OPERS Independent Contractor Form_fillable PDF Form (24) (5).pdfOPERS Independent Contractor Form_fillable PDF Form (24) (5).pdf

This is an OPERS Independent Contractor/Worker Acknowledgment form issued by the Ohio Public Employees Retirement System (OPERS) for use by public employers in Ohio. The form is completed when an individual begins providing personal services to a public employer on or after January 7, 2013, but is not classified as a public employee and will not have contributions made to OPERS. The form must be completed within 30 days of the service provider beginning work. The document requires completion of two primary sections: personal information including the contractor's name, Social Security number, and date of birth, along with a notation if the individual is an existing OPERS or other retirement system benefit recipient; and public employer information including the employer name, contact information, employer code, service description, and both the start and end dates of service provision.

No pricing terms, contract durations, set-asides, or funding information are contained within this form. This is an administrative acknowledgment document designed solely to establish that an independent contractor relationship exists and that the individual will not participate in the OPERS retirement system. The form serves as compliance documentation for Ohio public employers engaging independent contractors and does not contain substantive service delivery terms or financial arrangements.