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Forms

 

 
Salary Reduction Agreement (SRA)
What is it?
The Salary Reduction Agreement (SRA) is used to begin, stop, or change participation in the TSA Program including making changes to the amount withheld from your paycheck and the investment providers that receive your TSA contributions.  Please note that you must establish a TSA account with an investment provider prior to directing TSA contributions to that investment provider.

Instructions

Keep copy for your records.  Original must be mailed to:

 

   Department of Education

   Employee Benefits

   PO Box 2360

   Honolulu, HI 96804

Print and Fill Out

Fillable Version
 
See SRA Deadlines
 

 

Transaction Authorization Forms

What is it?

New IRS regulations require the DOE to share certain information with investment providers and coordinate with investment providers when you perform certain transactions.  As a result, an Authorization Form must be completed in addition to your investment provider's own paperwork to authorize the transaction.  The requested transaction will be reviewed by NBS for conformity with plan provisions and the Internal Revenue Code.  If the the transaction is approved your provider will be notified.  If the transaction is not approved you will receive notice by mail.

Instructions

Keep original for your records.  Mail or fax a copy to National Benefit Services:

 

   Fax: (800) 597-8206

 

   National Benefit Services

   Attn: Hawaii DOE 403(b)

   8523 S. Redwood Road

   West Jordan, UT 84088   

Distribution/Rollover

Loan

Hardship

Exchange

 

Maximum Allowable Contribution Worksheet (MAC)

What is it?

The IRS places a limit on the amount you are able to contribute to a 403(b) plan each year. You may experience adverse tax consequences if you exceed your annual limit. The Maximum Allowable Contribution Worksheet (MAC) will help you calculate your annual limit. Because the IRS limit and your personal limit may change each year, you should complete and submit a copy of this worksheet every year in which you participate in the Department of Education TSA Program.

Instructions

Keep copy for your records.  Original must be mailed to:

 

   Department of Education

   Employee Benefits

   PO Box 2360

   Honolulu, HI 96804

      

2010 Print and fill out

 

2009 Print and fill out

 

Post-Separation Vacation Pay Deferral Program Forms

What is it?

Upon retirement certain employees may be eligible for the Post-Separation Vacation Pay Deferral Program.  Download this packet for additional information and instructions.

Instructions

See packet for detailed instructions.  Contact the DOE Payroll Section at (808) 586-3181 if you have questions.

PSVPD Packet

 

 

 

Adobe Reader is required to view all forms.  It may be downloaded for free here.

 

 

 

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