use assistants or subcontractors, and answer questions regarding your responsibility for their payment and supervision.
- Availability of Services: Answer questions about your advertising efforts and your ability to work for multiple clients or businesses simultaneously.
- Review your application: Ensure all questions are answered, and all required information is included before submitting.
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What is the purpose of the Maine Predetermination form?
The Maine Predetermination form is used to determine whether an individual qualifies as an independent contractor under Maine law. By completing this form, you provide information that helps establish your status, which can protect you from being classified as an employee. This distinction is crucial for understanding your rights and responsibilities, especially regarding workers' compensation coverage.
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Who should complete the Predetermination form?
Anyone who believes they are working as an independent contractor in Maine should consider completing this form. This includes individuals who provide services for remuneration and want to clarify their status. However, it's important to note that filling out this form is voluntary; you are not required to obtain a predetermination before starting work as an independent contractor.
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What happens after I submit the application?
Once you submit your application, the Maine Workers’ Compensation Board will review it. They may grant or deny your request, or they might ask for additional information if your application is incomplete. You will receive a letter informing you of their decision. If approved, your predetermination is valid for one year and can be used with any employing unit.
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What are the consequences of submitting false information?
Submitting fraudulent or misleading information on the Predetermination form can lead to serious penalties. Individuals could face fines of up to $1,000, while corporations or partnerships could incur fines up to $10,000. It's crucial to provide accurate and honest information to avoid these repercussions.
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What criteria must be met to qualify as an independent contractor?
To be classified as an independent contractor, you must meet certain criteria. First, you should have the right to control how you perform your work. Additionally, you should be engaged in an independently established trade or business and have the opportunity for profit and loss. There are also specific conditions regarding your investment in tools and materials, the ability to work for multiple clients, and your responsibility for completing the work.
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Is the predetermination binding for other agencies?
No, the predetermination from the Maine Workers’ Compensation Board is not binding on the Department of Labor or other agencies. While it provides clarity on your status with respect to workers' compensation, other entities may have different criteria or considerations. Always keep this in mind when dealing with other regulatory bodies.
File Attributes
| Fact Name | Description |
|---|---|
| Governing Law | The Maine Predetermination form is governed by Title 39-A M.R.S.A. §13-A. |
| Presumption of Employment | Individuals are presumed to be employees unless proven otherwise by the employing unit. |
| Criteria for Independent Contractor | To qualify as an independent contractor, specific criteria regarding control, investment, and business practices must be met. |
| Voluntary Process | The predetermination process is voluntary and not a requirement under the Maine Workers’ Compensation Act. |
| Validity of Approval | Approved predeterminations are valid for one year and can be submitted to any employing unit. |
| Non-Binding Nature | A predetermination from the Board is not binding on the Department of Labor. |
Documents used along the form
The Maine Predetermination form is a crucial document for individuals seeking to establish their status as independent contractors. Alongside this form, several other documents and forms may be required or helpful in the process. Below is a list of commonly used forms and documents that often accompany the Maine Predetermination form, each serving a specific purpose in the overall application process.
- WCB-1: Employer's First Report of Injury - This form is used by employers to report any work-related injuries to the Maine Workers’ Compensation Board. It provides essential information about the incident and the injured employee, which is vital for processing claims.
- Lease Agreement Template: Having a proper lease agreement is crucial for any rental transaction. Ensure to review comprehensive options available, such as Templates and Guide, to facilitate a smooth leasing experience.
- WCB-2: Employee's Claim for Compensation - This document allows employees to formally file a claim for workers' compensation benefits. It includes details about the injury, medical treatment, and the impact on the employee’s ability to work.
- WCB-3: Notice of Controversy - When an employer disputes a claim, they must file this form to officially notify the Workers’ Compensation Board. It outlines the reasons for the dispute and is essential for resolving conflicts regarding claims.
- Independent Contractor Agreement - This contract defines the relationship between the independent contractor and the hiring entity. It clarifies the terms of service, payment structure, and responsibilities, which can help support the independent contractor status.
- IRS Form SS-8 - This form is used to request a determination of worker status for federal tax purposes. It can be submitted to the IRS to clarify whether an individual is an independent contractor or an employee.
- Business License or Registration - Depending on the type of work being performed, a business license may be required. This document demonstrates that the independent contractor is legally allowed to operate within their trade or profession.
- Tax Returns (Schedule C, E, or F) - These forms provide evidence of self-employment income and business expenses. They are often required to substantiate claims of independent contractor status and to show engagement in a trade or business.
- Proof of Insurance - Independent contractors may need to provide evidence of liability insurance or workers' compensation coverage. This document protects both the contractor and the hiring entity in case of accidents or injuries.
Understanding these accompanying documents is essential for anyone navigating the predetermination process in Maine. Each document plays a significant role in establishing and supporting the independent contractor status, which can ultimately impact rights and responsibilities under the law.
Misconceptions
Misconception 1: The Maine Predetermination form is mandatory for all independent contractors.
This is not true. The predetermination process is voluntary. Individuals do not need an approved predetermination before they can work as independent contractors.
Misconception 2: Submitting the application means giving up rights under the Maine Workers’ Compensation Act.
In fact, submitting this application does not mean you relinquish your rights. If you are injured while working, you can still file a claim for coverage under the Act.
Misconception 3: Once a predetermination is approved, it is valid indefinitely.
Approved predeterminations are only valid for one year. After that, you may need to reapply to ensure your status remains recognized.
Misconception 4: A predetermination from the Board is binding on all state and federal agencies.
This is incorrect. The predetermination is not binding on the Department of Labor, which means other agencies may have different interpretations or requirements.
Misconception 5: All applications will be approved if the criteria seem to be met.
Approval is not guaranteed. The application may be granted, denied, or returned for additional information if it is incomplete or unclear.
Misconception 6: The predetermination is valid regardless of the work performed.
The predetermination is only valid if the work performed aligns with the information provided in the application. If the nature of the work changes, the predetermination may no longer apply.
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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
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
STATE OF MAINE
WORKERS’ COMPENSATION BOARD
27 STATE HOUSE STATION
AUGUSTA, ME
Tel.
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
•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
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: ___________________________________________________________________________
Type of work you do: ___________________________________________________________________
Note: Information provided on this form, not otherwise confidential, may be shared with other state and federal agencies.
2
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
Yes No
3
(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
|
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
(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
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
(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
(a) |
Have you filed Form |
|
Yes |
No |
|
(b) |
If you filed Form |
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
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