OPERS Independent Contractor Form_fillable PDF Form (23).pdf

This document 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 includes sections for personal information, public employer details, and service dates. It establishes the formal acknowledgment that the individual will not have OPERS contributions made on their behalf.

The form outlines eight specific criteria that define an independent contractor under Ohio Administrative Code section 145-1-42(A)(2), including being paid by contractual arrangement, providing their own supplies and equipment, and receiving an IRS Form 1099. Individuals have the right to request a determination of their eligibility for OPERS membership within five years of beginning services if they disagree with their classification. The form must be retained by both the public employer and OPERS, as failure to maintain this acknowledgment could extend an individual's right to request a determination beyond the standard five-year period.