Please print using blue or black ink. Please keep a copy for your records and send completed form to the following address.
|
|
- Edgar Kelly
- 5 years ago
- Views:
Transcription
1 20 Disbursement for Beneficiary/QDRO Account IBEW Local Union No. 716 Retirement Plan Instructions About You Please print using blue or black ink. Please keep a copy for your records and send completed form to the following address. IBEW LU 716 Fund Office Questions? C/O BENEFIT RESOURCES 8441 GULF FREEWAY Ask for a Representative at SUITE HOUSTON, TX Plan number Sub Plan number IBEW Local 716 Please indicate what type of account this is: Spousal Beneficiary Non-Spousal Beneficiary Alternate Payee under Qualified Domestic Relations Order (QDRO) Social Security number Daytime telephone number area code First name MI Last name Address City State ZIP code Method of Payment For Beneficiary Choose Your Option(s) Date of birth month day year Gender M $,,. F 1. Total amount in a single sum to me. 20% federal income tax will automatically be withheld from the taxable portion of your distribution. 2. Partial single sum to me. 20% federal income tax will automatically be withheld from the taxable portion of your distribution. 3. Spousal Beneficiary Direct Rollover to an Individual Retirement Account or eligible employer plan that accepts rollovers, as indicated in the Direct Rollover Options section on this form. This election is only available if you are the spouse of the participant. No federal income tax will be withheld unless you are rolling non-roth money to a Roth IRA and elect to have tax withheld. 4. From the non Roth balance Non-Spouse Beneficiary Direct Rollover to an Inherited Individual Retirement Account. This is the only rollover option available if you are the non-spouse beneficiary of the original participant or the successor beneficiary of a deceased spousal beneficiary. Please complete the Direct Rollover Instructions section of this form. No federal income tax will be withheld unless you elect to roll non-roth money to a Roth IRA and elect to have tax withheld. Please note that if the original participant died prior to his/her required beginning date for minimum distributions and you elected to have the entire balance depleted by the end of the year that includes the fifth anniversary of his/her death, you may not elect a rollover in the final year. (Note: After-tax contributions will be included in the direct rollover, unless otherwise specified. It is your responsibility to confirm that the receiving IRA or plan accepts rollovers, including after-tax amounts and/or Roth amounts, if applicable.) You have the option to purchase an annuity. You can obtain an annuity quote and request a form by calling To request distributions in installment payments (if allowed by the plan), a Request for Systematic Disbursement form should be completed in place of this form. You can request the form by calling our toll-free number. Important information continued and signature required on the following page
2 Method of Payment For Alternate Payee Choose Your Option(s) 1. Total amount in a single sum to me. If you are the spouse of the participant, 20% federal income tax will automatically be withheld from the taxable portion of your distribution. If you are a non-spouse alternate payee of the participant, 10% federal income tax will automatically be withheld from the taxable portion of your distribution, unless you elect out of withholding in the Election for Withholding of Federal Income Tax section below. 2. Partial withdrawal. If this plan allows, and you wish to take a partial distribution, please enter the amount. If you are the spouse of the participant, 20% federal income tax will automatically be withheld from the taxable portion of your distribution. If you are a non-spouse alternate payee of the participant, 10% federal income tax will automatically be withheld from the taxable portion of your distribution, unless you elect out of withholding in the Election for Withholding of Federal Income Tax section below. $,,. From the non Roth balance 3. Direct Rollover to Individual Retirement Account or eligible employer plan that accepts rollovers as indicated in the Direct Rollover Options section on this form. This election is only available if you are the spousal alternate payee under a QDRO of the participant. No federal income tax will be withheld unless you are rolling non-roth money to a Roth IRA and elect to have tax withheld. (Note: After-tax contributions will be included in the direct rollover, unless otherwise specified. It is your responsibility to confirm that the receiving IRA or plan accepts rollovers, including after-tax amounts and/or Roth amounts, if applicable.) You have the option to purchase an annuity. You can obtain an annuity quote and request a form by calling To request distributions in installment payments (if allowed by the plan), a Request for Systematic Disbursement form should be completed in place of this form. You can request the form by calling our toll-free number. Important information continued and signature required on the following page
3 Direct Rollover Instructions (Only complete this section if you have selected the Direct Rollover option.) Direct Rollover- 1. Types of money in your account. Tax-Deferred and After-Tax Account. (Excludes Roth Accounts. May include one or more of the following: Your own contributions (pre-tax, after-tax, or both), made by the employer, or money rolled over from another employer-based plan.) Please complete applicable sections below. 2. What do you want to roll over? $ The entire Account. A portion of the Account: OR % Percentage of after-tax contributions (if any) to be rolled % (If no percentage is indicated, after-tax contributions will be included in the direct rollover. It is your responsibility to confirm that the receiving plan accepts rollovers, including after-tax, if applicable.) 3. What type of account are you rolling to? Another eligible employer - based plan (Spouse only) A Traditional IRA. 1 A Roth IRA. Note: Any rollover election for a non-spouse beneficiary must be characterized as an Inherited IRA. 4. Please choose a specific product/plan below. 2 Prudential SmartSolution IRA Brokerage IRA with Prudential Investment Management 3 Other Financial Institution Address Account number: 1 This type of rollover is subject to current taxes. Please complete the section called Election for Withholding Federal Income Taxes When Rolling Non-Roth Money to a Roth IRA below. 2 Your SmartSolution IRA must be opened before the distribution can be processed. If you have not already opened an account please call our toll-free number shown at the top of page 1 of this form. The money will be directly deposited into your account. 3If the address of the institution is not given, your direct rollover check will be sent to you. You are responsible for completing the direct rollover to your financial institution in a timely manner in accordance with applicable law. If rolling over to multiple institutions, please list additional institutions or IRA (note if Traditional or Roth) on a separate page. Important information continued and signature required on the following page
4 Election for Withholding of Federal Income Tax (Complete this section only if you are a non-spousal alternate payee under a QDRO, or are otherwise subject to Required Minimum Distributions.) This election will only be valid if a portion of your distribution will be applied to your Required Minimum Distribution (RMD) payment, or if you are a non-spousal alternate payee under a QDRO. The first dollars out of your account in the calendar year will be applied to your RMD payment, if applicable. Federal tax laws require Prudential to withhold income taxes from the taxable portion of a qualified retirement plan distribution. Some states also require withholding from the taxable portion of your distribution if federal income tax is withheld. RMD payments or payments to a non-spousal alternate payee under a QDRO are subject to 10% federal tax withholding unless you elect otherwise. You can elect to have no federal taxes withheld by checking the box below. If you elect out of withholding, you are still responsible for payment of any taxes due, and you may incur penalties if your withholding and/or estimated tax payments are not sufficient. If you do not check one of the options below, 10% federal income tax withholding will be automatically deducted from the taxable portion of your distribution. 1. I elect to have federal income tax withheld at 10% from the taxable amount of my distribution. 2. I elect not to have federal income tax withheld from my distribution. 3. I elect to have federal income tax withheld from the taxable amount of my distribution at either the following percentage or dollar amount. (The federal withholding calculated from your election below must be at least 10% of the taxable portion of your distribution applicable to this election.) % or $.00 Neither Prudential nor any of its employees, agents or representatives can give legal or tax advice, or financial advice on behalf of the Plan. You are urged to consult your own personal legal, tax and/or financial advisor with any questions on allowances, deductions, or tax credits that may apply to your particular situation before you take any action relating to Plan benefits. Election for Withholding Federal Income Taxes When Rolling Non-Roth Money to a Roth IRA (Trust only) Only complete this section if you elected to roll non-roth money to a Roth IRA above. If you do not complete this section, no federal income tax will be withheld if you elect to rollover non-roth money to a Roth IRA. A rollover of non-roth money to a Roth IRA is generally taxable. However, this distribution is not subject to 20% mandatory federal withholding. You may elect withholding by making an election below. Please withhold % (percent) or $ (amount) Please do not withhold federal income taxes (Note: If you elect federal income tax withholding for this type of rollover, you will receive a second 1099-R for the withholding amount.) Consult with your tax advisor to understand the tax implications for you. Important information continued and signature required on the following page
5 Election For Withholding of State Income Taxes (For Single Sum Payments and Rollovers of non-roth money to a Roth IRA) A. B. C. Mandatory State Withholding: If you reside in a state where state income tax withholding is mandatory AR, CA*, DC (mandatory for total single sum distributions only), DE, IA, KS, MA, MD (mandatory for eligible rollover distributions only, subject to 20% mandatory federal withholding), ME, MI (see below), NC, NE, OK*, OR*, VA or VT* applicable withholding will be deducted automatically, unless an election out is applicable (see below). Note: Some states require withholding if federal income tax is withheld from the distribution. If you are a resident of IA, have federal income taxes withheld, and receive one or more distributions totaling more than $6,000 in the calendar year, IA income taxes are required to be deducted for the amount over $6,000. My resident state is AR, DE, KS, ME, NC, NE, or VA (for NE and VA, election out is allowed for payments from IRA s only) and I do not want state income tax withholding deducted from my distribution. (An election out of AR, DE, KS, ME, NC, or VA state tax is not allowed for eligible rollover distributions, subject to 20% mandatory federal withholding.) Important note to Maine (ME) residents. If you elect out of ME withholding, you must either have elected out of federal withholding, or have no Maine State tax liability in the prior or current years. *My resident state is one of the following: CA, OK, OR, **VT and withholding is required if federal income tax is withheld, unless I elect out of state withholding. By checking this box I am electing out of state withholding. **An election out is not allowed for eligible rollover distributions, subject to 20% mandatory federal withholding. My resident state is MI and withholding of 4.25% is required, unless my payments are not taxable and I opt out. My resident state is MI and I would like to opt out of MI withholding. Note: Opting out may result in a balance due on your MI 1040 as well as penalty and/or interest. My resident state is MI and if my payments are taxable, I wish to have MI state withholding based on the number of exceptions selected. I have entered the number of exemptions below: Enter the number of personal exemptions allowed on your Michigan Income Tax Return (MI-1040). The total number of exemptions you claim may not exceed the number of exemptions you are entitled to claim when you file your MI Withholding will be computed at the percentage determined by the state after subtracting your personal exemption allowances. My resident state is MI and I am requesting % additional MI state tax withheld from my payment. This amount must be a whole percentage. Voluntary State Withholding: Please check the appropriate box below. If state income tax withholding is not mandatory in your state, you may be allowed to request state tax withholding. If your state of residence is not listed, or if you choose method of withholding that is not offered for your state, we cannot withhold state income tax. I reside in one of the following voluntary withholding states: AL, CO, CT, DC (voluntary for partial and systematic distributions), GA, ID, IA (voluntary if no federal tax withheld), IL, IN, KY, LA, MD (non-eligible rollover distributions only), MA (voluntary if no federal income tax withheld), MN, MO, MS, MT, ND, NE, NJ, NM, NY, OH, PA, RI, SC, UT, VA, WI, WV (NE and VA state withholding is voluntary for payments from IRA s only) and would like state income tax withheld. (Specify a percentage or dollar amount to be withheld.) % or $ I reside in one of the voluntary withholding states listed above and I do not want state income tax withholding deducted from my distribution. No State Withholding: Some states do not have state income tax withholding. My resident state is one of the following: AK, FL, HI, NV, NH, SD, TN, TX, WA, WY and there is no state income tax withholding. My resident state is AZ and there is no state income tax withholding on non-periodic (single sum) payments. Important information continued and signature required on the following page
6 This section must be completed and signed by an authorized plan representative. Your Plan Authorization X Authorized plan representative's signature Date Print name and title X Authorized plan representative's signature (if two signatures are required) Date Your Authorization Print name and title Prudential fax number: I understand that Prudential will rely on the information I have provided in processing my request. I further understand that I will be responsible for its accuracy in the event any dispute arises with respect to the transaction. I acknowledge that I have read the attached Special Tax Notice Regarding Plan Payments. I understand the tax implications regarding this disbursement, including that if I am entitled to an eligible rollover distribution, I have the right to consider the decision of whether or not to elect a Direct Rollover for at least 30 days after this special tax notice is provided. period. X Participant's/Account Owner's signature By signing this form, I am waiving this notice Date
7
8
9
10
Request for Disbursement Vermont State Teachers Retirement System 403(b) Plan
Instructions Request for Disbursement Vermont State Teachers Retirement System 403(b) Plan Please print using blue or black ink. This request must be authorized by your employer. Please forward this form
More informationReport of Termination/Request for Disbursement Plumbers Local Union No. 1 Employee 401(k) Savings Plan
Instructions About You Please print using blue or black ink. Send completed form to the following address or fax it to 1-866-439-8602. If faxing, please keep original for your records. Prudential PO Box
More informationDistribution Election for Governmental DCP 457 Plans State of Vermont Deferred Compensation Plan
Distribution Election for Governmental DCP 457 Plans State of Vermont Deferred Compensation Plan Instructions Please print using blue or black ink. This request must be authorized by your employer. Please
More informationReport of Termination/Request for Disbursement
Instructions Please print using blue or black ink. This request must be authorized by your employer. Please forward this form to your benefits/human resources office to complete the Your Plan Authorization
More informationDistribution of Account Balance up to $5,000 under a 457 Plan
About You Plan number 3 0 0 4 1 1 Social Security number - - First name MI Last name Sub plan number 000001 State of Hawaii 000004 County of Maui 000002 County of Hawaii 000005 County of Hawaii Water District
More informationRequest for Disbursement Vermont State Teachers Retirement System 403(b) Plan
Request for Disbursement Vermont State Teachers Retirement System 403(b) Plan Instructions Please print using blue or black ink. This request must be authorized by your employer. Please forward this form
More informationAttention; Benefits/Human Resources office - Please send completed form to our address or fax number. Questions?
21 Request for Systematic Disbursement Vermont Deferred Compensation Plan Instructions Please print using blue or black ink. Please forward this form to your benefits/human resources office to complete
More informationRequest for Disbursement
Instructions Request for Disbursement Deferred Salary Plan of the Electrical Industry Please print using blue or black ink. This request must be authorized by your Fund Office. Please forward this form
More informationSub Plan number. area code
617 Request for Unforeseeable Emergency Withdrawal MTA 457 Plan Instructions Please print using blue or black ink. Send completed form to the following address or fax it to 1-866-439-8602. If faxing, please
More informationIBEW Local 716 Marital status. - - Married - spousal signature required*. First name MI Last name. City State ZIP code
21 Request for Systematic Disbursement IBEW Local Union No. 716 Retirement Plan Instructions Please print using blue or black ink. Please forward this form to your Fund office to complete the 'Your Plan
More informationRequest for Systematic Disbursement
Instructions About You Request for Systematic Disbursement NC 401(k) PLAN Please print using blue or black ink. Please send completed form to the following address or fax it to 1-866-439-8602. Questions?
More informationRequest for Systematic Disbursement
Instructions Request for Systematic Disbursement ALAMEDA COUNTY DEFERRED COMPENSATION PLAN Please print using blue or black ink. Return this form to: Alameda County Treasurer s Office, Attn: DC Administration,
More informationName of Applicant Soc Sec # _ / / Marital Status (Circle One): Single Married Divorced Widow(er) Name of Spouse Date of Birth / / Soc Sec # _ / /
PLAN NUMBER 766570 20 IBEW LOCAL 102 SURETY FUND C/O I.E. SHAFFER & CO. 830 BEAR TAVERN RD 2 ND FLOOR PO BOX 1028 TRENTON NJ 08628-0230 PHONE (800)792-3666 FAX (609) 883-7560 Application for Benefits (Please
More informationNOTICE OF FEDERAL AND STATE TAX INFORMATION FOR PSA PLAN PAYMENTS YOUR ROLLOVER OPTIONS
NOTICE OF FEDERAL AND STATE TAX INFORMATION FOR PSA PLAN PAYMENTS YOUR ROLLOVER OPTIONS Retain this Notice for Future Reference You are receiving this notice because all or a portion of a payment you are
More informationIRA Distribution Form
Use this form to request distributions from your IRA account and to close an IRA. Instructions 1. Complete the form and include any necessary supporting documents. 2. Sign and send us the completed form.
More informationSub Plan number. area code. Please Reference Attached Worksheet before completing this section. Amount of Safe Harbor Hardship: [1] $ + [2] $
72 Request for Hardship Disbursement MTA 401K Instructions Please print using blue or black ink. Send completed form to the following address or fax it to 1-866-439-8602. If faxing, please keep original
More informationTHE TATITLEK CORPORATION 401(K) PLAN FINAL DISTRIBUTION FORM (907)
Return Form To: Human Resources Department 561 East 36 th Avenue Anchorage, AK 99503 Fax (907) 334-1981 THE TATITLEK CORPORATION 401(K) PLAN FINAL DISTRIBUTION FORM (907) 278-4000 Participant Information
More informationSPECIAL TAX NOTICE REGARDING PLAN PAYMENTS
SPECIAL TAX NOTICE REGARDING PLAN PAYMENTS This notice explains how you can continue to defer federal income tax on your retirement plan savings in the Plan and contains important information you will
More informationPRODUCER ANNUITY SUITABILITY TRAINING REQUIREMENTS BY STATE As of September 11, 2017
PRODUCER ANNUITY SUITABILITY TRAINING REQUIREMENTS BY STATE As of September 11, 2017 This document provides a summary of the annuity training requirements that agents are required to complete for each
More informationRequest an IRA Distribution
Request an IRA Distribution Use this form to request a new distribution from or change an existing distribution instruction for your Schwab IRA account. If you are an IRA beneficiary and are requesting
More informationIRA Distribution Request Instructions and Form
IRA Distribution Request Instructions and Form 877.836.3949 203.388.2714 www.vfmarkets.com Send to: Email: US Mail: (Please submit using one method) clientservices@vfmarkets.com 120 Long Ridge Rd., 3 North
More informationCWA Savings & Retirement Trust
CWA Savings & Retirement Trust CWA Savings & Retirement Trust INSTRUCTIONS FOR REQUESTING AN IN-SERVICE WITHDRAWAL Enclosed are the following items needed to request an In-Service Withdrawal from the CWA
More informationSystematic Distribution Form
Systematic Distribution Form (To be used for all Qualified Plans, IRA s and Non-Qualified Plans) (This form is not applicable to a Required Minimum Distribution ( RMD ). If you are older than 70 ½, refer
More informationFor Standard Mail Delivery: The Hartford Mutual Funds PO Box St. Paul, MN The Hartford Mutual Funds
The Hartford Mutual Funds IRA Distribution Request Form (Use Only For IRA Plans with US Bank NA as Custodian) For Standard Mail Delivery: The Hartford Mutual Funds PO Box 64387 St. Paul, MN 55164-0387
More informationTHE WINDERMERE REAL ESTATE 401(k) PLAN FOR EMPLOYEES DISTRIBUTION FORM
THE WINDERMERE REAL ESTATE 401(k) PLAN FOR EMPLOYEES DISTRIBUTION FORM INSTRUCTIONS 1.) Please read the notice regarding the (a.) TIMING & COST OF DISTRIBUTION on this page, (b.) the DISTRIBUTION ACKNOWLEDGEMENTS
More informationNon-Financial Change Form
Non-Financial Change Form Please Print All Information Below Section 1. Contract Owner s Information Administrative Offices: PO BOX 19097 Greenville, SC 29602-9097 Phone number (800) 449-0523 Overnight
More information2016 Workers compensation premium index rates
2016 Workers compensation premium index rates NH WA OR NV CA AK ID AZ UT MT WY CO NM MI VT ND MN SD WI NY NE IA PA IL IN OH WV VA KS MO KY NC TN OK AR SC MS AL GA TX LA FL ME MA RI CT NJ DE MD DC = Under
More informationOlder consumers and student loan debt by state
August 2017 Older consumers and student loan debt by state New data on the burden of student loan debt on older consumers In January, the Bureau published a snapshot of older consumers and student loan
More informationThe Lincoln National Life Insurance Company Term Portfolio
The Lincoln National Life Insurance Company Term Portfolio State Availability as of 7/16/2018 PRODUCTS AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MP MD MA MI MN MS MO MT NE NV NH NJ
More informationREQUIRED MINIMUM DISTRIBUTION FORM (not for use with Roth IRAs or for distributions other than required minimum distributions)
Dreyfus Brokerage Services P.O. Box 9008 Hicksville, NY 11802-9008 REQUIRED MINIMUM DISTRIBUTION FORM (not for use with Roth IRAs or for distributions other than required minimum distributions) Please
More informationIRA DISTRIBUTION REQUEST
IRA DISTRIBUTION REQUEST Use this form to request a distribution of assets from Traditional IRAs, SEP IRAs, SIMPLE IRAs, Roth IRAs, and Education Savings Accounts Do not use this form to request a trustee-to-trustee
More informationRequired Minimum Distribution Election Form for IRA s, 403(b)/TSA and other Qualified Plans
Required Minimum Distribution Election Form for IRA s, 403(b)/TSA and other Qualified Plans For Policyholders who have not annuitized their deferred annuity contracts Zurich American Life Insurance Company
More informationSTATE TAX WITHHOLDING GUIDELINES
STATE TAX WITHHOLDING GUIDELINES ( Guardian Insurance & Annuity Company, Inc. and Guardian Life Insurance Company of America (hereafter collectively referred to as Company )) (Last Updated 11/2/215) state
More informationAnnuity Partial Withdrawal & Full Surrender Form Athene Annuity & Life Assurance Company
Annuity Partial Withdrawal & Full Surrender Form Athene Annuity & Life Assurance Company 1. Contract Information Contract Number Name of Annuitant Social Security No. or Tax I.D. No. Name of Owner (If
More informationComparative Revenues and Revenue Forecasts Prepared By: Bureau of Legislative Research Fiscal Services Division State of Arkansas
Comparative Revenues and Revenue Forecasts 2010-2014 Prepared By: Bureau of Legislative Research Fiscal Services Division State of Arkansas Comparative Revenues and Revenue Forecasts This data shows tax
More informationIRA DISTRIBUTION FORM
Dreyfus Brokerage Services P.O. Box 9008 Hicksville, NY 11802-9008 IRA DISTRIBUTION FORM This form is used for all retirement distribution types except required minimum distributions (Please see separate
More informationFiduciary Tax Returns
Functions and Procedures Index Books On Line Main Directory Overview... 2 How does it work?... 3 What Information is transmitted to the Tax Service?... 4 How do I initiate this service?... 8 Do I have
More informationDistribution Election Form
IMPORTANT INFORMATION Distribution Election Form Please complete the form in its entirety. Missing pages and/or incomplete forms will delay processing. After completion, please return form to Pension Inc.
More informationState Treatment of Social Security Treatment of Pension Income Other Income Tax Breaks Property Tax Breaks
State-By-State Tax Breaks for Seniors, 2016 State Treatment of Social Security Treatment of Pension Income Other Income Tax Breaks Property Tax Breaks AL Payments from defined benefit private plans are
More informationThe Acquisition of Regions Insurance Group. April 6, 2018
The Acquisition of Regions Insurance Group April 6, 2018 Forward-Looking Statements This presentation contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform
More informationFinancial Transaction Form for IRA and Non-Qualified Contracts Only
Financial Transaction Form for IRA and Non-Qualified Contracts Only (Note: See Form ZA-8642 dealing with Financial Transactions for 403(b)/TSA s) Please Print All Information Below Zurich American Life
More informationUnforeseeable Emergency Withdrawal Request
Instructions About You Please print using blue or black ink. Return this form to: Alameda County Treasurer s Office, Attn: DC Administration, 1221 Oak Street, 1 st Floor, Room 131, Oakland CA, 94612 or
More informationLIFE POLICY ADMINISTRATION AND DISBURSEMENT REQUEST FORM
Customer Service P.O. Box 26100 Lehigh Valley, PA 18002-6100 www.guardianlife.com Call Center: 1-800-441-6455 Fax: 610-807-2720 THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA THE GUARDIAN INSURANCE & ANNUITY
More informationTax Breaks for Elderly Taxpayers in the States in 2016
AL Payments from defined benefit private plans are exempt; most public systems are exempt; military and US Civil service are exempt Special Homestead ion for 65+ +25.2% +2.4% AK No PIT Homestead ion for
More informationTCJA and the States Responding to SALT Limits
TCJA and the States Responding to SALT Limits Kim S. Rueben Tuesday, January 29, 2019 1 What does this mean for Individuals under TCJA About two-thirds of taxpayers will receive a tax cut with the largest
More informationUniform Consent to Service of Process
Applicant Company Name: NAIC No. FEIN: Uniform Consent to Service of Process Original Designation Amended Designation (must be submitted directly to states) Applicant Company Name: Previous Name (if applicable):
More informationState Trust Fund Solvency
Unemployment Insurance State Trust Fund Solvency National Employment Law Project Conference - Washington DC December 7, 2009 Robert Pavosevich pavosevich.robert@dol.gov Unemployment Insurance Program
More informationCost and Coverage Implications of the ACA Medicaid Expansion: National and State by State Analysis
Cost and Coverage Implications of the ACA Medicaid Expansion: National and State by State Analysis Report Authors: John Holahan, Matthew Buettgens, Caitlin Carroll, and Stan Dorn Urban Institute November
More informationFlorida 1/1/2016 Workers Compensation Rate Filing
Florida 1/1/2016 Workers Compensation Rate Filing Kirt Dooley, FCAS, MAAA October 21, 2015 1 $ Billions 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Florida s Workers Compensation Premium Volume 2.368 0.765 0.034
More informationTHE CULLEN/FROST BANKERS, INC. 401(K) STOCK PURCHASE PLAN (001332) Termination/Distribution Form
PLDISTRIB THE CULLEN/FROST BANKERS, INC. 401(K) STOCK PURCHASE PLAN () Termination/Distribution Form PARTICIPANT INFORMATION First Name MI Last Name Social Security Number Date Address 1 Address 2 City
More informationProperty Tax Relief in New England
Property Tax Relief in New England January 23, 2015 Adam H. Langley Senior Research Analyst Lincoln Institute of Land Policy www.lincolninst.edu Property Tax as a % of Personal Income OK AL IN UT SD MS
More informationLocal Anesthesia Administration by Dental Hygienists State Chart
Education or AK 1981 General Both Specific Yes WREB 16 hrs didactic; 6 hrs ; 8 hrs lab AZ 1976 General Both Accredited Yes WREB 36 hrs; 9 types of AR 1995 Direct Both Accredited/ Board Approved No 16 hrs
More informationehealth, Inc Fall Cost Report for Individual and Family Policyholders
ehealth, Inc. 2010 Fall Cost Report for and Family Policyholders Table of Contents Page Methodology.................................................................. 2 ehealth, Inc. 2010 Fall Cost Report
More information2016 GEHA. dental. FEDVIP Plans. let life happen. gehadental.com
2016 GEHA dental FEDVIP Plans let life happen gehadental.com Smile, you re covered, with great benefits and a large national network. High maximum benefits $25,000 for High Option Growing network of dentists
More information*City: *State/Province: *Country: *Postal Code: *Daytime Phone: * Address:
Toll Free: 1-800-962-4238 www.pensco.com IRA CONVERSION/ RECHARACTERIZATION REQUEST GENERAL INSTRUCTIONS This fm is to be completed by an IRA Account Owner who wishes to do a conversion of Traditional
More informationPLEASE NOTE: Required American Equity specific Product Training must be completed PRIOR to soliciting an Application to A
PLEASE NOTE: Required American Equity specific Product Training must be completed IOR to soliciting an Application to A Signed in as: JOSEPH E GOSS LTD 3/12/2014 1:18:30 PM Home Announcements Information
More informationSIGNIFICANT PROVISIONS OF STATE UNEMPLOYMENT INSURANCE LAWS JANUARY 2008
U.S. DEPARTMENT OF LABOR EMPLOYMENT AND TRAINING ADMINISTRATION Office Workforce Security SIGNIFICANT PROVISIONS OF STATE UNEMPLOYMENT INSURANCE LAWS JANUARY 2008 AL AK AZ AR CA CO CT DE DC FL GA HI /
More information2017 Supplemental Tax Information
2017 Supplemental Tax Information We have compiled the following information to help you prepare your 2017 federal and state tax returns: - Percentage of income from U.S. government obligations - Federal
More informationWho s Above the Social Security Payroll Tax Cap? BY NICOLE WOO, JANELLE JONES, AND JOHN SCHMITT*
Issue Brief September 2011 Center for Economic and Policy Research 1611 Connecticut Ave, NW Suite 400 Washington, DC 20009 tel: 202-293-5380 fax: 202-588-1356 www.cepr.net Who s Above the Social Security
More informationAPPLICATION FOR HARDSHIP WITHDRAWAL
APPLICATION FOR HARDSHIP WITHDRAWAL Account Number 51069-1-1 Participant's Name first middle last Social Security No. Address street city state zip Legal State of Residence If the Legal State of Residence
More informationCharles Gullickson (Penn Treaty/ANIC Task Force Chair), Richard Klipstein (NOLHGA)
MEMO DATE: TO: Charles Gullickson (Penn Treaty/ANIC Task Force Chair), Richard Klipstein (NOLHGA) FROM: Vincent L. Bodnar, ASA, MAAA RE: Penn Treaty Network American Insurance Company and American Network
More informationWithdrawal Instructions - Eligible for Rollover
Withdrawal Instructions - Eligible for Rollover This form should be completed if: You have been terminated from your Employer for at least sixty (60) days and want to take a distribution of your vested
More informationANNUITIZATION ELECTION FORM
1. CONTRACT INFORMATION Contract Number Name of Annuitant Name of Contract Owner Street Address, City, State, Zip Please check if this is a permanent change of address Telephone Number Name of Joint Owner
More informationSCHIP: Let the Discussions Begin
Figure 0 SCHIP: Let the Discussions Begin Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation and Executive Director, Kaiser Commission on for Alliance for Health Reform February
More information2018 National Electric Rate Study
2018 National Electric Rate Study Ranking of Typical Residential, Commercial and Industrial Electric Bills LES Administrative Board June 15, 2018 Emily N. Koenig Director of Finance & Rates 1 Why is the
More informationInsured Deposit Program. Updated 03/31/2017
Insured Deposit Program Welcome to the FDIC Insured Deposit Program. Under this program, available cash balances (from security transactions, dividend and interest payments and other activities) in your
More informationIndexed Universal Life Caps
Indexed Universal Life Caps Effective March 15, 2013, the caps on FG Life-Elite II will be changing as follows: Cap Illustrative Rate 100% Participation Annual Point-to-Point 14.75% 8.32% 140% Participation
More informationTaxing Investment Income in the States New Hampshire Fiscal Policy Institute 2 nd Annual Budget and Policy Conference Concord, NH January 23, 2015
Taxing Investment Income in the States New Hampshire Fiscal Policy Institute 2 nd Annual Budget and Policy Conference Concord, NH January 23, 2015 Norton Francis State and Local Finance Initiative Urban-Brookings
More informationRLI TRANSPORTATION A Division of RLI Insurance Company 2970 Clairmont Road, Suite 1000 Atlanta, GA Phone: Fax:
RLI TRANSPORTATION A Division of RLI Insurance Company 2970 Clairmont Road, Suite 1000 Atlanta, GA 30329 Phone: 404-315-9515 Fax: 404-315-6558 AGENCY/BROKER PROFILE Please type your answers. Use a separate
More informationPercent of Employees Waiving Coverage 27.0% 30.6% 29.1% 23.4% 24.9%
Number of Health Plans Reported 18,186 3,561 681 2,803 3,088 Offer HRA or HSA 34.0% 42.7% 47.0% 39.7% 35.0% Annual Employer Contribution $1,353 $1,415 $1,037 $1,272 $1,403 Percent of Employees Waiving
More informationInsured Deposit Program Updated 10/17/2016
Insured Deposit Program Welcome to the FDIC Insured Deposit Program. Under this program, available cash balances (from security transactions, dividend and interest payments and other activities) in your
More informationThe State Tax Implications of Federal Tax Reform Legislation
The State Tax Implications of Federal Tax Reform Legislation Executive Committee Task Force on State and Local Taxation Phoenix, Arizona January 14, 2017 Joe Crosby, Multistate Associates Karl Frieden,
More informationEye on the South Carolina Housing Market presented at 2008 HBA of South Carolina State Convention August 1, 2008
Eye on the South Carolina Housing Market presented at 28 HBA of South Carolina State Convention August 1, 28 Robert Denk Assistant Staff Vice President, Forecasting & Analysis 2, US Single Family Housing
More informationCOMPARISON OF ABA MODEL RULE FOR REGISTRATION OF IN-HOUSE COUNSEL WITH STATE VERSIONS
As of September 7, 2016 2016 American Bar Association COMPARISON OF ABA MODEL RULE FOR REGISTRATION OF IN-HOUSE COUNSEL WITH STATE VERSIONS AMERICAN BAR ASSOCIATION CENTER FOR PROFESSIONAL RESPONSIBILITY
More information2018 ADDENDUM INSTRUCTIONS
2018 ADDENDUM INSTRUCTIONS FEBRUARY 22, 2019 UPDATE: 2018 MUNICIPAL REFERENCE BOOK 1. DELAWARE funds are listed on page 15. You may note on page 15 to see the addendum for additional Delaware funds. The
More informationStreamlined Sales Tax Governing Board and Business Advisory Council Update
Streamlined Sales Tax Governing Board and Business Advisory Council Update Charles Collins, ADP Fred Nicely, Council On State Taxation Craig Johnson, Streamlined Sales Tax Governing Board NCSL SALT Taskforce
More informationTax Freedom Day 2018 is April 19th
Apr. 2018 Tax Freedom Day 2018 is April 19th Erica York Analyst Key Findings Tax Freedom Day is a significant date for taxpayers and lawmakers because it represents how long Americans as a whole have to
More informationAge of Insured Discount
A discount may apply based on the age of the insured. The age of each insured shall be calculated as the policyholder s age as of the last day of the calendar year. The age of the named insured in the
More informationMedicare Alert: Temporary Member Access
Medicare Alert: Temporary Member Access Plan Sponsor: Coventry/Aetna Medicare Part D Effective Date: Jan. 12, 2015 Geographic Area: National If your pharmacy is a Non Participating provider in the Aetna/Coventry
More informationReport to Congressional Defense Committees
Report to Congressional Defense Committees The Department of Defense Comprehensive Autism Care Demonstration December 2016 Quarterly Report to Congress In Response to: Senate Report 114-255, page 205,
More informationELITE 10 & 15. Make your money work for the long term. Fixed Indexed Annuity and Liquidity Rider
PERFORMANCE ELITE 10 & 15 Fixed Indexed Annuity and Liquidity Rider Make your money work for the long term. This material is provided by Athene Annuity and Life Company headquartered in West Des Moines,
More informationState of the Automotive Finance Market
State of the Automotive Finance Market A look at loans and leases in Q4 2017 Presented by: Melinda Zabritski Sr. Director, Financial Solutions www.experian.com/automotive 2018 Experian Information Solutions,
More informationAviva Announcing Changes to Products and Annuity Rates
September 9, 2011 Aviva Announcing Changes to Products and Annuity Rates This field update contains information on product and rate changes effective September 16, 2011. We want to thank you for all of
More informationCWA SAVINGS & RETIREMENT TRUST (# )
IN-SERVICE WITHDRAWAL REQUEST PARTICIPANT INFORMATION CWA SAVINGS & RETIREMENT TRUST (#990500050) Name: Social Security Number: Employer: Birth Date: Address: City/State/Zip: Country Email Address: Phone
More informationANNUITIZATION ELECTION
1. Contract Information Contract Number Name of Annuitant Name of Contract Owner Street Address, City, State, Zip Telephone Number Name of Joint Owner, if applicable 2. Benefit Election I elect to receive
More informationUnemployment Insurance Benefit Adequacy: How many? How much? How Long?
Unemployment Insurance Benefit Adequacy: How many? How much? How Long? Joel Sacks, Deputy Commissioner Washington State Employment Security Department March 1, 2012 1 Outline How many get unemployment
More informationOregon: Where Taxes Are Low, Fees Are High and Revenue Is Slightly Below Average
Issue Brief March 6, 2012 Oregon: Where Taxes Are Low, Fees Are High and Revenue Is Slightly Below Average The money we pay in fees and taxes helps create jobs, build a strong economy, and preserve Oregon
More informationObamacare in Pictures
Obamacare in Pictures VISUALIZING THE EFFECTS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT Spring 2014 If you like your health care plan, can you really keep it? At least 4.7 million health care plans
More informationLong-Term Care Education Requirements Prior to Selling
for Training AK All Health 8 hrs 4 hrs 24 months AL All Accident & Health 8 hrs 4 hrs Renewal deadline is the date the license expires. s are renewed biennially based on agent's birth month and year. AR
More informationAlternative Paths to Medicaid Expansion
Alternative Paths to Medicaid Expansion Robin Rudowitz Kaiser Commission on Medicaid and the Uninsured Kaiser Family Foundation National Health Policy Forum March 28, 2014 Figure 1 The goal of the ACA
More informationMassachusetts Budget and Policy Center
Progressive Massachusetts 2013 Policy Conference March 24, 2013 Lasell College Newton, MA Presentation by Massachusetts Budget and Policy Center Our State Budget: Building a Better Future Together Massachusetts
More informationCorporate Income Tax and Policy Considerations
Corporate Income Tax and Policy Considerations Presentation by Richard Anklam, Executive Director, New Mexico Tax Research Institute To The Interim Revenue Stabilization and Tax Policy Committee September
More informationLong-Term Care Education Requirements Prior to Selling
for AK All Health 8 hrs 4 hrs 24 months AL All Accident & Health 8 hrs 4 hrs Renewal deadline is the date the license expires. s are renewed biennially based on agent's birth month and year. AR All Accident,
More informationCWA Savings & Retirement Trust
CWA Savings & Retirement Trust INSTRUCTIONS FOR REQUESTING FINAL DISTRIBUTION Enclosed are the following items needed to request a final distribution from the CWA Savings & Retirement Trust. Please review
More informationPRODUCTS CURRENTLY AVAILABLE FOR SALE. Marquis SP
INTEREST RATES - April 16, 2017 to May 15, 2017 Notices 1. Before soliciting or taking any annuity applications, it is required that you have completed Lafayette Life's Annuity Training and any Continuing
More informationJust The Facts: On The Ground SIF Utilization
Just The Facts: On The Ground SIF Utilization The Access 4 Learning Community (A4L), previously the SIF Association, has changed its brand name due to the fact that the majority of its 3,000 members represent
More informationYolanda K. Kodrzycki New England Public Policy Center Federal Reserve Bank of Boston
The Growing Instability of Revenues over the Business Cycle: Putting the New England States in Perspective Yolanda K. Kodrzycki New England Public Policy Center Federal Reserve Bank of Boston Lincoln Institute
More informationIntroducing LiveHealth Online
Introducing LiveHealth Online Online Health Care when you need it! Meeting Members Wherever They Are 1 Why Consider Tele-Health? Convenience: Employees are able to access care at work, outside of traditional
More informationPresented by: Matt Turkstra
Presented by: Matt Turkstra 1 » What s happening in Ohio?» How is health insurance changing? Individual and Group Health Insurance» Important employer terms» Impact small businesses that do not offer insurance?
More informationFederal Tax Reform Impact on 2019 Legislative Sessions: GILTI
Federal Tax Reform Impact on 2019 Legislative Sessions: GILTI Executive Committee Task Force on State and Local Taxation Scottsdale, Arizona November 17, 2018 Karl Frieden, COST Deborah Bierbaum, AT&T
More information