Report Worker Misclassification/1099 Abuse Form

Use this form to report a business for misclassifying a worker as an independent contractor or for 1099 abuse. If you would like to complete an assessment prior to completing the form, click here.

Misclassified Workers Hotline: 573-751-1099
To mail, print this form and send to:
Division of Employment Security
Attn: Report Worker Misclassification/1099 Abuse
P.O. Box 59, Jefferson City, MO 65104-0059
Fax: 573-751-3900
E-mail: esemptax@labor.mo.gov
 Date:
 
Your Name
       
     
 
 
 
 
 
()     -    
 
 
  Worker Misclassification Information Please provide as much information in the following areas as known.
Attach additional sheets, if necessary. (* = Required)
 
   
   
 
 
  ()     -    
 
 
 
 
 
       
 
 
 
  Are you currently or have you been employed by this business?        
 
 
  Provide the names of the workers whose wages were not reported.
 
1 $per 1099
W2
 
 
(This may include work performed frequently, recurring, or whenever work is available
 
 
 
 
 
 
 
 
 
 
(Such as contract, registration, license, etc.)
 
 
(Please note: If there are errors and this form reloads, you will need to re-select your files)
 
    
 
    
 
    
 
  * If you are unable to attach the documentation electronically, please indicate below in the "Summary of Complaint" a brief description of documentation you have. An investigator may contact you and ask to have it mailed or faxed to our agency if the documentation is needed.  
 
 
 
   
By entering my name and submitting this electronically,
I do hereby affirm under penalties of perjury that the above-stated information is true and correct to the
best of my knowledge, information, and belief.