OPERS Independent Contractor Form_fillable PDF Form (9).pdf
PDF 249 KB Posted
- Attached to
- New Roof, Fallsville WA Office
- Solicitation number
- SRC0000023642
- Issued by
- Clermont County, Ohio
About this file
This document is an OPERS (Ohio Public Employees Retirement System) Independent Contractor/Worker Acknowledgment form. It is to be completed by individuals who begin providing personal services to a public employer on or after January 7, 2013, but are not considered public employees, such as independent contractors. The form must be completed within 30 days of the start of service. It requires the individual to provide personal information, including their Social Security number, date of birth, and name of current employer. It also requires the public employer information, including the name, employer contact, employer code, phone number, the service provided, and the start and end dates of the service.
The form outlines the requirements for individuals who are not considered public employees to acknowledge that they will not have contributions made to OPERS on their behalf. It does not provide any information about pricing, set-asides, incumbents, funding requirements, or other contractual terms.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Standard Terms and Conditions (9).pdf | ||
| Standard Affirmation & Disclosure Form_fillable PDF Form (9).pdf | ||
| Barn Spec sheet FY25.doc | DOC document | |
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
OPERS
INDEPENDENT CONTRACTOR/WORKER
ACKNOWLEDGMENT
Ohio Public Employees Retirement System 277 East Town Street, Columbus, Ohio 43215-4642
Employer Services: 1-888-400-0965 www.opers.org
This form is to be completed if you are an individual who begins providing personal services to a public employer on or after
Jan. 7, 2013 but are not considered by the public employer to be a public employee (e.g, you are an independent contractor) and will not have contributions made to OPERS. This form must be completed not later than 30 days after you begin providing personal services to the public employer.
STEP 1: Personal Information
Social Security Number
Date of Birth
Month Day
I First Name
Year
I
Name of Current Employer
Ml Last Name
0 I am an OPERS or other retirement system benefit recipient
STEP 2: Public Employer Information
Name of Public Employer for Which You Are Providing Personal Services
Employer Contact
First Name Ml Last Name
Employer Code Employer Contact Phone Number
Service Provided to Public Employer
Start Date of Service End Date of Service
Month Day Year Month Day Year
I I I j
PEDACKN (Revised 6/2017) Page 1 (continued on back)
File details come from the government source that posted it. Updated .