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


* = Required

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

Email: esemptax@labor.mo.gov


When using this form, please use one of the following web browsers: Microsoft Edge, Google Chrome, or Mozilla Firefox.

Date: 06/21/2021

Your Information
 
 
 
Worker Misclassification Information

 
What is the name and title of the individual who is believed to be responsible for the business entity?
 

Provide the names of the workers whose wages were not reported
 
  First Name Last Name Method of Payment Rate of Pay Per IRS Form Job Title  
1
$


Additional Information - Supporting Documentation
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.