Fillable 457 Deferred Compensation Normal Contribution Change Form (City of Oakland)

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457 Deferred Compensation Normal Contribution Change Form (City of Oakland)

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The 457 Deferred Compensation Normal Contribution Change Form (City of Oakland) form is 1 page long and contains:

  • 1 signature
  • 6 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

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457 DEFERRED COMPENSATION PLANS
NORMAL CONTRIBUTION FORM
1
PARTICIPANT INFORMATION
3
SIGNATURES
Participant Signature
Date: / /
ICMA-RC • Attn: Workow Management Team • P.O. Box 96220 • Washington, DC 20090-6220 • Toll Free 800-669-7400 • www.icmarc.org/cityofoakland • Fax 202-682-6439
43176-0719-C3015
2
CONTRIBUTION AMOUNT & EFFECTIVE DATE
Contribution Amount (per pay period)
I authorize my employer to contribute the amount specied below from my pay each pay period, to be contributed to my 457 deferred compensation plan account with ICMA-RC. (Specify a
percentage or dollar amount for pre-tax and/or Roth contributions.)
Pre-Tax Contributions: Percentage:* __ __ % or Dollar Amount: $__ __ __ __ __ (per pay period)
Roth Contributions: Percentage: *__ __ % or Dollar Amount: $__ __ __ __ __ (per pay period)
* Percentage of gross pay cannot be 100%.
Effective Date
All contribution changes will be effective as of the rst pay period of the calendar month following the date you submit this form, or as soon as administratively possible thereafter.
1. Use this form to initiate contributions to your 457 deferred compensation plan or change the amount of your after-tax contributions.
Note: You should only use this form if you have previously established an account in your employer’s plan.
2. Do not use this form for age 50 or pre-retirement catch-up. Use the Age 50/Special Pre-Retirement Catch-Up Form.
3. Fax or mail the completed form to ICMA-RC.
FAX: MAIL:
ICMA-RC ICMA-RC
ATTN: Workow Management Team ATTN: Workow Management Team
202-682-6439 P.O. Box 96220
Washington, DC 20090-6220
Year Maximum Contribution
2019
19,000
(Approximately $731 every two weeks)
Identication (Please provide your Social Security Number or Employee ID)
Social Security Number:
– –
OR Employee ID: _____________________________________
Employer Plan Number:
307108 Employer Plan Name: City of Oakland
Full Name of Participant: _________________________________________________ Department: ______________________________
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457 Deferred Compensation Normal Contribution Change Form (City of Oakland)

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Completed 22 July 2020

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