Submit all completed forms to your County Clerk. Contact the Empower Retirement Office at 1-877-895-1394 if you have any questions about the savings plan forms.
| Form Name | Last Revision |
|---|---|
| Savings Plan Enrollment | February 24 |
| 401(a) Beneficiary | September 24 |
| 401(a) In Service Withdrawal Age 59.5 or Older | September 24 |
| 401(a) Incoming Direct Rollover | September 24 |
| 401(a) Separation From Employment Withdrawal Request | September 24 |
| 401(a) Death Claim | September 24 |
| 457 Beneficiary | September 24 |
| 457 In Service Withdrawal Age 59.5 or Older | September 24 |
| 457 Incoming Transfer | September 24 |
| 457 Paycheck Contribution Election | September 24 |
| 457 Death Claim | September 24 |
| 457 Separation From Employment Withdrawal Request | September 24 |
Enrollment
| Form Number | Form Name | Last Revision |
|---|---|---|
| 1 | Enrollment | July 23 |
| 1A & 8 | Beneficiary Designation - Death Benefits for Active Participants and Unmarried Vested Death Benefit | August 21 |
| Form Number | Form Name | Last Revision |
|---|---|---|
| 2A | Refunds - Payment Election | July 21 |
| Instructions | Instructions for Form 2A - Refunds Payment Election | May 20 |
| Form Number | Form Name | Last Revision |
|---|---|---|
| 9 | Application by Spouse | June 21 |
| 3A | Death Benefits - Non-Spouse Payment Election $10,000 Death Benefit | November 22 |
| 3B | Death Benefit - Spouse Payment Election $10,000 Death Benefit | November 22 |
| 3C | Death Benefit - Non-Designated Non-Spouse Payment Election $10,000 Death Benefit | November 22 |
| 4A | Death Benefits - Designated Non-Spouse Payment Election Single-Vested/Non-Vested Refund | November 22 |
| 4B | Death Benefit - Spouse Payment Election Non-Vested Refund | November 22 |
| 4C | Death Benefits - Non-Designated Non-Spouse Payment Election Single-Vested/Non-Vested Refund | November 22 |
| Instruction | Instructions for Forms 3A, 3B, 3C, 4A, 4B & 4C - Death Benefits Payment Election | April 19 |
Term vested
| Form Number | Form Name | Last Revision |
|---|---|---|
| 2V | Termination Vested | November 22 |
| 2B |
Retirement Application Designation of Survivor (Employees termed after 12/31/1999) |
July 21 |
| 6 |
Retirement Application (Employees termed before 1/1/2000) |
June 16 |
| EFT | Electronic Funds Transfer | January 24 |
| Federal W4P | Federal Withholding for Pension or Annuity Payments | January 24 |
| MO-W4P | State Withholding for Pension or Annuity Payments | October 22 |
| 2C | Co-Annuitant for 10 Year Certain | January 21 |
