Forms

The forms listed below are the most frequently used forms. Log in to your account or contact us if you have questions about which form to use.

Enroll

County employees' NACo Participation Agreement: Download and Print (PDF) or Complete online
City Plans Participant Agreement: Download and Print (PDF) or Complete online

Use these forms to:

• Enroll in the plan
• Change your contributions
• Elect or change annual automatic contribution increase
• Select or change beneficiaries
• Select or change investment options

Manage my money

Incoming Assets Form (PDF)

Use this form to:

• Roll money over from other retirement savings accounts into your Plan
• Decide which investments you want the rollover money to go into
• Decide if you want to enroll in Asset Rebalancing

457(b) Plan Distribution Request Form (PDF)
2023 W-4R (PDF)

Use this form(s) to:

• Provide Federal Tax Withholding direction for all withdrawal requests except systematic distributions lasting more than 10 years

401(a)/403(b)/401(k) Plan Distribution Request Form (PDF)

Use this form(s) to:

• Select your payout options when you end your employment or retire
• Request a payout
• Stop current payouts
• Change a current payout
• Restart a payout
• Defer payout until Required Minimum Distribution (RMD) is required at age 70½

PEHP Claim Reimbursement Form (PDF)

Use this form to:

• Request reimbursement from your Post Employment Health Plan for a qualified medical expense

Deferred Compensation Unforeseeable Emergency Distribution Application

Use this form to:

• Apply for an unforeseeable emergency distribution. You may be able to apply online. If you prefer personal assistance, please call our Solution Center at 1-877-677-3678.

Manage my account

Beneficiary Change Form (PDF)

Use this forms to change beneficiary information:

• Select primary and contingent beneficiaries
• Change how your money will be divided between your beneficiaries
• Remove and add beneficiaries

Automatic Deposit Authorization (PDF)

Use this form to:

• Add or change your checking or savings information for automatic deposits to your bank account

Manage someone else's account

Divorce (Domestic Relations Orders)

Follow this link to view/print the information you and your attorney will need to provide in the event of a divorce.

Military Leave

Follow this link to view/print information on how to notify us if you are going on military leave.

Beneficiary Distribution (PDF)

Distributions for beneficiaries

Alternate Payee Distribution (PDF)

Distributions for alternate payees

Estimate my health care costs in retirement

Health Care Cost Assessment (PDF)

Use this form to:

• Estimate your (and your spouse’s, if applicable) potential health care costs in retirement
• Get a projection of your potential longevity based on the information you provide
• Get a detailed report that can help you plan to cover those costs