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It specifies that nonresident aliens must contact Fidelity first and clarifies when not to use the form for other IRA types, directing users to the correct Fidelity forms. The document outlines required participant information, detailed excess contribution description, correction type choices, and payment method instructions, including how excess deferrals may affect taxation and reporting.",{"@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/self-employed-401kroth-self-employed-401k-plan-return-of-excess-contribution-request/303653/",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/self-employed-401kroth-self-employed-401k-plan-return-of-excess-contribution-request/303653.png","ImageObject",442,249,{"name":88,"@type":89},"Oliver Hayes","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of this Self-Employed 401(k)/Roth Self-Employed 401(k) form?","Question",{"text":108,"@type":109},"It is used to request a return of an eligible employee contribution made to a Self-Employed 401(k) or Roth Self-Employed 401(k) account.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When should participants not use this form?",{"text":113,"@type":109},"Do not use it to request a return of excess contributions from Traditional, Rollover, Roth, Inherited SEP, SARSEP, or SIMPLE IRA. 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Go to [Fidelity.com/se401k or](Fidelity.com/se401k or) call 800-544-5373.  \nSelf-Employed 401(k)/Roth Self-Employed 401(k) Plan Return of Excess Contribution Request  \nUse this form to request a return of an eligible employee contribution made to your Self-Employed 401(k) or Roth Self-Employed 401(k) account. If you are a nonresident alien, please contact Fidelity prior to completing this form, as you may be subject to additional requirements.  \nDo NOT use this form to request a return of excess contribution from your Traditional, Rollover, Roth, Inherited SEP, SARSEP, or  \nSIMPLE IRA. Go to [Fidelity.com/forms](Fidelity.com/forms) to download the appropriate form. For Profit Sharing or Money Purchase Retirement Plan account issues, please contact a Fidelity representative or your tax advisor. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room for information, make a copy of the relevant page.  \nHelpful to Know  \n• Additional information may also be found in the 401(k) Fix-It Guide or through the IRS Employee Plan Compliance Resolution System (EPCRS), both of which can be found on the IRS website, [irs.gov](irs.gov. To view the)[. To view the](irs.gov. To view the) current contribution limits, visit [Fidelity.com/se401k](Fidelity.com/se401k).  \n• The IRS requires the excess deferral to be adjusted by any attributed earnings or loss when it is removed from the plan. You should consult your tax advisor for assistance in calculating the earnings/loss for the excess deferral. The earnings calculation is also described in Article 12.7 of the Defined Contribution Retirement Plan Basic Plan Document No. 04. You will need to provide the earnings/ loss calculation on this form.  \n• This form should not be used to correct an excess employer contribution. Typically, the nondeductible employer contribution would be carried forward and deducted in the following year. The excess contribution would generally be subject to the 10% penalty for each year it is carried forward.  \n– The employer must file IRS Form 5330 for each year the excess remains in the account, as well as the year of the final resolution of the excess. IRS Form 5330 must be filed by the last day of the seventh month after the close of the plan year.  \n– You should consult your tax advisor, Article 4.1 of the Defined Contribution Retirement Plan Basic Plan Document No. 04, the Instructions for Form 5330, and IRC Section 4972 for additional information.  \n• Important to note: The excess deferral contribution, plus or minus any earnings/loss, if applicable, will only be removed from your core position. If there is insufficient cash in the core position, you MUST place a liquidating trade into your core position before the excess deferral contribution can be removed. You can direct the sale of securities on [Fidelity.com](Fidelity.com) or through a Fidelity representative.  \n• If the Plan Participant is not also the Plan Administrator, both individuals must sign this form.  \n• Use this form to correct an eligible employee contribution that is either an excess employee deferral contribution that you are correcting before the deadline, or an excess employee annual addition, that would include a contribution that exceeded 100% of the participant’s compensation, or exceeded the allowable annual contribution limit set by the IRS. See your tax advisor if you are unsure if either applies to your circumstance.  \n1. Participant Account Information  \n\n| Self-Employed 401(k) or Roth Self-Employed 401(k) Participant Name | Fidelity Account Number |\n| --- | --- |\n|  |  |\n\nThis phone number may be used if we have questions, but will not be used to update your account information.  \nSocial Security or Taxpayer ID Number Primary Phone  \nForm continues on next page.   \n1.9909082.102  \nPage 1  \nof 4  \n042280201  \n2. Excess Contribution Description  \nIf you have multiple deposit dates, provide the date of the first deposit that was made t","cbCairPeS9pSDot3","https://ap.wps.com/l/cbCairPeS9pSDot3","pdf",1755971,13,"English","# Participant Account Information\n# Excess Contribution Description\n# Type of Correction\n## Excess Deferral\n## Excess Annual Addition\n# Method of Payment","[{\"question\":\"What is the purpose of this Self-Employed 401(k)/Roth Self-Employed 401(k) form?\",\"answer\":\"It is used to request a return of an eligible employee contribution made to a Self-Employed 401(k) or Roth Self-Employed 401(k) account.\"},{\"question\":\"When should participants not use this form?\",\"answer\":\"Do not use it to request a return of excess contributions from Traditional, Rollover, Roth, Inherited SEP, SARSEP, or SIMPLE IRA. Use the appropriate Fidelity form instead.\"},{\"question\":\"What information must be provided for the earnings/loss calculation?\",\"answer\":\"The earnings/loss amount must be provided, and participants are responsible for obtaining and providing the earnings/loss calculation to Fidelity, as required for removing the excess deferral.\"}]","Self-Employed 401(k)/Roth Self-Employed 401(k) Plan Return of Excess Contribution Request | PDF",1789805916]