Vendor Selection Form printable pdf download

OPTIONAL RETIREMENT PLAN (ORP) VENDOR SELECTION FORM

UNIVERSITY SYSTEM OF MARYLAND (USM)

In order to enroll in the Optional Retirement Plan and select the ORP Vendor of my choice,

I, _________________________________________________, SSN __________________________,

(First Name

Middle Initial

Last Name)

have attached an “Election Not to Participate in the MD State Pension System” form (MSRA-60),

and the required proof of identity (see reverse side).

I select the following vendor and action (Please select one vendor and one action):

VENDOR:

FIDELITY INVESTMENTS ________

TIAA-CREF _________

ACTION:

Enroll: _________

Change: ________

I recognize that the University will contribute an amount equal to 7.25% of my base annual salary

to the ORP on my behalf. I understand that University contributions will be made over 20 pays

during the academic year, and invested upon enrollment in a “LifeCycle Fund”. After enrollment is

in effect, I can access the ORP Vendor website and, at my direction, designate my investment

among the funds available for the USM-ORP. No money will be deducted from my salary. I

reserve the right to make voluntary contributions on a salary reduction (before tax) basis to a

Supplemental Retirement Plan, subject to Federal limits.

LIMITS ON CONTRIBUTIONS - I recognize that if I was hired on or after July 1, 1996, the

University’s 7.25% contribution to my ORP will stop once my earned salary in the fiscal year

reaches the Federal limit on employer contributions to the ORP.

REHIRES - I understand that if I am rehired and I was an ORP participant in MD before July 1,

1996, the Federal contribution limit does not apply to me and I am entitled to have the 7.25%

contribution apply to my full salary. My prior USM or other MD Institution of Higher Education

dates of employment are: Hired: _____________ Terminated: ___________________

My initial MD-ORP participation date was: _________ Institution________________

By signing this form I understand: 1. the conditions stated above; 2. that I may enroll with only

one ORP Vendor at any given time; 3. that I am entitled to change ORP Vendors only once during

any calendar year; 4. I will keep a copy of this document for my files.

Employee’s Signature: __________________________________________

Date: ________________

USM Institution___________________________________________ Office Phone_________________

USM Benefits Coordinator: ______________________________________ Date:_________________

(Institution Representative)

_______________________

USM Form-RV – ORP – Plan Selection Form - Revised 01/30/09

Vendor Selection Form