Request To Restore Forfeiture - Thrift Savings Plan
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1
2THRIFT SAVINGS PLAN
TSP-U-5-R
REQUEST TO RESTORE FORFEITURE
Use this form to request the restoration of service contributions that were forfeited from a participant’s Thrift Savings Plan (TSP) account
and to verify that corrected employee data have been submitted to the TSP.
Fax the form to:
Thrift Savings Plan
Agency Technical Support
FAX: (703) 788-2936
I.
PARTICIPANT
1.
Name
INFORMATION
Last
First
Middle
2.
Social Security Number
–
–
II.
3.
Corrected Employee Data. Corrected employee data (e.g., Retirement Code, Vesting Code, TSP-Serv ice
VERIFICATION
Computation Date, Employment Code, or Employment Code Date) were submitted to the TSP with:
OF
CORRECTIONS
a.
b.
JV Report Number
Report Date
/
/
MADE TO
mm
dd
yyyy
PARTICIPANT’S
Note: Form TSP-U-5-R will not be processed if this section is not completed. Employee data must be
TSP ACCOUNT
corrected before forfeited funds will be restored.
III.
4.
5.
SERVICE
Name of Service
Payroll Office Number
IDENTIFYING
DATA
6.
7 . (
)
–
Service Contact Person
Telephone (Area Code and Number)
IV.
I hereby request that forfeited funds be restored for the above participant. In addition, I certify that the infor ma-
CERTIFICATION
tion provided in Section II is correct and that the participant is entitled to have the forfeited amounts restored to
his or her TSP account.
AND REQUEST
TO RESTORE
8.
FUNDS
Typed or Printed Name of Authorized Certifying Official
9.
10.
Signature of Authorized Certifying Official
Date Signed
Reproduce Locally
Form TSP-U-5-R (1/2018)
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