Form 4101 PDF Details

The intricacies of the Form 4101, a crucial document for individuals seeking a refund from various South Carolina Retirement Systems, are manifold and warrant thorough comprehension. This form, which has undergone revisions as recently as December 2006, serves a dual purpose: it not only enables members or alternate payees to request refunds but also outlines the implications of such refunds on future benefits. Eligibility spans several systems, including the State Budget and Control Board South Carolina Retirement System, Police Officers Retirement System, General Assembly Retirement System, and the Judges and Solicitors Retirement System, each requiring the applicant's detailed information and a clear choice among payment methods—lump-sum payment, direct rollover, or partial rollover. Of particular note is the form’s section on tax implications, highlighting the necessity of understanding the federal and state tax repercussions of a refund, especially regarding rollover options, withholding rates, and potential penalties for early withdrawal. The decision to request a refund via Form 4101 thus carries significant financial implications for an individual’s retirement planning strategy, emphasizing the importance of informed decision-making.

QuestionAnswer
Form NameForm 4101
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names1099Rs, 1099R, distributions, South_Carolina

Form Preview Example

Form 4101

REFUND REQUEST

CHECK ONE:

Revised 12/06/2006

State Budget and Control Board

South Carolina Retirement System

Page 1

South Carolina Retirement Systems

Police Officers Retirement System

 

 

Customer Service Refund Claims

General Assembly Retirement System

PRINT OR TYPE IN INK

Box 11960, Columbia, SC 29211-1960

Judges and Solicitors Retirement System

 

 

 

Section I MEMBER / ALTERNATE PAYEE INFORMATION

Last Name & Suffix

First/Middle Name

 

 

 

 

Date of Birth

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

Former/Maiden Name (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

ZIP+4

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check here if you are the alternate payee under a Qualified Domestic Relations Order (Member SSN

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I do hereby apply for a refund of the total amount of contributions plus interest credited to me in the above-checked Retirement System. I understand that upon payment of such amount I do hereby waive for myself, my heirs, and assigns all my rights, title, and interest in any fund under the care and control of this Retirement System. I also understand that by receiving a refund that I am forfeiting my service credit and giving up all rights to any future service retirement or disability retirement benefits. I further understand that my refund request will be canceled if I return to employment covered by the Retirement Systems prior to payment of my refund. This includes any employment for which I am eligible to join the SC Retirement System, the Police Officers Retirement System, or the State Optional Retirement Program.

NOTE: Refunds for members of the SC Retirement System and Police Officers Retirement System are payable within 6 months after demand, but not less than 90 days after termination of employment. All required paperwork must be received from the member and the employer before a refund can be paid.

I terminated from

on

 

Employer

 

Date

Section II For your refund payout, please select ONE of the payment methods below. (See page 2 for detailed explanation.)

Lump-Sum Payment

Pay the total refund amount (less required federal tax withholding) directly to me.

Direct Rollover

Rollover the taxable portion of my refund to the

trustee/plan named below.

The portion you rollover will not be taxed until you take it out of the eligible plan.

(Information must be provided in Section III)

Partial Rollover

Rollover the Partial Amount of

$to the trustee/plan named

below. Pay the remaining balance directly to me in a lump-sum payment.

(Information must be provided in Section III)

Section III COMPLETE THIS SECTION IF YOU SELECTED A DIRECT OR PARTIAL ROLLOVER ABOVE.

Account Number With Trustee/Plan (Limit to 25 characters)

Name of Trustee/Plan

P.O. Box or Street Address

Account Types Available

(Check only ONE box)

I R A

Annuity Plan - 403(b)

Qualified Plan - 401(k) or 401(a)

Other-see instructions on page 2 Specify Plan Name

City

 

State

 

Zip + 4

You must attach a legible copy of your current driver's license or special identification card issued by your State Department of Transportation or Public Safety.

Please read all information on page 2 before signing this form IN BLUE INK.

I hereby certify I have read and understand the information on this form, including the tax rules, and I agree to the terms stated.

MEMBER'S OR ALTERNATE PAYEE'S SIGNATURE

 

Date:

(Certified copy of legal authorization required with signature other than applicant's)

WITNESS

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

(Required only when signed by a mark)

 

 

 

 

 

 

 

 

 

STATE OF

 

 

 

COUNTY OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACKNOWLEDGED BEFORE ME THIS DATE

 

 

NOTARY NAME

 

 

 

 

 

 

 

 

 

 

 

(Please print)

MY COMMISSION EXPIRES

 

 

 

NOTARY SIGNATURE

 

NOTARY BUSINESS PHONE

 

 

 

 

 

 

 

 

 

 

Please call SC Retirement Systems Customer Service with any questions: (800) 868-9002 (in state) or (803) 737-6800

THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SOUTH CAROLINA RETIREMENT SYSTEMS. THE SOUTH CAROLINA RETIREMENT SYSTEMS RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT.

Form 4101

Revised 12/06/2006

Page 2

When you receive a refund you forfeit your retirement service credit and give up rights to any future service retirement or disability retirement benefits. If you return to work for an employer covered by the Retirement Systems after receiving your refund check and rejoin the system, you may request to pay back with interest your withdrawn (refunded) member contributions and interest. When you leave the funds in your retirement account, you retain your years of service credit, which may be added to any future service you may accrue, should you later be employed in a position covered by the Retirement Systems. For current retirement eligibility information, please call South Carolina Retirement Systems Customer Serivce at (800) 868-9002 or (803) 737-6800 or visit our website at www.retirement.sc.gov. Should you choose a refund, there are some important tax consequences (see below and IRS Publication 575, available at www.irs.gov).

SPECIAL TAX RULES

This payment from the South Carolina Retirement Systems is classified as a Qualified Total Distribution under Internal Revenue Code Section 401(a) and will be reported to the Internal Revenue Service on Form 1099R. This distribution may consist of both taxable and nontaxable income.

Rollover

A rollover is a tax-free transfer from one retirement plan to another. If you are the retirement plan participant, or if you are the former spouse of the participant and an acceptable Qualified Domestic Relations Order (QDRO) exists, the taxable portion of the refund is eligible for rollover to an IRA, 403(b) plan, 457 plan, 401(k) plan, or other 401(a) plan (an "eligible" plan). You may elect to rollover all or any part of the taxable portion of your refund. The portion rolled over will not be taxed until you take it out of the eligible plan.

A rollover may be accomplished by: 1) a direct transfer by the South Carolina Retirement Systems on your behalf to an eligible plan; or 2) a rollover by you to an eligible plan within sixty (60) days of receipt of the distribution. ANY AMOUNT ELIGIBLE FOR ROLLOVER NOT

DIRECTLY TRANSFERRED BY THE SOUTH CAROLINA RETIREMENT SYSTEMS TO AN ELIGIBLE PLAN MUST HAVE FEDERAL TAXES WITHHELD AT A RATE OF TWENTY PERCENT (20%). If you do not choose a direct transfer, you can still decide to rollover all or part of the taxable portion of your refund within 60 days of receipt of the distribution. However, you must find other money to replace the 20% withheld if you want to rollover 100% of the taxable portion of your refund.

A rollover from the Retirement Systems 401(a) plan is not allowed into the South Carolina 457 Deferred Compensation Plan. If you intend to roll over funds from the Retirement Systems 401(a) plan into a governmental 457 plan other than the South Carolina 457 Deferred Compensation Plan, verify with that Plan Administrator that the 457 plan accepts rollovers. If it does accept rollovers from the Retirement Systems 401(a) plan, check the "Other" box and provide the plan name.

Under Age 59 1/2 and Do Not Elect Rollover

If you do not take advantage of a rollover as indicated above and are under the age of 59 1/2 at the time of distribution, your distribution will be subject to regular income tax in the year you receive the payment, plus THERE WILL BE A 10% PENALTY TAX ON THE TAXABLE PORTION OF YOUR DISTRIBUTION. The 10% penalty tax will be due when your income tax return is filed. This tax penalty does not apply to distributions due to death, disability, separation from service in or after the year in which you reach age 55, or distribution pursuant to a QDRO--see Special Tax Rules in IRS Publication 575 and IRS Form 5329 for more information on this tax penalty.

The Pension Protection Act of 2006 provides for the waiver of the 10 percent early withdrawal penalty tax if a qualified public safety employee, as defined by the Pension Protection Act, receives a distribution from a qualified retirement plan after separation from service in or after the year in which the employee reaches age 50. Note: A Qualified Public Safety Employee Certification (Form 7507) must be completed by your current employer.

Born Before 1936 and Do Not Elect Rollover

If you were born before 1936, the ordinary income portion of your distribution may be eligible for 10-year averaging based on the tax rates in effect in the year of distribution, and the capital gains portion may be taxed as a long-term capital gain at a rate of 20%. Averaging often reduces the tax you owe because it treats the payment as if it were paid out over 10 years.

This special tax treatment discussed above requires that your refund must be a lump-sum distribution. A distribution cannot be treated as a lump-sum distribution unless you have been a plan participant for at least 5 years preceding the tax year in which the distribution was received. The 5-year participation requirement does not apply if this refund is made to the beneficiary or estate on account of the participant's death. You may elect to use the special tax treatment for income averaging and capital gains only once per employee, and the election applies to all lump- sum distributions you received in that year. This election is made by completing Form 4972 with your annual income tax return.

Withholding

A taxable distribution eligible for rollover but paid directly to you will generally be subject to an automatic federal withholding rate of 20%.

South Carolina Income Taxes

The taxable portion of this refund will be subject to South Carolina income taxes in the year in which you receive your refund. The above federal provisions (except for the additional 10% penalty tax and the mandatory 20% withholding) also apply in computing South Carolina income taxes.

The tax laws are complex and always changing. You should consult your personal tax advisor with regard to the application of all federal and state taxes on benefits received from the South Carolina Retirement Systems.

Please notify us, in writing, should your address change prior to the payment of your refund or prior to the receipt of your 1099R. For tax reporting purposes, 1099Rs are mailed no later than January 31 each year for the previous calendar year's refund. If you return to work for an employer covered by the Retirement Systems prior to receiving your refund check, your refund request will be canceled.

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