Employer Forms

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The following form can be filled out online by tabbing though each field or placing your cursor in a specific field. Information typed into the form cannot be saved or submitted through the Internet. Once all information is completed, print the form and mail or fax to OP&F. Please be sure to sign and date the form, and, if required, have it notarized.

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This form must be completed by prospective members of OP&F and a licensed examining physician.

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About this Form?

This form should be completed and filed with the Ohio Police & Fire Pension Fund (OP&F) for each new employee who is hired as a full–time police officer or firefighter in a position qualifying for enrollment in OP&F. Ohio law requires an employer to cause the employee to undergo a physical examination in the form established by OP&F prior to his or her employment and, with limited exceptions, timely file the required documentation with OP&F. Otherwise, penalties and interest may be imposed against the employer.

OP&F reserves the right to reject membership or service credit at a later date as information becomes available.

Ohio law defines the eligibility guidelines for individuals who are required to become a member of OP&F. Before enrolling in OP&F, the employer should review the following guidelines and confirm that the individual meets the requirements for OP&F membership. If the individual meets the requirements, the employer should complete the Personal History Record form to begin the process of enrollment in OP&F as well as filing the appropriate documentation for the pre–employment physical.

A summary of OP&F's membership requirements are as following:

Firefighters contributing to OP&F must be paid from public funds of the employing municipal entity and be:

A full-time firefighter who is employed by a fire department of the state, instrumentally of the state, or of a municipal corporation, township, joint fire district, or other political subdivision in a position in which he or she is required to satisfactorily complete, or to have satisfactorily completed, a firefighter training course approved under former Ohio Revised Code (ORC) Section 3303.07 or Section 4765.55, or conducted under ORC Section 3737.33.

Police officers contributing to OP&F must be paid from public funds of the employing municipal entity and be:

A full-time, regular police officer in a police department of a municipal corporation appointed from a duly–established civil service eligible list or pursuant to ORC Section 124.411 [124.41.1];

A full-time, regular police officer in a police department who is appointed pursuant to ORC Section 737.15 or 737.16 and is paid solely out of public funds of the employing municipal corporation; or

A full-time police officer with a police department who is required to satisfactorily complete a peace officer training course in compliance with ORC Section 109.77.

The employee applying for OP&F membership should complete Sections A through F and the employer should complete Sections G, H, and I.

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About this Form

This form is mandatory to accompany payments in order to help the Ohio Police & Fire Pension Fund (OP&F) to process employer payments accurately and eliminate the need for research or calling the employer. Complete this form and remit with all payments submitted to OP&F. Employer representatives must enter their employer’s office street address and phone number on this form; do not enter your home address or phone number, even if you work from home. This form is commonly referred to as the “recap form,” and is mandatory under Ohio Administrative Code section 742–9–10.

Instructions

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Section 419(c) of Public Law 108-203, the Social Security Protection Act of 2004, requires State and local government employers to disclose the effect of the Windfall Elimination Provision and the Government Pension Offset to employees hired on or after January 1, 2005, in jobs not covered by Social Security. The law requires newly hired public employees to sign a statement that they are aware of a possible reduction in their future Social Security benefit entitlement. For more detailed information about this law, and to view a copy of the statement concerning employment in a job not covered by Social Security (Form SSA-1945), please click on the link below:

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