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 collects 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 contractual payment arrangements, ineligibility for benefits, and responsibility for providing their own equipment.

The form requires acknowledgment that the contractor understands they will not receive OPERS contributions and are not eligible for retirement benefits as an independent contractor. Contractors have five years from the start of services to request a determination of their classification status if they disagree with their designation. The form also addresses specific provisions for OPERS retirees who become contractors, including potential suspension of annuity benefits and liability for incorrectly paid benefits. Both the public employer and OPERS must retain copies of this acknowledgment form, as failure to maintain records may extend the contractor's right to request classification determination beyond the standard five-year period.