Form Tsp-19 - Transfer Of Information Between Agencies - Thrift Savings Plan

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THRIFT SAVINGS PLAN
TSP-19
TRANSFER OF INFORMATION BETWEEN AGENCIES
Gaining agencies must obtain the Thrift Savings Plan (TSP) account information of employees who transfer from other Federal agencies
or who change payroll offices. The losing agency must provide the relevant TSP information to the gaining agency, whether or not the
employee is contributing to the TSP. The gaining agency should provide a copy of the completed form to the employee and forward the
original to the payroll office. A copy may also be filed in the employee’s Official Personnel Folder.
Employee Information
Section A
1.
Name
Last
First
Middle
2.
3.
/
/
4.
/
/
Social Security No.
Date of Birth
Effective Date of Transfer
mm
dd
yyyy
mm
dd
yyyy
Information to Be Transferred
Section B
Enrollment Information
Enter the employee's contribution election using either Item 5 (a whole percentage of basic pay per pay period) or Item 6 (a whole
dollar amount per pay period).
5.
.
6.
.
7.
0%
OR
$
00
Check if noncontributing FERS employee
and is not eligible for agency contributions
8.
Total employee contributions made for current year:
$
as of
/
/
mm
dd
yyyy
9.
10.
TSP Service Computation Date (FERS only)
/
/
TSP Vesting Code
mm
dd
yyyy
(FERS Only)
11.
12.
TSP Status Code (Enter the appropriate code):
TSP Status Date
/
/
mm
dd
yyyy
W = FERS contributing but not eligible for agency contributions
E = FERS eligible for agency contributions but not contributing
Y = contributing and, if FERS, eligible for agency contributions
T = stopped contributions and, if FERS, eligible for agency contributions
S = FERS stopped contributing but not yet eligible for agency contributions
13.
/
/
If TSP Status Code is W or S or if Item 7 is checked, indicate date employee will become eligible for
mm
dd
yyyy
agency contributions.
14.
If TSP Status Code is T or S and employee is in the noncontribution period resulting from a financial
/
/
mm
dd
yyyy
hardship in-service withdrawal, indicate the ending day of this period.
Catch-up Contributions
15.
If the employee is currently making catch-up contributions, enter the
dollar amount per pay period and the attributable calendar year.
$
.00
for
year
16.
Total catch-up contributions made for current year: $
as of
/
/
mm
dd
yyyy
Loan Information
17.
Does employee have a TSP loan? (Check one.)
Yes (Complete Items below, as applicable.)
No (Skip to Item 22.)
18.
19.
First Loan
Account Number:
Payment Amount $
Second Loan
20.
Account Number:
21.
Payment Amount $
Identification of Losing Agency
Section C
22.
22.
22.
22.
22. Agency Name and Location
23.
23.
23.
23.
23. Payroll Office
8-digit Identifying Number
24. Name of Contact Person
24.
24.
24.
24.
25. Telephone
25.
25.
25.
25.
(
)
Area Code and Number
Form TSP-19 (Revised 6/2005)
Reproduce Locally
PREVIOUS EDITIONS OBSOLETE

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