Human Resources Department
For RCUH Use Only
☐ Enrolled in TIAA SRA account Data Entry Initial/Date ____________
Data Entry Special Instructions: ________________________ Edited By Initial/Date ____________
_________________________________________________________________________________________
RCUH Form B-6
Created 05/25/2004, (Revised 03/2011, 06/2012, 07/31/2012, 02/11/2014, 03/11/2014, 09/26/2014, 03/30/16, 02/23/18, 12/14/18,
12/21/18)
Research Corporation
of the University of Hawai‘i
Employee Name: RCUH Employee ID #:
SECTION I: Salary Reduction Election **Must be updated each Tax/Calendar Year
☐ _______% Fixed percentage per pay period
☐ $______ Fixed amount per pay period
☐ Cancel current contribution/deduction
☐ **Maximum allowable (Based on IRS Regulations for Calendar Year)
SECTION II: Agreement of Terms and Conditions
By this AGREEMENT made between the Employee named above, and the RESEARCH CORPORATION OF THE
UNIVERSITY OF HAWAII, hereinafter referred to as the RCUH, the parties hereto agree as follows:
1. The RCUH agrees to make the initial premium payment and all successive premium payments so long as this
Agreement is in force. The Employee shall be responsible for compliance with the provisions of Section 403(b),
the limitations of Section 415, or the limitations of Section 402(g) of the United States Internal Revenue Code, as
amended, to include, but not limited to, compliance with the maximum exclusion allowance provisions.
2. This Agreement supersedes any other previously executed Agreement for Salary Reduction.
3. The Employee releases all rights, present and future, to receive any or all of the amounts to be used by the RCUH
as premium payments in any other form except as such right might accrue under the Tax-Sheltered Annuity
program.
4. This Agreement shall be legally binding and irrevocable as to each of the parties hereto while employment
continues; provided, however, that from the effective date hereof either party may terminate this Agreement as
of the end of the pay period so that it will not apply to salary subsequently earned, by giving written notice of such
termination in accordance with RCUH policies and procedures governing reduction of income for SRAs.
5. It is the Employee’s responsibility to coordinate maximum allowable benefits with any multiple tax sheltered
annuities under another Employer to ensure they do not exceed the IRS limit.
6. Employees who are at least 50 years of age during the current calendar year will be eligible to elect in the catch-up
option that is based on their age (IRC Section 414(v)).
Employee Signature:
Date:
____/____/____
(Mo) (1
st
or 16
th
) (Yr)
*RCUH may change start date as
necessary due to PAF deadline.
3.560 RCUH Retirement Plans
TIAA-SRA Supplemental Retirement Annuity -
Agreement for Salary Reduction Form (B-6)
IMPORTANT NOTICE: Prior to submitting this form to RCUH, you will need to first enroll
in an Supplemental Retirement Annuity (SRA) account on-line with TIAA. Please go to
https://www.tiaa.org/rcuh to create an account.
Submit via email: rcuh_benefits@rcuh.com or Fax: 808-956-5022
Submit via email: rcuh_benefits@rcuh.com or Fax: 808-956-5022
RCUH will only accept wet signatures and will validate the information prior to processing
