OPERS Independent Contractor Form_fillable PDF Form.pdf

This is an Ohio Public Employees Retirement System (OPERS) Independent Contractor/Worker Acknowledgment form that must 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. The form must be submitted within 30 days of beginning services and requires personal information, public employer details, and service dates. The document outlines the criteria for independent contractor classification under Ohio Administrative Code section 145-1-42(A)(2), including requirements about bilateral agreements, payment arrangements, and ineligibility for benefits like workers' compensation.

The form serves as acknowledgment that the contractor understands they are not eligible for OPERS contributions or benefits. It specifies that contractors have five years to request a determination of their classification status if they disagree with their designation. The document also addresses special considerations for OPERS retirees who become contractors, noting potential impacts on retirement benefits and medical expense reimbursements. Both the public employer and OPERS must retain copies of this form, as failure to maintain the acknowledgment may extend the contractor's right to request classification determination beyond the standard five-year period.