[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304378-105":53,"doc-detail-304378-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","403b-plan-distribution-request-form","403(b) Plan Distribution Request Form","","403(b) Plan Distribution Request Form for participants to request distributions based on the plan’s distribution withdrawal hierarchy. Collects personal information, employment separation status, and distribution choices including rollovers, age-based withdrawals, full or partial distributions, and required minimum distribution rules. Includes rollover options, check delivery details, and federal and state income tax withholding election guidance, noting mandatory withholding rules and eligibility constraints for rollover of RMD amounts.",{"@graph":63,"@context":123},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/403b-plan-distribution-request-form/304378/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/403b-plan-distribution-request-form/304378.png","ImageObject",442,249,{"name":88,"@type":89},"Lucas Martin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-30","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115,119],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required to submit the 403(b) distribution request?","Question",{"text":109,"@type":110},"The form requests personal information (name, Social Security number, address, contact numbers, email, and date of birth) and details for employment status and distribution choices. Follow the instructions to complete applicable sections and include required documentation and signatures if needed.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How are distribution options determined for participants who are currently employed or separated from service?",{"text":114,"@type":110},"Funds are withdrawn based on the plan’s distribution withdrawal hierarchy. Currently employed participants choose from available withdrawal and rollover sources, while separated participants choose one option such as full distribution, partial distribution, or required minimum distribution.",{"name":116,"@type":107,"acceptedAnswer":117},"Can required minimum distribution (RMD) amounts be rolled over?",{"text":118,"@type":110},"Generally, the RMD amount described on the form is not eligible for rollover. If an RMD is due in the current year, that amount cannot be rolled over and is sent in a separate check.",{"name":120,"@type":107,"acceptedAnswer":121},"What are the federal income tax withholding rules for eligible rollover distributions?",{"text":122,"@type":110},"Eligible rollover distributions are subject to mandatory 20% federal withholding, and you cannot choose not to withhold income tax. 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Please review and complete all applicable sections of this form to enable prompt processing.  \n2. All checks issued by Voya Financial are mailed to your current address on record. If the address on this form does not match what we have on record the form will be rejected. You cannot use this form to change your address. Before submitting this form, please go online to verify that the Plan has your current address. The contact information is available on the last page of this form. If the address on record is incorrect you can go online to change your address or fill out the Change of Address form available on the Web or by contacting our call center.  \n3. Prior to mailing this form for processing, include your signature and the approval of the TPA or employer if required.  \nPLEASE NOTE: AN INCOMPLETE APPLICATION OR NOT SUPPLYING ALL REQUIRED DOCUMENTATION WILL CAUSE A DELAYIN RECEIVING YOUR CHECK.  \n\n| q EMPLOYED | q SEPARATED FROM SERVICE | SEPARATION DATE   |\n| --- | --- | --- |\n\nEMPLOYMENT STATUS  \nDISTRIBUTION CHOICES FOR CURRENTLY EMPLOYED PARTICIPANTS  \nFunds for distribution will be withdrawn based on the plan’s distribution withdrawal hierarchy.  \nq Rollover Source Withdrawal AMOUNT $  Withdrawal of non-Roth funds that were rolled into your account from a previous employer’s plan  \nq Age 59 ½ Withdrawal AMOUNT $  Withdrawal of funds for participants that have attained age 59 ½  \nq Age 73 Withdrawal AMOUNT $  Withdrawal of funds for participants that have attained age 73  \nq Roth Withdrawal AMOUNT $  See attached Roth special tax notice.  \nDISTRIBUTION CHOICES FOR PARTICIPANTS SEPARATED FROM SERVICE (ONLY CHECK 1 BOX)  \nFunds for distribution will be withdrawn based on the plan’s distribution withdrawal hierarchy.  \nq Full Distribution  \nComplete distribution of your vested account balance  \nq Partial Distribution AMOUNT $  Partial distribution of your vested account balance  \nq Required Minimum Distribution  \nGenerally, the Required Beginning Date for a RMD is April 1st following the later of the calendar year in which you: (1) attain age 73, or (2) retire from the plan sponsor/employer. If the first RMD is delayed to April 1st following the attainment of age 73, then the second RMD must be made by December 31st of that same calendar year and annually thereafter. Special rules apply to 5% owners. This amount is not eligible for rollover.  \nq Rollover Source Distribution AMOUNT $  Distribution of non-Roth funds that were rolled into your account from a previous employer’s plan  \nq Roth Distribution AMOUNT $  Distribution of Roth funds  \nROLLOVER OPTIONS  \nYou must complete either the section entitled Distribution Choices for Currently Employed Participants, or, the section entitled Distribution Choices for Participants Separated From Service, in addition to this Rollover Options section.  \nIf a dollar amount or percentage has not been provided, a full rollover will be processed. Check will be mailed to your home address. If an RMD is due in current year, that amount cannot be rolled over and it will be sent in a separate check payable to you.  \nRollover Amount $  or %  \nIf selecting less than 100% rollover, the remainder of the requested funds will be taxed as outlined below and made payable to you.  \nq Rollover to a 401, 403(b) or government 457(b) plan  \nq Rollover to an IRA (traditional)  \nCheck made payable to (Institution):   Account Number:   q Rollover to a Roth IRA  \nCheck made payable to (Institution):   Account Number:   Please note that by using your social security number as the account number we will print this on your rollover check and ","cbCaicoo3JAgGa5a","https://ap.wps.com/l/cbCaicoo3JAgGa5a","pdf",1784544,"English","# Personal Information\n# Instructions\n# Employment Status and Distribution Choices\n## Currently Employed Participants\n## Separated From Service Participants\n# Rollover Options\n# Federal and State Income Tax Withholding","[{\"question\":\"What information is required to submit the 403(b) distribution request?\",\"answer\":\"The form requests personal information (name, Social Security number, address, contact numbers, email, and date of birth) and details for employment status and distribution choices. Follow the instructions to complete applicable sections and include required documentation and signatures if needed.\"},{\"question\":\"How are distribution options determined for participants who are currently employed or separated from service?\",\"answer\":\"Funds are withdrawn based on the plan’s distribution withdrawal hierarchy. Currently employed participants choose from available withdrawal and rollover sources, while separated participants choose one option such as full distribution, partial distribution, or required minimum distribution.\"},{\"question\":\"Can required minimum distribution (RMD) amounts be rolled over?\",\"answer\":\"Generally, the RMD amount described on the form is not eligible for rollover. If an RMD is due in the current year, that amount cannot be rolled over and is sent in a separate check.\"},{\"question\":\"What are the federal income tax withholding rules for eligible rollover distributions?\",\"answer\":\"Eligible rollover distributions are subject to mandatory 20% federal withholding, and you cannot choose not to withhold income tax. You may elect a higher withholding percentage, and Form W-4R can be used for the election.\"}]","403(b) Plan Distribution Request Form | PDF",1789812622]