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). The form applies to individuals who begin providing personal services to a public employer on or after January 7, 2013, but are not classified as public employees and therefore will not have contributions made to OPERS. The form must be completed within 30 days of beginning service. The document requires contractors to provide personal information including Social Security number, date of birth, name, and current employer, along with public employer information such as the employer name, contact details, employer code, service description, and start and end dates of service.

The form serves as a written acknowledgment that the individual has been informed of their independent contractor classification and understands that no OPERS contributions will be made on their behalf. Per Ohio Administrative Code section 145-1-42(A)(2), the form defines the characteristics of an independent contractor, including that the individual is party to a bilateral agreement defining compensation and responsibilities, is paid by contractual arrangement, is not eligible for workers' compensation or employee benefits, does not appear on the employer's payroll, provides their own supplies and equipment, is not controlled by the employer regarding manner of work, and receives an IRS Form 1099. The form explicitly warns contractors about potential liability to OPERS if they are later determined to be eligible for contributions and outlines restrictions on OPERS Health Reimbursement Arrangements and Retiree Medical Account eligibility. The form must be retained by the public employer, and the contractor's right to request a determination of OPERS eligibility may extend beyond the five-year reference period mentioned in the document.