%PDF-1.3 %矣腕 1 0 obj << /Producer (OmniForm Converter for PDF) /Creator (OmniForm Premium) >> endobj 4 0 obj [ /PDF /Text ] endobj 6 0 obj << /Length 7 0 R >> stream BT /F0 12 Tf 0 g 235.290 763.994 Td 112 Tz (911卯創利) Tj /F0 18 Tf -74.920 -20.177 Td 100 Tz (Student Employee FICA Checklist) Tj /F1 10 Tf -137.809 -40.530 Td 106 Tz (Navigate in PS HRRPT8.9 to Workforce Administration) Tj /F0 10 Tf ( ) Tj /F1 10 Tf (> Job Information) Tj /F1 9 Tf ( > ) Tj /F1 10 Tf (Job Data >UM Specific tab) Tj ET .75 w 0 G 0 J 18 690.182 m 594 690.182 l S 0 J 18 690.182 m 18 632.149 l S 0 J 594 690.182 m 594 632.149 l S BT /F2 10 Tf 32.862 676.74 Td 100 Tz (Is there a date populated in the field for FICA exp. date?) Tj 0 -14.159 Td (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, is this date still in the future?) Tj /F3 10 Tf 339.429 13.918 Td 111 Tz (NO) Tj -58.079 -0.238 Td 110 Tz (YES) Tj /F2 10 Tf 101.999 0 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''NO') Tj /F2 10 Tf (', go to question 2.) Tj 0 -14.159 Td (If the response is ) Tj /F3 10 Tf (''NO') Tj /F2 10 Tf (', go to question 2.) Tj /F3 10 Tf -101.999 0.238 Td 113 Tz (YES) Tj 58.079 0 Td 115 Tz (NO) Tj /F2 10 Tf -339.429 -14.4 Td 100 Tz (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, the employee is exempt form FICA as a qualifying nonresident alien. ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, ) Tj /F3 10 Tf (sign ) Tj /F4 10 Tf (and) Tj -0.24 -11.04 Td 99 Tz (date the form below.) Tj ET 0 J 18 632.149 m 594 632.149 l S BT /F1 10 Tf 22.853 619.364 Td 109 Tz (Navigate in PS HRRPT8.9 to Workforce Administration > Job Information ) Tj /F1 9 Tf (> ) Tj /F1 10 Tf (Job Data) Tj /F1 9 Tf ( ) Tj /F1 10 Tf (> Job Information) Tj ET 2 J 18 564.616 576 42 re S BT /F2 10 Tf 21.413 594.125 Td 98 Tz (2. Is the employee in a benefits eligible position \(Regular at the 911卯創利?\)) Tj /F3 10 Tf 422.399 -0.238 Td 112 Tz (YES) Tj 58.079 0 Td 120 Tz (NO) Tj /F2 10 Tf -450.96 -10.8 Td 100 Tz (If the response is ) Tj /F3 10 Tf (''NO'') Tj /F2 10 Tf (, go to question 3.) Tj 0.003 -12.002 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, the employee is subject to FICA. ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, sign and date the form below.) Tj ET 0 J 18 564.559 m 18 289.89 l S 0 J 594 562.714 m 594 288.615 l S BT /F3 10 Tf 444.773 548.918 Td 111 Tz (YES) Tj /F2 10 Tf -422.16 0 Td 101 Tz (3. Is the employee enrolled at least half-time in a course of study at the 911卯創利?) Tj /F3 10 Tf 479.999 -0.24 Td 113 Tz (NO) Tj /F2 10 Tf -450.72 -10.559 Td 100 Tz (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, go to question 4.) Tj -0.238 -12.48 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''NO'') Tj /F2 10 Tf (, the employee is subject to FICA. \(see EXCEPTION\). ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, sign and date the) Tj -2.163 -12.719 Td (form below.) Tj /F2 10 Tf 59.28 -12.96 Td (Is the student in the last semester of a course of study requiring at least two semesters to complete and is enrolled in) Tj 0 -12.96 Td (the number of credit hours needed to complete the requirements for obtaining a degree or certificate offered by the) Tj -72 12.719 Td 105 Tz (EXCEPTION:) Tj /F3 10 Tf 334.562 -25.44 Td 111 Tz (NO) Tj -58.082 -0.238 Td 110 Tz (YES) Tj /F2 10 Tf -204.48 0 Td 100 Tz (911卯創利?) Tj -57.359 -12.722 Td (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, go to question 4.) Tj 0.24 -13.198 Td 102 Tz (If the response is ) Tj /F3 10 Tf (''NO'') Tj /F2 10 Tf (, the employee is subject to FICA. ) Tj /F5 10 Tf (S) Tj /F4 10 Tf (top) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, sign and date the form below.) Tj /F3 10 Tf 347.76 -22.32 Td 109 Tz (YES) Tj 58.558 -0.24 Td 115 Tz (NO) Tj /F2 10 Tf -436.799 0 Td 101 Tz (4. Is the employee regularly attending classes at the 911卯創利?) Tj 29.038 -10.8 Td 100 Tz (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, go to question 5.) Tj 0.003 -17.52 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''NO'') Tj /F2 10 Tf (, the employee is subject to FICA. ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, ) Tj /F3 10 Tf (sign ) Tj /F4 10 Tf (and date the form below.) Tj /F2 10 Tf -28.803 -20.16 Td (5. Does the employee regularly work 40 or more hours per week for all jobs at the 911卯創利?) Tj 144.482 -11.999 Td (If the response is ) Tj /F3 10 Tf (''NO') Tj /F2 10 Tf (', go to question 6.) Tj /F3 10 Tf -101.52 -0.24 Td 97 Tz (YES) Tj 57.6 0 Td 105 Tz (NO) Tj /F2 10 Tf -71.759 -18 Td 101 Tz (If the response is) Tj /F3 10 Tf ( ''YES'') Tj /F2 10 Tf (, the employee is subject to FICA. ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, ) Tj /F3 10 Tf (sign ) Tj /F4 10 Tf (and date the form below.) Tj /F2 10 Tf -29.282 -21.118 Td (6. Is the educational aspect of the employee's relationship with the 911卯創利 predominant over the service aspect?) Tj /F3 10 Tf 43.2 -12.24 Td 97 Tz (YES) Tj 57.6 0 Td 111 Tz (NO) Tj /F2 10 Tf 43.92 0 Td 100 Tz (If the response is ) Tj /F3 10 Tf (''YES'') Tj /F2 10 Tf (, go to question 7.) Tj -115.679 -15.602 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''NO'',) Tj /F2 10 Tf ( the employee is subject to FICA.) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (Stop) Tj /F3 10 Tf ( ) Tj /F4 10 Tf (here. Complete Box 10, ) Tj /F3 10 Tf (sign ) Tj /F4 10 Tf (and date the form below.) Tj ET 0 J 18 289.89 m 594 289.89 l S 0 J 18 289.78 m 594.363 289.78 l S 0 J 594.116 289.706 m 594.116 108.07 l S BT /F2 10 Tf 21.96 279.448 Td 109 Tz (7. Is the employee required to be licensed in the field in which s/he performs services for the 911卯創利?) Tj 143.64 -13.742 Td 101 Tz (If the response is ) Tj /F3 10 Tf (''NO'') Tj /F2 10 Tf (, the employee is exempt from FICA. ) Tj /F4 10 Tf (Stop here. Complete Box 10, sign and) Tj /F3 10 Tf -101.52 -0.24 Td 111 Tz (YES) Tj 57.6 0 Td 117 Tz (NO) Tj /F4 10 Tf 58.56 -10.8 Td 100 Tz (date the form below.) Tj /F2 10 Tf -14.64 -14.318 Td (If the response to this question is ) Tj /F3 10 Tf (''YES') Tj /F2 10 Tf (', continue to question 8.) Tj -143.52 -24.72 Td 98 Tz (8. How would you characterize the work performed by the employee? \(indicate only one choice\):) Tj ET 0 J 18 289.78 m 18 108.306 l S BT 50.879 202.666 Td 97 Tz (Professional, \(performing work: \(1\) requiring knowledge of an advanced type in a field of science or learning, \(2\) requiring the) Tj 57.362 -11.038 Td 100 Tz (consistent exercise of discretion and judgment, and \(3\) that is predominantly intellectual and varied in character) Tj 145.919 -12.48 Td 99 Tz (Technical) Tj -102.48 0 Td 100 Tz (Teaching) Tj -101.038 -0.24 Td 102 Tz (Research) Tj 101.038 -13.918 Td 99 Tz (Manual) Tj -100.797 -0.24 Td 102 Tz (Clerical) Tj -14.64 -14.4 Td 100 Tz (Continue to question 9,) Tj -14.64 -23.04 Td 101 Tz (9. If you checked Professional in question 8, then the employee is subject to FICA. If you checked any other box in question 8, then the) Tj 14.64 -11.047 Td 102 Tz (employee is exempt from FICA. ) Tj /F4 10 Tf (Complete box 10) Tj /F3 10 Tf (,) Tj /F3 16 Tf ( ) Tj /F4 10 Tf (then sign and date the form below.) Tj ET 0 J 18 108.306 m 594 108.306 l S BT /F2 10 Tf 22.56 95.335 Td 100 Tz (10. After considering the facts and circumstances of this employee's relationship with the 911卯創利 this employee \(indicate) Tj ET 0 J 17.870 107.9 m 17.870 61.727 l S BT 38.239 86.176 Td (only one choice\):) Tj 201.784 -17.683 Td 105 Tz (Is subject to FICA \(i.e. employee does not qualify for exemption.\)) Tj -174.48 -0.482 Td 103 Tz (Is exempt from FICA) Tj ET 0 J 17.759 62.229 m 594 62.229 l S 2 J 84.977 26.785 126.232 30.246 re S 2 J 340.214 26.785 64.59 30.246 re S 2 J 404.796 26.785 125.385 30.246 re S 2 J 530.184 26.785 63.814 30.246 re S BT /F1 8 Tf 532.32 48.609 Td 100 Tz (Date) Tj -123.84 0 Td 105 Tz (Departmental Signature) Tj -66.243 0 Td 96 Tz (Date) Tj -252.377 0 Td 106 Tz (Employee Signature) Tj /F1 7 Tf -69.534 -30.291 Td 95 Tz (UM 284 \(NOV 06\) 11/15/06) Tj ET 0 J 594 108.400 m 594 62.226 l S BT /F2 10 Tf 22.311 677.648 Td 100 Tz (1.) Tj ET 2 J 211.612 57.03 m 340.316 57.03 l 340.316 26.785 m 211.612 26.785 l S BT /F1 8 Tf 215.643 48.609 Td 102 Tz (Employee Printed Name) Tj ET 2 J 17.804 57.03 m 84.852 57.03 l 84.852 26.785 m 17.804 26.785 l 17.804 57.03 l S BT 22.56 48.609 Td 104 Tz (Emplid) Tj /F3 10 Tf 82.046 674.113 Td 109 Tz (Fall Semester) Tj 170.473 -0.181 Td 100 Tz (Winter Semester) Tj 176.250 -0.369 Td 105 Tz (Summer Term) Tj /F1 9 Tf -428.590 -30.112 Td 102 Tz (See the field for FICA exp. date.) Tj -1 -83.789 Td 109 Tz (See the field for Regular/Temporary.) Tj ET 2 J 85.887 721.054 11.76 10.08 re S 2 J 256.360 720.873 11.76 10.08 re S 2 J 432.609 720.505 11.76 10.08 re S 2 J 295.251 675.794 11.76 10.08 re S 2 J 353.33 675.553 11.76 10.08 re S 2 J 295.492 660.912 11.76 10.08 re S 2 J 353.571 660.674 11.76 10.08 re S 2 J 425.092 592.699 11.76 10.08 re S 2 J 483.412 592.458 11.76 10.08 re S 2 J 425.812 547.73 11.76 10.08 re S 2 J 484.132 547.489 11.76 10.08 re S 2 J 294.531 472.85 11.76 10.08 re S 2 J 352.61 472.85 11.76 10.08 re S 2 J 381.651 424.848 11.76 10.08 re S 2 J 440.212 424.61 11.76 10.08 re S 2 J 45.89 363.41 11.76 10.08 re S 2 J 103.252 363.41 11.76 10.08 re S 2 J 45.652 312.528 11.76 10.08 re S 2 J 103.252 312.528 11.76 10.08 re S 2 J 45.6 264.759 11.76 10.08 re S 2 J 101.358 265.022 11.76 10.08 re S 2 J 31.816 200.999 11.76 10.08 re S 2 J 31.170 178.231 11.76 10.08 re S 2 J 31.569 163.712 12.478 9.47 re S 2 J 132.72 177.718 11.76 10.08 re S 2 J 132.72 163.559 11.76 10.08 re S 2 J 235.68 177.959 11.76 10.08 re S 2 J 46.8 68.074 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