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How do I fill this out?
To fill out this form, begin by providing your personal information including your name, email, and account details. Select the appropriate plan type and distribution reason that applies to your situation. Ensure to choose your payment method and provide any necessary authorizations.

How to fill out the Distribution Request for 401a, 401k, & 403b Plans?
1
Provide personal details including your name and contact information.
2
Select the plan type and distribution reason from the provided options.
3
Choose your preferred payment type and complete the payment method section.
4
Check if employer authorization is required and gather necessary signatures.
5
Review all provided information for accuracy before submission.
Who needs the Distribution Request for 401a, 401k, & 403b Plans?
1
Individuals planning to retire who need access to their retirement funds.
2
Employees leaving their jobs and wishing to withdraw from their 401(k).
3
Individuals applying for total disability benefits.
4
Public safety employees seeking distributions that meet specific criteria.
5
Beneficiaries of deceased plan participants needing to access funds.
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Editing this PDF on PrintFriendly is straightforward. Simply upload your document and use the editing tools available to modify text and fields. You can easily make any necessary changes and ensure your form is completed accurately before submission.
1
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2
Select the text or fields you wish to edit.
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4
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5
Download the edited PDF to save your changes.

What are the instructions for submitting this form?
To submit this form, ensure all sections are filled out correctly and completely. You can send it via mail to the designated physical address on the form or use the online submission features provided on your plan's website. For immediate assistance, you can also call 1-877-677-3678 for help regarding your submission.
What are the important dates for this form in 2024 and 2025?
Please check your plan's specific guidelines for important dates related to distributions in 2024 and 2025. Typically, understanding your retirement age and expected retirement date can influence your distribution timing. Contact your plan administrator for detailed deadlines.

What is the purpose of this form?
The purpose of this form is to facilitate the distribution process from 401(a), 401(k), and 403(b) plans. It allows plan participants to request disbursement of their retirement savings under specific conditions. Completing this form ensures that the necessary steps are followed for obtaining accessible funds when needed.

Tell me about this form and its components and fields line-by-line.

- 1. Personal Information: Fields for entering your name, email, account details, and contact numbers.
- 2. Plan Type: Options to select your retirement plan type.
- 3. Distribution Reason: List of reasons for requesting the distribution.
- 4. Payment Method: Selection of preferred payment options and details.
- 5. Employer Authorization: Section for employer to verify participation and authorization.
What happens if I fail to submit this form?
If you fail to submit this form, your request for distribution will not be processed, resulting in a delay in accessing your retirement funds. It is essential to ensure all required fields are completed accurately to avoid this situation.
- Delayed Processing: Incomplete submissions can lead to delays in receiving your funds.
- Rejection of Request: Missing information may result in outright rejection of your distribution request.
- Tax Implications: Failure to correctly complete the tax withholding options can lead to unexpected tax liabilities.
How do I know when to use this form?

- 1. Retirement: Use this form when you reach retirement age and wish to access your funds.
- 2. Separation from Employment: If you change jobs, you can request your funds using this form.
- 3. Disability Claims: For those qualifying for total disability benefits, this form facilitates fund access.
- 4. Beneficiary Distribution: Beneficiaries can use this form to withdraw funds from a deceased participant's plan.
- 5. Plan Termination: This form can be utilized when a plan is terminated by the sponsor.
Frequently Asked Questions
How do I fill out the distribution request form?
Provide your personal details, select the plan type and payment method, then review before submitting.
Can I edit the PDF after I download it?
Yes, you can edit the PDF again using PrintFriendly's editing tools.
What payment options are available?
You can choose between one-time payments or systematic payments based on your preferences.
Is there a minimum amount for partial distributions?
Yes, most plans require a minimum of $25 for partial distributions.
How do I ensure my tax withholding is correct?
Select your preferred withholding option when filling out the form.
What should I do if I need help while filling out the form?
You can contact Nationwide customer service at 1-877-677-3678 for assistance.
When will I receive my funds after submission?
Funds are typically processed and sent within 5-10 business days after approval.
Can I cancel my request after submission?
To cancel your request, contact Nationwide as soon as possible.
Do I need my employer's authorization?
Employer authorization is required only for first-time distribution requests.
What happens if I don't complete all sections?
Incomplete forms may delay the processing of your distribution request.
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