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Collects employee identity details, requires selecting vendor(s) to stop contributions to, and listing the bi-weekly contribution amount for each remaining vendor with a $10 minimum. Specifies the effective date rules after HR benefits office receipt and authorization terms, including contract submission requirements, change procedures, IRS 402(g) contribution limit guidance, and irrevocable salary reduction election upon signing.",{"@graph":63,"@context":118},[64,80,101],{"@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-tax-sheltered-annuity-plan-project-new-election-form/304373/",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-tax-sheltered-annuity-plan-project-new-election-form/304373.png","ImageObject",442,249,{"name":88,"@type":89},"Patrick","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-29","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be provided in the employee information section?","Question",{"text":108,"@type":109},"The form requests the employee’s name, email address, and daytime phone number.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How are vendors and bi-weekly contribution amounts handled?",{"text":113,"@type":109},"You indicate which vendor(s) you will no longer contribute to, then enter the bi-weekly contribution amount for each applicable vendor, with a minimum of $10.00 bi-weekly.",{"name":115,"@type":106,"acceptedAnswer":116},"When does the salary reduction agreement become effective and what does signing mean?",{"text":117,"@type":109},"It becomes effective on the earliest available paycheck date after the Human Resources Benefits Office receives the form, unless a different effective paycheck date is specified. 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Employee Information:  \nName (Last, First)  \nEmail Address Daytime Phone Number  \nB. Indicate which vendor(s) you will no longer be contributing to:  \n􀀃s s  \nC. Indicate the bi-weekly contribution amount(s) next to the applicable vendor(s): (*minimum $10.00 bi-weekly):  \n\n| Vendor | New Contribution (specify $ or %) |\n| --- | --- |\n| TIAA |  |\n| AIG |  |\n| Voya Financial |  |\n\nD. Effective Date:  \nThis SRA is effective on the earliest available paycheck date after the form is received by the Human Resources  \nBenefits Office, unless otherwise indicated below.  \nEffective on the   paycheck date  \nE. Acknowledgment, authorization and signature:  \nContract: Prior to completing this agreement, I have submitted the required account contract(s) for the vendor selected. I understand that failure to  \ncomplete the vendor contract may result in my contributions being returned.  \nChanges: 403(b) participants may make changes at any time throughout the year by completing a new SRA.  \nState University System Optional Retirement Program (SUSORP) Participants: Must contribute the maximum 5.14% of eligible earnings to their SUSORP account before making elective deferrals to this 403(b) plan, unless contributing to a 403(b)(7) custodial account.  \nIRS Contribution Limits: The 402(g) annual limit includes elective deferrals to 403(b) plans, including Roth, Tax‐Deferred and the SUSORP, 401(k) plans and the federal government’s Thrift Savings Plan, including contributions to other employer plans.  \nDeferral Authorization: This SRA must be signed in order to be processed. By signing this SRA, I understand that this agreement is legally binding and  \nirrevocable with respect to amounts earned while it is in effect. I am responsible for the accuracy of the excludable amounts stated in this SRA; for monitoring the accuracy of the dollar amount/percentage to be deferred on an annual basis; for any overstatement of the amounts excludable as a salary reduction in this agreement or any other violation of the requirements of Sections 403(b), 402(g) and/or 415, IRC; and for any additional taxes, interest and penalties that may be assessed.  \nDate    \nEmployee Signature  \n** Submit completed form to the HR Retirement office, via fax to (850) [645‐9509 or email:retirement@fsu.edu](645‐9509 or email:retirement@fsu.edu)**","cbCaifticpSXNG5r","https://ap.wps.com/l/cbCaifticpSXNG5r","pdf",786513,"English","# Employee Information\n# Vendor Contribution Changes\n# Bi-weekly Contribution Amounts\n# Effective Date\n# Acknowledgment, Authorization and Signature","[{\"question\":\"What information must be provided in the employee information section?\",\"answer\":\"The form requests the employee’s name, email address, and daytime phone number.\"},{\"question\":\"How are vendors and bi-weekly contribution amounts handled?\",\"answer\":\"You indicate which vendor(s) you will no longer contribute to, then enter the bi-weekly contribution amount for each applicable vendor, with a minimum of $10.00 bi-weekly.\"},{\"question\":\"When does the salary reduction agreement become effective and what does signing mean?\",\"answer\":\"It becomes effective on the earliest available paycheck date after the Human Resources Benefits Office receives the form, unless a different effective paycheck date is specified. Signing authorizes legally binding and irrevocable deferral of amounts earned while the agreement is in effect.\"}]","403(b) Tax-Sheltered Annuity - Plan Project New Election Form | PDF",1789812610]