In compliance with the Americans with Disabilities Act, OSGP sta will provide assistance in filling out this form to anyone who needs it. You
may request assistance from Oregon Savings Growth Plan by calling 888-320-7377 or TTY 503-603-7517.
Submit completed form to: Voya Plan Administration
Attn: Oregon Savings Growth Plan
Administration PO Box 389
Hartford, CT, 06141
Address/name change form
Old
Participant Name
Address
City, State, Zip
New
Participant Name
Address
City, State, Zip
Participant’s Signature (Do not print)
(This form must be signed by the participant in order to be processed.)
Date
Social Security Number Phone Number
II. Authorization
Complete this fo
rm if your address/name has changed. You must use this form, unless you are terminated or retired. If you are
terminated or retired, you may update your information online at osgp.voya.com.
Employees should also submit address/name change information to their agency payroll and/or human resource departments
to make sure all address information on file is correct. If address and name change information is not provided to agency
payroll and/or human resource departments, new information could convert back to old information.
I. Address / name change directions
888-320-7377 (Phone) • 503-603-7655 (Fax) • growyourtomorrow.com
160121 376354_1220
SAVI N G S G R O WTH PLA
