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

457(b) Plan Employee Participation Agreement — Traditional & Roth 457(b) (PDF)

401(a) Plan Employee Participation Agreement (PDF)

EZ Enrollment Form (PDF)

Enroll online – Traditional 457(b) and 401(a) only1

Use these forms to:

  • Enroll in the plan
  • Select your contributions
  • Select your investment options

Manage my money

Change Contribution Amount — Traditional & Roth 457(b) (PDF)

Use this form to:

  • Change your contribution amount for the Traditional & Roth 457(b)2

Automatic Deposit Authorization (PDF)

Use this form to:

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

Retirement Benefits Options (PDF)

Use this to:

  • Choose your distribution method for a qualifiable event, such as retirement

Special Tax Notice Regarding Plan Payments (PDF)

Use this notice to:

  • Understand how you can continue to defer federal income tax on your retirement plan savings
  • Understand your options on how to receive your Plan benefits

457(b) Unforeseeable Emergency Distribution Application (PDF)

Use this form to:

  • Apply for an unforeseeable emergency distribution for the 457(b) plan

W-4P — Federal Tax Withholding Form (PDF)

Use this form to:

  • Have more federal income tax withheld than is required for payout

DE-4P — State Tax Withholding Form (PDF)

Use this form to:

  • Designate a specific amount of state taxes to be withheld

Self-Directed Brokerage Option Form (PDF)

Use this form to:

  • Understand the requirements of investing your retirement plan in a self-directed brokerage option

Manage my account

Beneficiary Change Form (PDF)

Use this form to change beneficiary information:

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

401(a) Hardship Certification Form (PDF)

Use this form to:

  • Stop your Plan contributions due to a hardship

Traditional & Roth 457(b) 3-Year Catch-Up Form (PDF)

Use this form to:

  • Apply for the catch-up provision

Purchase of Service Credit Form (PDF)

Use this form to:

  • Request the purchase of retirement service credit

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

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 Claim/Alternate Payee Form (PDF)

Use this form if you're a beneficiary or an alternate payee, such as a former spouse or a dependant of a Plan member:

  • Report the death of a Plan member; please remember to submit a certified copy of the death certificate if you are reporting the death of a plan member
  • Update your beneficiary information
  • Request a payout


For Roth 457(b) new enrollments, please call 1-888-324-5433.

This option is not available for the 401(a) plan; see 401(a) hardship form.

PDFs require Adobe® Reader®

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