Research Corporation of the University of Hawaiʻi

Attachment 3225-E(4)
Details to complete:
REQUEST FOR AN EIC DETERMINATION – INDEPENDENT CONTRACTOR
1. Date of your EIC Memo
2. Principal Investigator and Project Identification & Contact
2a. Full Name of Principal Investigator
2b. Full Name of Project Contact Person who can clarify EIC Memo
2c. Contact Person’s Email
2d. Contact Person’s Phone Number
3. Individual’s Legal First and Last Name
4. Individual is an expert in what field of study/research. Describe how this expertise will be utilized by your project.
5. Request for Proposal or description how individual was selected.
6. Describe type of services individual will perform for the project.
7. Where will individual perform work? Hawaii? If not Hawaii, provide location (State, Country, etc.)
8. Duration
8a. Start Date
8b. End Date
9. Describe method of payment and amount.
10. Hawaii General Excise Tax Number if work is performed in Hawaii. Attach a photocopy from Hawaii Department of Taxation’s website: https://dotax.ehawaii.gov/tls/app
11. Name of Agency/Employer
12. If Individual terminated from the UH, State, RCUH or County; provide date of termination.
Revision: February 17, 2004, January 31, 2017