OPERS Independent Contractor Form_fillable PDF Form (1).pdf

This is an Ohio Public Employees Retirement System (OPERS) Independent Contractor/Worker Acknowledgment form used for individuals providing personal services to public employers in Ohio who are classified as independent contractors rather than public employees. The form must be completed within 30 days of beginning services and includes sections for personal information, public employer information, and acknowledgment of independent contractor status. The form references requirements effective as of January 7, 2013 and outlines the criteria for independent contractor classification under Ohio Administrative Code section 145-1-42(A)(2).

The form details eight specific criteria that define an independent contractor, including requirements about bilateral agreements, payment arrangements, and ineligibility for various benefits. It specifies that independent contractors are not eligible for OPERS contributions and have five years to request a determination if they disagree with their classification. The form includes important notifications about retiree medical benefits, the Health Reimbursement Arrangement (HRA), and potential liability for incorrectly paid benefits. Both the public employer and OPERS must retain copies of this completed form, and failure to retain the acknowledgment may extend the contractor's right to request classification determination beyond the standard five-year period.