OPERS_Independent_Contractor_Form_fillable_PDF_Form.pdf

This document is an Independent Contractor/Worker Acknowledgment form issued by the Ohio Public Employees Retirement System (OPERS), located at 277 East Town Street in Columbus, Ohio. The form is designed for individuals providing personal services to a public employer on or after January 7, 2013, who are classified as independent contractors and will not have contributions made to OPERS. The form must be completed within 30 days of beginning service, and requires detailed information about the independent contractor and the public employer, including personal details, service dates, and the specific services to be provided.

The form serves to formally document the independent contractor status and clarify that no retirement system contributions will be made for these services. It outlines specific criteria for independent contractor classification, such as being paid by fee or contractual arrangement, not being eligible for employee benefits, not appearing on a public employer's payroll, and providing one's own supplies and equipment. The document also explains potential implications, including the ability to request a determination of public employee status within five years, and warns that failing to accurately classify the working relationship could result in future liability for the contractor and potential extension of determination rights.