Forms

The forms listed below are the most frequently used forms. Log in to your account or contact us if you have questions about which form to use.

Enroll

457(b) Participation Agreement (PDF)

Use this form to:

  • Enroll in the plan
  • Change your contributions
  • Select or change beneficiaries
  • Select or change investment options

EZ Enrollment Form 457(b) (PDF)

Use this form to quickly and easily enroll in the plan

Charles Schwab Self-Directed Brokerage Option Account (PDF)

Contact a Plan Service Representative to enroll.

Plan Document 457(b) (PDF)

Plan Document 401(a) (PDF)

457 Plan Amendments (PDF)

401(a) Plan Amendments (PDF)

Manage my money

Rollover/Transfer Request for Incoming Assets (PDF)

Certain plans may have special requirements. All information on this document must be completed and returned to Nationwide Retirement Solutions in order to be processed. If you require assistance in completing this form or need additional information, please contact us.

Use this form to:

  • Roll money over from other retirement savings accounts into your 457(b)/401(a) Plan(s)
  • Decide which investments you want the rollover money to go into
  • Decide if you want to enroll in Asset Rebalancing

Payout Request Form 457(b)/401(a) Plans (PDF)

Use this form to:

  • Select your payout options when you end your employment or retire
  • Request a payout
  • Stop current payouts
  • Change a current payout
  • Restart a payout
  • Defer payout until Required Minimum Distribution (RMD) is required at age 70½

457(b) Deferred Compensation Plan Unforeseeable Emergency Distribution Application (PDF)

Your employer may have specific rules regarding unforeseeable emergencies. Please contact your benefits representative for details or contact us.

Use this form to apply for an unforeseeable emergency distribution

Manage my account

Log in and make beneficiary changes online.

457(b)/401(a) Plans Beneficiary Designation Form (PDF)

Use this form to make beneficiary designations or to change existing beneficiary information:

  • Select primary and contingent beneficiaries
  • Change how your money will be divided between your beneficiaries
  • Change current beneficiary designation(s)

457(b)/401(a) Plans Beneficiary Designation Form for Minors (PDF)

Use this form to designate a custodian to receive distributions for a beneficiary under the age of 21.

Direct Deposit Authorization (PDF)

Use this form to establish or change your checking or savings information for automatic deposits to your bank account

Federal Tax Change Request Form (W-4P) (PDF)

Use this form to choose to have more federal income tax withheld than the standard 20%.

State Tax Withholding Form (PDF)

Use this form to change your state income tax withholding.

PEHP Claim Form (PDF)

Use this form to request reimbursement from your PEHP account for qualified medical care expenses for yourself, your spouse or dependents

Phoenix Law Enforcement Association (PLEA) Employment Health Plan (PEHP) Claim Form (PDF)

Use this form to request reimbursement from your PLEA PEHP account for qualified medical care expenses for yourself, your spouse or dependants

Follow this link to view/print information on how to notify us if you are going on military leave.

Payout Request Form 457(b)/401(a) Plans (PDF)

Use this form if you’re a beneficiary or an alternate payee, such as a former spouse or a dependent of a participant in the City’s 457(b) and/or 401(a) Plans:

  • Report the death of a participant in the Plan(s). Please remember to submit a certified copy of the death certificate if you are reporting the death of a plan participant.
  • Update your beneficiary information.
  • Request a payout.

PDFs require Adobe® Reader®

NRW-2891AZ-PX.9
NRW-2891AZ-PX.9
Modal Dialog Start Close

You are going to a page that is not part of this website

We make no endorsement of its content or guarantee of its accuracy. If the Continue button does not work, the page may have been moved or removed.

Please consider logging out of your account before you proceed.

NRW-2913AO.1
Modal Dialog End