4.1435 Distribution request form-Filing requirements.

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(a) A completed distribution request form prescribed by the board shall be filed with the administrator upon separation from service. Additional information may be required by the board prior to approval of the request.

(b) The following shall be entered on the form:

(1) identifying information, including name, social security number, date of birth, home address, and home telephone number;

(2) date of and reason for separation from service;

(3) whether the catch-up provision has been utilized;

(4) normal retirement age;

(5) payment option;

(6) commencement date of payments; and

(7) signature authorizing proper withholding of taxes and certifying the information is true and correct to the best of the person’s knowledge and belief.

(c) The form shall be filed no later than 30 days after the close of the calendar year in which the separation from service occurs.

(d) In the event a distribution request form is not filed within the prescribed time or is otherwise rendered ineffective by the plan or this chapter, benefits shall be paid in accordance with 4.1439.

History: Rule 11-87, eff 17 Jun 87.