OPERS Independent Contractor Form_fillable PDF Form.pdf
PDF 249 KB Posted
- Attached to
- Middle Harbor Pump Structure Modification
- Solicitation number
- SRC0000030984
- Issued by
- Putnam County, Ohio
About this file
This document is an Ohio Public Employees Retirement System (OPERS) Independent Contractor/Worker Acknowledgment form designed for individuals providing personal services to a public employer on or after January 7, 2013, who are not considered public employees. The form requires independent contractors to acknowledge their classification and understand that no retirement system contributions will be made on their behalf. Contractors must complete this form within 30 days of beginning services, detailing their personal information, the public employer's details, and the specific services to be provided.
The form outlines key provisions for independent contractors, including that they are not eligible for workers' compensation, do not receive employee fringe benefits, are not on the public employer's payroll, must provide their own supplies and equipment, and will receive an Internal Revenue Service Form 1099 for tax reporting. The document also explains that contractors may request a determination of their employment status within five years of service, and warns that if they begin providing services to the same employer from which they retired, there may be limitations on their retirement benefits and allowances.
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Other files
| File | Type | Posted |
|---|---|---|
| IMG_0316.jpeg | JPEG file | |
| Standard Terms and Conditions.pdf | ||
| Affirmation and Disclosure Form_3-4-22.pdf | ||
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys.docx | DOCX document | |
| Scope of Work_Middle Harbor Pump Structure Repair.docx | DOCX document |
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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 .