SUU RETIREMENT CHANGE FORM
Employee Name ____________________________________ T Number _______________________
Change Request Date ___________________
May take up to 2 pay periods for change to be effective on payroll
Distribution of University Contribution 14.2% - 401(a)
Fidelity _____________% TIAA ______________%
(must equal 100% ex; 60/40, 70/30, 90/10 etc.)
Initial investments will be into a “target date” fund. Employees should log on to their investment provider and
personally review and allocate funds. Employees will have access to 401(a) funds 32 days after they end
employment with SUU.
VOLUNTARY CONTRIBUTION AND SALARY REDUCTION AGREEMENT
(Put the amount you would like in total PER PAY PERIOD)
Fidelity $ A
mount OR Percentage
403b $_____________ ____________%
403b ROTH $_____________ ____________%
457 $_____________ ____________%
TIAA $ Amount OR Percentage
403b $_____________ ____________%
403b ROTH $_____________ ____________%
457 $_____________ ____________%
403(b) and 457 are contributions are pre-tax, 403(b)ROTH is post-tax.
403(b), 403(b)ROTH Have a combined contribution limit. 457 has a separate contribution limit. These amounts have
been set by the IRS. Each year the limit may change, or employees may be eligible for “catch up” contribution limits.
SUU and/or Human Resources cannot give retirement advice or calculate the amount the employee is eligible to
contribute. If the employee needs advice, they can contact their investment provider.
_____________________________________________ _________________________
Employee Signature Date
_____________________________________________ _________________________
HR Signature Date
