TECHNICIAN REQUEST FOR RETROACTVE THRIFT SAVINGS PLAN (TSP) CONTRIBUTIONS
OR
INVESTMENT OF GOVERNMENT FUNDS
For us of this form, see Public Law 103-353. The proponent agency is Idaho National Guard - HRO.
PRIVACY ACT STATEMENT
AUTHORITY:
PL 103-353, 1994, Uniformed Services Employment and Reemployment Rights Act (USERRA).
PRINCIPAL PURPOSE:
For employeess to make retroactive TSP contributions following periods of ABSENT - US.
ROUTINE USES:
For employeess to make retroactive TSP contributions following periods of ABSENT - US.
DISCLOSURE:
Voluntary
SECTION A - EMPLOYEE INFORMATION
Employee's Name:
SSN:
Date of Birth:
SECTION B - EMPLOYEE CERTIFICATION
1. I want to make retroactive payments and I understand that my contributions will be doubled for as many pay
periods as I was in ABSENT-US. I wish to have my retroactive contributions based on:
a.
* The TSP-1 Form in effect at the time I went on ABSENT-US. In other words, I wish to
continue my TSP contributions as elected at the time I entered ABSENT-US.
OR
b.
A new TSP-1 Form (attached). I wish to change my election as indicated to be effective on
________ (the new TSP-1 Form can not be effective before the first full pay period beginning
after the start of the election period.)
c.
I want the government matching funds invested in the G Fund.
2. * FERS ONLY: I am NOT making retroactive payments, however I am eligible to receive government matching
contributions (the automatic 1% contributions plus any matching contributions which are based on contributions I
made into my Uniformed Services TSP during the period I was in ABSENT-US.
a.
I want the government matching funds invested according to the most current contribution
allocations.
OR
I want the government matching funds invested in the G Fund.
b.
Employee's Signature: _______________________________
Date: ___________________
SECTION C - REQUIRED DOCUMENTATION
1. Started ABSENT-US on: _______________
2. Returned to Duty on: ________________
(Use a separate form for each period of ABSENT-US.)
a.
Copy of ABSENT-US SF50-B attached.
c.
Copy of Returned to Duty
SF50-B attached.
b.
Copy of all Military LES's or
d.
Copy of TSP-1 Form attached.
or TSP Statements.
*N/A TSP Form not needed.
SECTION D - CERTIFICATION BY HRO PERSONNEL
1. Name:
2. Office Title:
3
Idaho National Guard
Human Resources Office
4. Date:
5. Telephone Number:
4794 Farman St., Bldg 442
Boise, ID 83705-8112
6. Signature: