Initials _______
Date ________
Fhdr ________
INVESTMENT ELECTION (FUTURE ONLY)
Make your selection(s) in whole increments totaling 100%. Elections will only change future contributions. See transfer section below for transfer
of existing balances. Funds are not guaranteed as to rate of return or principal stability. Your employer is held harmless against any losses.
% Conservative Premixed (21)
% S & P 500 Stock Index (15)
% Small Company Stock (16)
% Lg. Co. Gro. Stock Index (19)
% International Stock (17)
% Aggressive Premixed (22)
% Lg. Co. Value Stock Index (20)
% Age-Based: Age 0-39 (26)
% Age-Based: Age 40-59 (27)
% Age-Based: Age 60 & Up (25)
TRANSFER OF EXISTING BALANCES/ELECTED DEFERRALS
A transfer will move a dollar amount or % of your existing funds from one investment fund to another. A transfer between the Stable Value
Fund and the Money Market Fund, which is a “competing fund,” is not allowed.
If making contribution changes or deferring sick/vacation leave, please submit this form to your payroll department.
They will forward the form to NPERS and set up the payroll deduction. If you are only making changes to investment elections or transfers, you may
submit directly to NPERS. Changes to investment elections/ transfers will be processed within 3 business days of receipt. Changes to contribution
amounts will be made the month following receipt of this form. For vacation and sick leave payments for terminating employees, this form must be
submitted the calendar month prior to the month of termination.
AGENCY ACTION: Please review
this form and the instructions above
(for deadlines). You will be notified
when the member has been
enrolled and deductions may begin.
Deferred Compensation Plan (DCP) Change Form
COMPLETE ONLY THOSE SECTIONS BELOW THAT APPLY TO CHANGES YOU WISH TO MAKE.
Contributions to the plan are pre-tax deductions from your pay. The maximum amount that may be contributed each year is the lesser of
(a) 100% of your annual compensation less contributions to retirement plans OR (b):
NORMAL LIMITATION DEFERRAL
AGE 50 ADDITIONAL CATCH-
UP
You will be notified if contributions designated on this form are expected to exceed IRS limitations. If you are 50 or older
you may contribute up to the Age 50 Maximum Deferral.
Contribution Per Pay Period: $_____________
FREQUENCY:
Monthly = 12 per year Bi-Weekly = 24 per year
Start date:
As soon as possible.
(No sooner than the month following the month the form is submitted.)
After paycheck dated: __________/__________/____________
Estimated Annual Salary: $________________ Have you contributed to another 457 plan this calendar year? Yes No
(If yes, please attach a copy of your statement from the other 457 plan.)
I wish to defer from final sick/vacation leave pay. Termination Date: ________/________/_________
