Form Tsp-1 - Election Form - Thrift Savings Plan

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THRIFT SAVINGS PLAN
TSP-1
ELECTION FORM
Use this form to start, stop, or change the amount of your contributions to the Thrift Savings Plan (TSP).
Before completing this form, please read the Summary of the Thrift Savings Plan and the instructions on the back of this form. Type or print
all information. Return the completed form to your agency personnel or benefits office. Your agency should return a copy to you after
completing Section V.
Note: To choose your investment funds, see the instructions in the General Information section on the back of this form.
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 the amount of traditional (pre-tax) or Roth (after-tax) contributions to your TSP account, enter
CHOOSE THE
either a whole percentage of your basic pay per pay period or a whole dollar amount per pay period for each type
of contribution you elect. (You may choose a percentage for one type of contribution and a dollar amount for the
AMOUNT OF
other type of contribution.) Remember: A blank line next to a type of contribution equals 0% or $0 contributed.
YOUR
CONTRIBUTIONS
6.
7.
Traditional (Pre-Tax) Contributions
.0%
OR
$
.00
Your choice will cancel
all previous elections.
8.
9.
Roth (After-Tax) Contributions
.0%
OR
$
.00
III.
To stop all or any portion of your contributions to the TSP, check the box in Item 10 that applies and complete
STOP SOME OR
Section IV. Your payroll contributions will stop no later than the first full pay period after your agency employing
ALL OF YOUR
office receives this form. (If you are a Federal Employees’ Retirement System (FERS) employee, and you stop your
contributions, your Agency Matching Contributions will stop, but Agency Automatic (1%) Contributions will
CONTRIBUTIONS
continue. Read the instructions on the back.)
10.
I choose not to save for my retirement. Please stop all my payroll contributions to my TSP account.
Stop only my traditional (pre-tax) payroll contributions to my TSP account.
Stop only my Roth (after-tax) payroll contributions to my TSP account.
If you are a newly hired (or rehired) employee, you can generally stop your automatic employee contributions be-
fore they start if you submit this form to your agency before the end of your first full pay period. (See note on back.)
IV.
/
/
11.
12.
SIGNATURE
Participant’s Signature
Date Signed (mm/dd/yyyy)
V.
/
/
/
/
10005697
FOR
13.
14.
15.
EMPLOYING
Payroll Office Number
Receipt Date (mm/dd/yyyy)
Effective Date (mm/dd/yyyy)
OFFICE USE
ONLY
16.
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,
vide on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System.
former spouses, and beneficiaries, and their attorneys. Relevant portions of the
Your agency or service will use this information to identify your TSP account and to
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
start, change, or stop your TSP contributions. In addition, this information may be
shared with other Federal agencies for statistical, auditing, or archiving purposes.
provide this information, but if you do not provide it, your agency or service will not
The information may also be shared with law enforcement agencies investigating a
be able to process your request.
violation of civil or criminal law, or agencies implementing a statute, rule, or order.
ORIGINAL TO PERSONNEL FOLDER
Provide a copy to the employee and to the payroll office.
Form TSP-1 (10/2012)
PREVIOUS EDITIONS OBSOLETE

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