Form Tsp-1-C - Catch-Up Contribution Election - Thrift Savings Plan

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THRIFT SAVINGS PLAN
TSP-1-C
CATCH-UP CONTRIBUTION ELECTION
Use this form to start, stop, or change your ‘‘catch-up’’ contribution election to your TSP account. You are eligible to make catch-up contribu-
tions if you are age 50 or older (or if you will become age 50 during the calendar year for which you are making this election), and you are
already contributing a percentage or a dollar amount which will result in reaching the Internal Revenue Code (IRC) elective deferral limit by
the end of the year. (See back of form.) Catch-up contributions will be taken from your basic pay each pay period and invested according to
your most recent contribution allocation; they are in addition to your regular TSP contributions.
Before completing this form, read the information on the back. Type or print all information. Return the completed form to your agency.
I.
1.
INFORMATION
Name (Last)
(First)
(Middle)
ABOUT YOU
2.
Street Address
City
State
Zip Code
3.
4.
(
)
Social Security Number
Daytime Phone (Area Code and Number)
5.
Office Identification (Agency and Organization)
II.
To start or change your catch-up contributions, complete Items 6, 7, and 8. Use whole dollar amounts. (See additional
CHOOSE THE
instructions on the back of the form.) Remember: A blank line next to a type of contribution is equal to $0 contributed.
AMOUNT OF
6.
I elect to contribute the following catch-up contributions per pay period:
YOUR CATCH-UP
}
CONTRIBUTIONS
$
.00 Traditional (Pre-Tax)
Total cannot exceed $6,000
You must be in pay
for the calendar year.
$
.00 Roth (After-Tax)
status. (See back
of form.)
I understand that my election will continue until:
Your choice will
the end of the calendar year; or
l
cancel all previous
I reach the annual limit for catch-up contributions; or
l
elections.
I submit a new election to stop or change these contributions.
l
I certify that I will make regular contributions to the TSP or an equivalent employer plan up to the maximum
amount allowed by the IRS and TSP plan rules. I understand that my catch-up contributions are in addition to
my regular TSP contributions.
/
/
7.
8.
Participant’s Signature
Date Signed (mm/dd/yyyy)
III.
9.
STOP SOME OR
I want to stop the catch-up contributions indicated below:
ALL OF YOUR
All catch-up contributions
CATCH-UP
Traditional (pre-tax) catch-up contributions only
CONTRIBUTIONS
Roth (after-tax) catch-up contributions only
I understand that I must
make a new election
/
/
10.
11.
to resume these
contributions.
Participant’s Signature
Date Signed (mm/dd/yyyy)
IV.
/
/
/
/
FOR
12.
13.
14.
Receipt Date (mm/dd/yyyy)
EMPLOYING
Payroll Office Number
Effective Date (mm/dd/yyyy)
OFFICE USE
15.
ONLY
Signature of Agency Official
PRIVACY ACT NOTICE.
We are authorized to request the information you pro-
It may be shared with congressional offices, private sector audit firms, spouses,
former spouses, and beneficiaries, and their attorneys. Relevant portions of the
vide on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System.
Your agency will use this information to identify your TSP account and to start,
information may also be disclosed to appropriate parties engaged in litigation and for
other routine uses as specified in the Federal Register. You are not required by law to
change, or stop your TSP contributions. In addition, this information may be shared
with other Federal agencies for statistical, auditing, or archiving purposes. The infor-
provide this information, but if you do not provide it, your agency or service will not
be able to process your request.
mation may also be shared with law enforcement agencies investigating a violation of
civil or criminal law, or agencies implementing a statute, rule, or order.
ORIGINAL TO PERSONNEL FOLDER
Form TSP-1-C (1/2016)
Provide a copy to the employee and to the payroll office.
PREVIOUS EDITIONS OBSOLETE

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