State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts - DC-4531 - Things to Remember

Sep 19, 2026

State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts DC-4531 (12/2016) collects participant details and plan selection for 457(b), 401(k), and 403(b) options, including pre-tax and Roth election. It covers authorization and paperless delivery consent for electronic statements and confirmations, contribution summary and payroll frequency choices, effective timing rules for changes, and guidance on qualified versus non-qualified Roth distributions and potential taxes/penalties. It also includes beneficiary designation and funding options that must total 100%.

LanguageEnglish

CategoryForms

FormatPDF

Pages8

Reading Time3 min

AccessFree to download

Things to Remember

Personal Information

Type of Request & Paperless Delivery Consent

Contribution Summary & Payroll Frequency

Beneficiary Designation

Funding Options

State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts DC-4531 (12/2016) For help, please call 800-966-6355 [marylanddc.com](marylanddc.com) 1 Things to Remember c Complete all of the sections on the Participation Agreement that apply to your request. c Complete the Authorization section, and remember to sign and date this Participation Agreement. c Enclose the completed Participation Agreement, and any other documentation in the business reply envelope included with this booklet. c All contributions will use the same investment election and allocation. If you wish to have different selections, call us at 443-886-9402 or toll-free at 800-966-6355. c Earnings from Designated Roth contributions may be subject to income taxes and penalties upon distribution if the distribution is deemed to be Non-Qualified. A Qualified distribution is one that the contributions are held in the Designated Roth Account for 5 consecutive tax years and the participant is at least age 59 ½, has become disabled or has died. In addition, Designated Roth Accounts which are rolled over into this account may be subject to income taxes and penalties if they are deemed Non-Qualified. Designated Roth Contributions are generally not subject to income taxes or penalties. c Please note that, once made, contributions and/or rollovers to a Roth account may not be reversed. In the event you wish to make changes, only future contributions and/or rollovers can be redirected. 2 DC-4531 (12/2016) For help, please call 800-966-6355 [marylanddc.com](marylanddc.com) State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts Personal Information | Select Plan Type: c 457(b) Pre-Tax c 401(k) Pre-Tax c 403(b) Pre-Tax | | | | --- | --- | --- | | c 457(b) Roth* c 401(k) Roth* *Contributions to Roth are made on a post-tax basis. | | | | Name: | | Social Security Number or Account Number: | | Address: | | City, State, & Zip Code: | | Date of Birth: | | Work Phone Number: | | Email Address: | | Home Phone Number: | | Date of Hire: | Agency Code: | Gender: c Male c Female | Type of Request & Paperless Delivery Consent c New c Change Amount c Reinstate c Change Direction of Future Contributions NOTE: All increases, decreases and suspensions will be implemented no sooner than the first payroll of the month following the change. Please remember to check your pay stub to confirm your selected contributions are accurately reflected and being processed. Paperless Delivery: By providing your email address you are consenting to receive statements, confirmations, terms, agreements and other information provided in connection with your retirement plan electronically. Unless you choose to have statements, account documents and other documents sent in connection with your retirement plan delivered via U. S. Mail to the mailing address of record by checking the box below, these documents will be made available to you electronically. c I wish to receive my statements and account documents via U.S. Mail. Contribution Summary & Payroll Frequency | | Dollar Amount* | | --- | --- | | Contribution Amount-Pre-Tax | | | Contribution Amount-Roth* | | | Special Amount Per Pay | | | Total | 0 | *Contributions to Roth are made on a post-tax basis. Payroll Frequency: Please select your payroll frequency to insure timely processing. c Weekly c Monthly c Semi-Monthly c Bi-Weekly c Other Contribution to begin on pay-period ending date: Payroll Type: c Regular c University Special Pay-Period Date Range: Start Date/End Date: c Contractual c Other (Special Amount Only) \# of Pay-Periods: Payroll Center Name: c Central c University c Other Beneficiary Designation c Check here if this is a change of beneficiary. (Beneficiaries listed below replace any prior designation) PLEASE NOTE: Percentage split must total 100% for each category of beneficiary. If additiona

FAQs

What sections must be completed on the Participation Agreement?

Complete all applicable sections and complete the Authorization section. Sign and date the Participation Agreement before submitting it with the included business reply envelope.

How do Roth earnings and qualified distributions differ?

Earnings from designated Roth contributions may be subject to income taxes and penalties if the distribution is non-qualified. A qualified distribution requires holding contributions in the designated Roth account for 5 consecutive tax years and meeting age 59 ½, disability, or death conditions.

When will changes to contributions be implemented?

Increases, decreases, and suspensions are implemented no sooner than the first payroll of the month following the change. Check your pay stub to confirm selected contributions are accurately processed.

Sep 19, 2026

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