OPERS Independent Contractor Form_fillable PDF Form (23).pdf

This is an Ohio Public Employees Retirement System (OPERS) Independent Contractor/Worker Acknowledgment form that must be completed by individuals providing personal services to public employers in Ohio who are classified as independent contractors rather than public employees. The form must be submitted within 30 days of beginning services and requires personal information, employer details, and service dates. The document outlines eight specific criteria that define an independent contractor under Ohio Administrative Code section 145-1-42(A)(2), including payment arrangements, equipment requirements, and tax reporting obligations.

The form serves as legal acknowledgment that the contractor understands they are not eligible for OPERS contributions or benefits, including workers' compensation, unemployment compensation, and employee fringe benefits. Contractors have five years from their service start date to request a determination of their employment classification if they disagree with their independent contractor status. The form must be retained by the public employer with a copy sent to OPERS, and failure to retain this acknowledgment may extend the contractor's right to request a determination beyond the standard five-year period.