Edit, Download, and Sign the Distribution Request Form for Roth IRA Transfer
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How do I fill this out?
To fill out the Distribution Request Form, begin by completing all required sections clearly and accurately. Ensure you have all necessary signatures, especially if you are married and spousal consent is needed. Finally, submit the completed form to your employer for processing.

How to fill out the Distribution Request Form for Roth IRA Transfer?
1
Complete Sections A-F as applicable.
2
Provide your signature in Section G.
3
Ensure spousal consent is obtained if required.
4
Submit the form to your employer for review and signature.
5
Await processing confirmation from your plan administrator.
Who needs the Distribution Request Form for Roth IRA Transfer?
1
Individuals transitioning from a Traditional 401(k) to a Roth IRA need this form for their transfer request.
2
Employees seeking retirement planning options require this form to facilitate their fund distributions.
3
Spouses of participants may need this form to consent to withdrawals or rollover options.
4
Plan administrators use this form to process distribution requests efficiently.
5
Financial advisors or brokers may utilize this form on behalf of clients looking to manage their retirement accounts.
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What are the instructions for submitting this form?
To submit this form, you may either send it via fax to (877) 449-4443 or mail it to the Processing Center at 8488 Shepherd Farm Drive, West Chester, OH 45069. Ensure all required signatures are obtained from both you and your plan administrator before submission. Following these instructions will help ensure timely processing of your request.
What are the important dates for this form in 2024 and 2025?
Important dates related to this form for 2024 and 2025 typically include deadlines for submissions for tax year contributions and required distributions. Always check with your plan administrator for any specific cutoff dates related to transfers or distributions. For the most accurate information, refer to your plan’s summary plan description or official notifications from your employer.

What is the purpose of this form?
The purpose of this form is to facilitate the transfer of funds from a Traditional 401(k) plan to a Roth IRA. This transfer allows participants to take advantage of tax-free growth and withdrawals in retirement, provided certain conditions are met. Properly completing this form ensures that both the plan administrator and the participant understand the implications and processes involved in the rollover.

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

- 1. Participant Information: Includes personal and employment-related information such as name, date of birth, and marital status.
- 2. Reason for Distribution: Participants must indicate the reason for their request.
- 3. Rollover Information: Participants provide details on the Roth IRA account into which funds will be transferred.
- 4. Outstanding Loan Payoff: Instructions for handling any loans associated with the plan.
- 5. Income Tax Withholding: Participants may choose to withhold taxes on rolled-over amounts.
- 6. Spousal Consent: Necessary if applicable to ensure regulatory compliance.
- 7. Participant and Administrator Signature: Requires signatures to validate the form.
What happens if I fail to submit this form?
Failing to submit this form or submitting an incomplete version can lead to delays in processing your request. Important transactions may be held up until all requirements are met properly.
- Processing Delays: Incomplete submissions can cause significant delays in the distribution process.
- Tax Implications: Failure to comply with required distribution processes may have tax consequences.
- Plan Administrator Rejection: Missing information might lead to outright rejection of the request.
How do I know when to use this form?

- 1. Upon Leaving Employment: Use this form to transfer your 401(k) when you leave your job.
- 2. Retirement Planning: Helpful when planning for retirement to enhance your tax position.
- 3. Divorce Proceedings: An option for alternate payees under a QDRO may use this form.
Frequently Asked Questions
What is the purpose of this form?
This form is used for requesting the transfer of a Traditional 401(k) account to a Roth IRA.
How do I submit this form?
You can submit the completed form to your employer or plan administrator for processing.
Who needs spousal consent?
Spousal consent is required if your plan allows for annuities and your account balance exceeds certain thresholds.
Can I edit this PDF online?
Yes, you can easily edit this PDF using PrintFriendly's editing tools before submitting it.
How long does the processing take?
Processing usually takes 1-4 business days, depending on the details provided.
What happens if I don't complete the required fields?
Incomplete forms may result in delays or rejection of your distribution request.
Is there a fee for the distribution?
There may be a distribution fee based on your plan's provisions, check with your administrator.
Where do I send the completed form?
Send the completed form to your plan administrator or the specified processing center.
Can I track the status of my request?
You should check with your plan administrator for any tracking details.
What should I do if I need help filling out the form?
Contact your plan administrator for guidance on completing the form correctly.
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