How to fill out a Web Administrator Agreement form

To become a web administrator, you must submit a Web Administrator Agreement form to PERS. Here’s how to fill out the five sections of this form.

Section A: Employer information

The employer number is the five-digit number (beginning with zero) assigned to your organization by PERS.

The contact person is your organization’s reporting official.

The reporting official is typically the head of your organization or someone who has the authority to make financial decisions. They might be your Financial Officer, Fire Chief, Superintendent, Mayor, or Board Member. This is usually the person who appointed the web admin to the role.

screen capture showing section A, and highlighting 'employer number' and 'contact person'

Section B: Responsibilities

The web admin must read the responsibilities of the role before signing the form.

screen capture of section B, listing responsibilities

Section C: Web Administrator

Sign and date the agreement. (It’s okay to fill in the date only once.)

Section D: Web Administrator contact information

Fill in your contact information.

Section E: Reporting Official

The reporting official fills out this section authorizing the web admin to carry out the responsibilities in the agreement.

Tip: PERS will not accept the form unless it is signed by an official. It can’t be signed by the outgoing web admin.

Email the form

When the form is completed, printed, and signed by the web administrator and reporting official, scan it to create a digital copy. Email that digital copy to the PERS Employer Service Center at PERS.EDX.Support@pers.oregon.gov. If you have questions, call your ESC representative or email PERS.EDX.Support@pers.oregon.gov.