Form Tsp 16 – Fill Out and Use This PDF

I.

INFORMATION ABOUT YOU

1.Name

LastFirstMiddle

2.

TSP Account Number

3.

Date of Birth

/

/

mm

dd

yyyy

4.

Daytime Phone (Area Code and Number) (

)

–

5.

Address

Street Address or Box Number

6.

City

7.

8.

State/Country

Zip Code

9.

I am applying for a Thrift Savings Plan:

Loan

Withdrawal

II.

REQUEST FOR EXCEPTION

10.				11.		–		–
	Name of Spouse (LAST)	(FIRST)	(MIDDLE)		Spouse’s Social Security Number

12.Whereabouts Unknown

For Federal Employees’ Retirement System (FERS) Participants. I am asking for an exception to the requirement to obtain the signature of my spouse identified above because I do not know where my spouse is. I have made a good faith effort to locate my spouse in the 90 days before I submitted this request and have been unable to do so through any person or other source. The required statements or police, agency, or judicial determinations are attached to this form.

For Civil Service Retirement System (CSRS) Participants. I am asking for an exception to the require- ment to notify my spouse identified above because I do not know where my spouse is. I have made a good faith effort to locate my spouse in the 90 days before I submitted this request and have been un- able to do so through any person or other source. The required statements or police, agency, or judicial determinations are attached to this form.

III.

YOUR SIGNATURE AND CERTIFICATION

I certify that the information I have provided in connection with this request is true and complete to the best of my knowledge. Warning: Any intentional false statement or willful misrepresentation in this form is a violation of law that is punishable by a fine or imprisonment for as long as 5 years, or both (18 U.S.C. §1001).

IV.

OFFICIAL USE 16. ONLY

Approved

Disapproved

17.

Date

PRIVACY ACT NOTICE. We are authorized to request the information you provide on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System. We will use this information to identify your TSP account and to process your transaction. In addition, this information may be shared with other Federal agencies for statistical, auditing, or archiving purposes. We may share the information with law enforcement agencies investigating a violation of civil or criminal law, or agencies implementing a

statute, rule, or order. It may be shared with congressional offices, private sector audit firms, spouses, former spouses, and beneficiaries, and their attorneys. We may dis- close relevant portions of the information to appropriate parties engaged in litigation and for other routine uses as specified in the Federal Register. You are not required by law to provide this information, but if you do not provide it, we will not be able to process your request.

Form TSP-16 (1/2011)

PREVIOUS EDITIONS OBSOLETE

GENERAL INFORMATION

Make a copy of this form and all documents for your records. Mail the original form along with supporting docu- ments to: TSP Legal Processing Unit, P.O. Box 4390, Fairfax, VA 22038-4390.

For overnight delivery, send the form to: ATTN: TSP Legal Processing Unit, 12210 Fairfax Town Center, Unit 906, Fairfax, VA 22033.

Or fax the completed form to: 1-703-592-0151. If you have questions, call the toll-free ThriftLine at 1-TSP-YOU- FRST (1-877-968-3778) or the TDD at 1-TSP-THRIFT5 (1-877-847-4385). Outside the U.S. and Canada, please call 404-233-4400 (not toll free).

By law, your spouse (including a separated spouse) has certain rights when you withdraw or borrow from your TSP account. The legal requirements are summarized in the chart below. If you are covered by FERS, it is your respon- sibility to obtain the signature of your spouse; your spouse’s signature is required to waive the required joint annuity when you make a post-separation full withdrawal or to consent to your loan, in-service withdrawal, or post-separa- tion partial withdrawal. If you are covered by CSRS, the TSP is responsible for sending the required notice to your spouse. The notice does not contain personal information about you; it informs your spouse that you have applied for a withdrawal or a loan from your TSP account. The notice does not give your spouse a right to the money in your TSP account.

The TSP will notify you of the decision regarding your request for an exception to the spouses’ rights requirements. An exception may be granted only under limited conditions.

SECTION I. and

SECTION II.

1–9: Complete all of these items.

10–11: Enter your spouse’s name and Social Security number.

12:Whereabouts Unknown. If you are requesting an exception to the spousal requirements because your spouse’s whereabouts are unknown, you must attach one of the following items to this form:

• a court order which states that the whereabouts of your spouse are unknown, OR

•a police or governmental agency determination issued by the appropriate department or division head which states that the whereabouts of your spouse are unknown, OR

•three statements, including:

–a statement by you that

(1)provides the full name(s) of your spouse;

(2)clearly states that you are unable to locate your spouse;

(3)states the last time you knew your spouse’s location;

(4)explains why your spouse’s location is not known; and

(5)describes in detail the efforts you have made to locate your spouse in the 90 days preceding your submission of this request and the results of those efforts; and

–statements from two persons supporting your statement that you do not know your spouse’s location and describing the person’s knowledge of your efforts within the last 90 days to locate your spouse.

Each statement must be signed and dated and must contain the following statement:

I understand that a false statement or willful misrepresentation in this form is a violation of law that is punishable by a fine or imprisonment for as long as 5 years, or both (18 U.S.C. § 1001).

13:Exceptional Circumstances (FERS only). If you are a married FERS participant and exceptional circum- stances make it inappropriate to obtain your spouse’s signature, you must attach either a court order or a govern- mental agency determination issued by the appropriate department or division head explaining the exceptional circumstances. For example, a court order could indicate that you and your spouse have been maintaining sepa- rate residences with no financial relationship for three or more years; or indicate that your spouse abandoned you, but for religious or other compelling reasons, you chose not to divorce; or state that you may borrow money from or withdraw all or a portion of your TSP account notwithstanding the absence of your spouse’s signature.