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Home Our Commitment Principals Forms Contact Us Secure Communications What's New?Home Our Commitment Principals Forms Contact UsHome Our Commitment Principals Forms Contact Us What's New?

Administrative Forms

These forms are only intended for use by employer-sponsored plans who utilize PA Retirement Solutions, Inc. as their Third Party Administrator.  Please also note that some investment providers require their own forms to be completed for all distribution and loan requests.  If you are not sure if these forms are right for you, please contact PA Retirement Solutions, Inc. or your Employer/Plan Administrator before completing and returning for processing.

Beneficiary Form                                                                  
For use by participants to designate their primary and contingent beneficiary(ies).  All participants should have a completed and up to date beneficiary form on file with their Employer/Plan Sponsor.

PDF Version - Click Here Word Fill-In Version - Click Here

Deferral Percentage Change Form – without Roth          
For use by participants to elect a change to the amount or percentage currently being deferred to the plan.  Election changes must be made in accordance with plan provisions.  Please refer to the plan’s SPD for more information.

PDF Version - Click Here Word Fill-In Version - Click Here

Deferral Percentage Change Form – with Roth
For use by participants to elect a change to their deferral percentage or dollar amount to plans that allow Roth deferrals.  Election changes must be made in accordance with plan provisions.  Please refer to the plan’s adoption agreement or SPD for more information on availability in your plan.

PDF Version - Click Here Word Fill-In Version - Click Here

Please contact our office for any of the following forms:

  • Special Tax Notice
  • Normal Withdrawal Form
  • Loan Application
  • Hardship Application
  • Death or QDRO Form
PA Retirement Solutions, Inc.     |     1110 N. Mountain Road, Harrisburg, PA 17112     |      Phone Number:  717-412-4073     |      Fax Number: 717-412-4079
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