Fillable Printable Report Of Independent Contractor(S) (De 542)

Report Of Independent Contractor(S) (De 542)

REPORT OF

INDEPENDENT CONTRACTOR(S)

05420101

See detailed instructions on reverse side. Please type or print.

SERVICE-PROVIDER (INDEPENDENT CONTRACTOR):

ADDRESS

DATE

CA EMPLOYER ACCOUNT NUMBER

SERVICE-RECIPIENT (BUSINESS OR GOVERNMENT ENTITY):

SERVICE-RECIPIENT NAME / BUSINESS NAME

SOCIAL SECURITY NUMBER

PHONE

NUMBER

FEDERAL ID NUMBER

ZIP CODE

CONTACT PERSON

CITY

STATE

FIRST NAME

LAST NAME

START DATE OF CONTRACT

CONTRACT EXPIRATION DATE CHECK HERE IF CONTRACT IS ONGOING

CHECK HERE IF CONTRACT IS ONGOING

SOCIAL SECURITY NUMBER

STREET NUMBER

STREET NAME

UNIT/APT

ZIP CODE

STATE

CITY

FIRST NAME

LAST NAME

START DATE OF CONTRACT

CONTRACT EXPIRATION DATE

SOCIAL SECURITY NUMBER

STREET NUMBER STREET NAME UNIT/APT

ZIP CODE

STATE

CITY

FIRST NAME

LAST NAME

START DATE OF CONTRACT

CONTRACT EXPIRATION DATE

SOCIAL SECURITY NUMBER

STREET NUMBER

STREET NAME

UNIT/APT

ZIP CODE

STATE

CITY

M M D D Y Y

AMOUNT OF CONTRACT

MAIL TO: Employment Development Department • PO Box 997350, MIC 96 • Sacramento, CA 95899-7350

or Fax to 916-319-4410

DE 542 Rev. 9 (6-17) (INTERNET) Page 1 of 2

INSTRUCTIONS FOR COMPLETING ALL OF THE ELEMENTS ON THE

REPORT OF INDEPENDENT CONTRACTOR(S), DE 542

WHO MUST REPORT:

Any business or government entity (dened as a “Service-Recipient”) that is required to le a federal Form 1099-MISC

for service performed by an independent contractor (dened as a “Service-Provider”) must report. You must report to the

Employment Development Department (EDD) within 20 days of EITHER making payments of $600 or more OR entering into a

contract for $600 or more with an independent contractor in any calendar year, whichever is earlier. This information is used to

assist state and county agencies in locating parents who are delinquent in their child support obligations.

An independent contractor is further dened as an individual who is not an employee of the business or government entity

for California purposes and who receives compensation or executes a contract for services performed for that business or

government entity either in or outside of California. For further clarication, request Information Sheet: Employment Work Status

Determination, DE 231ES. See below for information on how to obtain additional forms.

YOU ARE REQUIRED TO PROVIDE THE FOLLOWING INFORMATION THAT APPLIES:

HOW TO COMPLETE THIS FORM:

If you use a typewriter or printer, ignore the boxes and type in UPPER CASE as shown. Do not use commas or periods.

If you handwrite this form, print each letter or number in a separate box as shown. Do not use commas or periods.

ADDITIONAL INFORMATION:

If you have questions concerning the independent contractor reporting requirement, you may visit our web page at

www.edd.ca.gov/Payroll_Taxes/Independent_Contractor_Reporting.htm, call the New Employee Registry and Independent

Contractor Reporting at 916-657-0529, call the Taxpayer Assistance Center at 888-745-3886, or visit your local Employment Tax

Ofce listed in the California Employer’s Guide, DE 44, and on our web page at www.edd.ca.gov/Ofce_Locator/.

To obtain additional DE 542 forms:

• Visit the EDD website at www.edd.ca.gov/Forms/.

• For 25 or more forms, call 916-322-2835.

• For less than 25 forms, call 916-657-0529 or call 888-745-3886.

HOW TO REPORT:

For a fast, easy, and secure way to report your independent contractor information, use e-Services for Business.

For more information or to enroll, visit www.edd.ca.gov/e-Services_for_Business.

To le a paper DE 542 form, complete all of the information on the reverse side of this form and fax it to 916-319-4410 or

mail it to:

EMPLOYMENT DEVELOPMENT DEPARTMENT

PO Box 997350, MIC 96

Sacramento, CA 95899-7350

Service-Recipient (Business or Government Entity)

• Federal Employer Identication Number (FEIN)

• California employer payroll tax account number

(if applicable)

• Social Security number

• Service-recipient name/business name, address,

and phone number

• Contact person

Service-Provider (Independent Contractor)

• First name, middle initial, and last name

• Social Security number (do not use FEIN)

• Address

• Start date of contract (if no contract, date

payments equal $600 or more)

• Amount of contract (including cents)

• Contract expiration date or check the box if the

contract is ongoing

FIRST NAME LAST NAMEMI

SOCIAL SECURITY NUMBER

I M O G E N E A S A M P L E

X X X X X X X X X 1 2 3 4 5 M A I N S T R E E T 3 0 1

STREET NAME

STREET NUMBER

UNIT / APT.

FIRST NAME LAST NAMEMI

SOCIAL SECURITY NUMBER

IMOGENE A SAMPLE

STREET NUMBER

STREET NAME

UNIT / APT.

xxxxxxxxx 12345 MAIN STREET 301

DE 542 Rev. 9 (6-17) (INTERNET)

Page 2 of 2