OPERS Independent Contractor Form_fillable PDF Form (14).pdf

This document is an Independent Contractor/Worker Acknowledgment form issued by the Ohio Public Employees Retirement System (OPERS), located at 277 East Town Street in Columbus, Ohio. The form is designed for individuals providing personal services to a public employer on or after January 7, 2013, who are classified as independent contractors and will not have contributions made to OPERS. The form must be completed within 30 days of beginning services and requires detailed information about the individual's personal details, current employer, and the public employer for whom services are being provided.

The document outlines specific criteria for independent contractor classification under Ohio Administrative Code, including being party to a bilateral agreement, being paid a fee, not being eligible for workers' compensation, not appearing on a public employer's payroll, providing own supplies and equipment, and receiving an Internal Revenue Service Form 1099 for income tax reporting. The form also explains potential implications for independent contractors, such as ineligibility for certain medical reimbursements and the possibility of retirement system contribution determinations. By signing the form, the individual acknowledges their classification and understands the potential limitations on retirement benefits and medical allowances.