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 providing personal services to Ohio public employers who are not considered public employees. The form must be submitted within 30 days of beginning services and consists of three main sections: Personal Information, Public Employer Information, and Acknowledgment. It requires details such as the contractor's Social Security Number, birth date, current employer information, public employer details, service dates, and the specific services being provided.

The form outlines eight key criteria defining an independent contractor under Ohio Administrative Code section 145-1-42(A)(2), including payment arrangements, ineligibility for benefits, and tax reporting requirements. It specifies that independent contractors are not public employees and cannot contribute to the retirement system, though they may request an eligibility determination within five years of service commencement. The form includes important provisions regarding OPERS Health Reimbursement Arrangement (HRA) and OPERS Retiree Medical Account (RMA) eligibility, and requires both the contractor's signature and retention by the public employer, with a copy sent to OPERS.