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If you wish to have different selections, call us at 443-886-9402 or toll-free at 800-966-6355.  \nc 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.  \nc 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.  \n2 DC-4531 (12/2016) For help, please call 800-966-6355 [marylanddc.com](marylanddc.com)  \nState of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts  \nPersonal Information  \n\n| Select Plan Type: c 457(b) Pre-Tax c 401(k) Pre-Tax c 403(b) Pre-Tax |  |  |\n| --- | --- | --- |\n| c 457(b) Roth* c 401(k) Roth* *Contributions to Roth are made on a post-tax basis. |  |  |\n| Name: |  | Social Security Number or Account Number: |\n| Address: |  | City, State, & Zip Code: |\n| Date of Birth: |  | Work Phone Number: |\n| Email Address: |  | Home Phone Number: |\n| Date of Hire: | Agency Code: | Gender: c Male c Female |\n\nType of Request & Paperless Delivery Consent  \nc New c Change Amount c Reinstate c Change Direction of Future Contributions  \nNOTE: 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.  \nPaperless 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  \nelectronically. c I wish to receive my statements and account documents via U.S. Mail.  \nContribution Summary & Payroll Frequency  \n\n|  | Dollar Amount* |\n| --- | --- |\n| Contribution Amount-Pre-Tax |  |\n| Contribution Amount-Roth* |  |\n| Special Amount Per Pay |  |\n| Total | 0 |\n\n*Contributions to Roth are made on a post-tax basis.  \nPayroll Frequency:  \nPlease select your payroll frequency to insure timely processing.  \nc Weekly c Monthly  \nc Semi-Monthly  \nc Bi-Weekly  \nc Other   \nContribution to begin on pay-period ending date:   Payroll Type: c Regular c University  \nSpecial Pay-Period Date Range: Start Date/End Date:  c Contractual c Other  \n(Special Amount Only) \\# of Pay-Periods:   Payroll Center Name: c Central c University c Other  \nBeneficiary Designation  \nc Check here if this is a change of beneficiary. (Beneficiaries listed below replace any prior designation)  \nPLEASE NOTE: Percentage split must total 100% for each category of beneficiary.  \nIf additiona","cbCaijvVk6KDZNm8","https://ap.wps.com/l/cbCaijvVk6KDZNm8","pdf",515063,8,"English","# Things to Remember\n## Personal Information\n## Type of Request & Paperless Delivery Consent\n## Contribution Summary & Payroll Frequency\n## Beneficiary Designation\n## Funding Options","[{\"question\":\"What sections must be completed on the Participation Agreement?\",\"answer\":\"Complete all applicable sections and complete the Authorization section. Sign and date the Participation Agreement before submitting it with the included business reply envelope.\"},{\"question\":\"How do Roth earnings and qualified distributions differ?\",\"answer\":\"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.\"},{\"question\":\"When will changes to contributions be implemented?\",\"answer\":\"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.\"}]","State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts - DC-4531 - Things to Remember | PDF",1789780949]