Tsp 17 Fillable Form PDF Details

Are you a business, taxpayer, or individual looking to complete your tax forms correctly and quickly? Then the TSP 17 Fillable Form is perfect for you! This form can help make it easier to provide all of the necessary information needed when filing taxes. By understanding how this particular fillable form works and what needs to be included on it, one can manage their finances more efficiently by properly completing their returns before they are due. In this blog post we will discuss in detail the steps required to use and understand the Tsp 17 fillable form.

QuestionAnswer
Form NameTsp 17 Fillable Form
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namestsp 17 form, tsp 17 fillable form, 17 tsp fillable, tsp form 17

Form Preview Example

This Form TSP-17, Information Relating to Deceased Participant,

replaces Form TSP-U-17 and previous editions of Form TSP-17.

Form TSP-U-17 and previous editions of Form TSP-17, Information Relating to Deceased Participant, are no longer available. They have been combined into a single Form TSP-17.

This version of Form TSP-17 should be used both by members of the uniformed services and by civilians. (Scroll down to view form.)

Thrift Savings Plan

Form TSP-17

Information Relating

to Deceased Participant

March 2015

INFORMATION AND INSTRUCTIONS

GENERAL INFORMATION

Use this form to provide information about potential beneficiaries of a deceased participant’s Thrift Savings Plan (TSP) account or accounts. If the participant had multiple accounts with the TSP, the information here will be applied to each account separately. If a valid Form TSP-3, Designation of Beneficiary, is on file with the TSP recordkeeper for the account, payment of the account will be made according to the designation(s). In that case, the information provided on this form may be used to update beneficiary information (e.g., addresses) on file with the recordkeeper.

Type or print all information on this form. Make a copy for your records and mail the original form to: TSP Death Benefits Processing Unit, P.O. Box 4450, Fairfax, VA 22038-4450.

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

Or fax the completed form to: 1-703-592-0170.

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).

I. INFORMATION ABOUT DECEASED PARTICIPANT

Complete all items in this section. This information is needed to identify the deceased participant’s account(s). You MUST include a copy of the participant’s death certificate with this form. The death certificate must state the cause or manner of death. (Note: Some states do not routinely include cause or manner of death on death certificates, so you may have to request specifically a death certificate with cause or manner of death included.)

II. INFORMATION ABOUT YOU

Complete all items in this section.

If you are not a potential beneficiary, you may leave Item 11 (Social Security number) and Item 12 (Date of Birth) blank.

If you are an executor or administrator of the deceased participant’s estate, enter “Executor” or “Adminis- trator” in Item 18. Note: If there is not a valid Form TSP-3, Designation of Beneficiary, on file and there is no spouse, child, or parent of the deceased participant, you must provide the estate’s Taxpayer Identi- fication Number (TIN) in Item 11 if payment is expected to be made to the estate. In this case, you must attach a copy of your court appointment along with a copy of the TIN. You do not need to provide the requested information again in Section IV.

III. INFORMATION ABOUT POTENTIAL BENEFICIARIES

If the participant was married at the time of death (i.e., you answered “Yes” to Item 19), proceed to Section IV; information about other potential beneficiaries is not required. Otherwise, answer all of the remaining ques- tions in this section before proceeding to Section IV.

Beneficiaries will be determined using the following statutory order of precedence:

1.To your spouse;

2.If none, to your child or children equally, and to descendants of deceased children by representation;

3.If none, to your parents equally or to the surviving parent;

4.If none, to the appointed executor or administrator of your estate; or

5.If none, to your next of kin who would be entitled to your estate under the laws of the state in which you resided at the time of your death.

 

In this order of precedence, a child includes a natural child (even if the child was born out of wedlock) and

 

a child adopted by the participant; it does not include a stepchild or a foster child who was not adopted.

 

Note: If your natural child was adopted by someone other than your spouse, that child is not entitled to a

 

share of your TSP account under the statutory order of precedence. “By representation” means that if a child

 

of yours dies before you do, that child’s share will be divided equally among his or her children. “Parent” does

 

not include a stepparent unless the stepparent adopted you.

 

In Item 20, if you know that the participant had children but you are uncertain as to the number of children,

 

please provide your best estimate of the number of children and check the adjoining box.

 

If you are applying on behalf of the participant’s estate, please provide the court papers appointing executor

 

or administrator and a copy of the Estate EIN number on IRS letterhead.

Page 2 of 8

Form TSP-17 (3/2015)

 

PREVIOUS EDITIONS OBSOLETE

THRIFT SAVINGS PLAN

TSP-17

INFORMATION RELATING

TO DECEASED PARTICIPANT

Use this form to provide information about potential beneficiaries of a deceased Thrift Savings Plan (TSP) participant. Read the instructions for each section before completing the form. A copy of the participant’s death certificate must accompany this form.

I.

INFORMATION ABOUT DECEASED PARTICIPANT

1.Name of Deceased Participant

LastFirstMiddle

2.

 

 

3.

/

/

4.

/

/

 

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy)

 

Date of Death (mm/dd/yyyy)

 

Social Security Number

 

 

 

 

5.Legal Residence at Time of Death

Street Address

6.

City

7.

 

8.

 

 

 

 

 

 

State/Country

 

Zip Code

9.

 

Check here to indicate that you have attached a copy of the death certificate (as required).

II.

INFORMATION ABOUT YOU

10.Name

LastFirstMiddle

11.

 

 

 

 

 

 

 

 

 

 

 

12.

/

/

 

 

 

 

Social Security Number (or TIN if estate)

 

 

 

Date of Birth (mm/dd/yyyy)

13.

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address or Box Number

 

 

 

 

 

 

 

 

14.

City

 

 

 

 

 

 

 

 

 

15.

 

16.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/Country

 

 

Zip Code

17.

Daytime Phone

(

 

 

)

 

 

 

18.

 

 

 

 

 

 

 

 

 

 

 

 

Area Code and Number

 

 

 

Relationship to Deceased Participant

III.

INFORMATION ABOUT POTENTIAL BENEFICIARIES

19.Participant’s Spouse—Was the participant married at the time of death?

Yes

No

Don’t Know

If “Yes,” skip to Section IV; if “No” or “Don’t Know,” complete questions 20 – 22 below.

20.Participant’s Children—

A. Were there any living children of the participant at the time of death?

Yes

No

Don’t Know

If “Yes,” how many? _______

Check here if the number of children you identified is an estimate.

B.Were there any children of the participant who died before the participant died?

Yes

No

Don’t Know

If “Yes,” please complete the following:

1.How many children died before the participant? _______

you identified is an estimate.

Check here if the number of children

2.Were there any descendants of those deceased children (i.e., the participant’s grandchildren) living at the time of the participant’s death?

Yes

No

Don’t Know If “Yes,” how many? _______

of children you identified is an estimate.

Check here if the number

21.Participant’s Parents—Did the participant have at least one living parent at the time of death?

Yes

No

Don’t Know

22.Executor or Administrator of Participant’s Estate—Is there an executor or administrator for the estate of the participant? If yes, please provide the court documentation appointing the executor or administrator and a copy of the Taxpayer Identification Number (TIN).

Yes

No

Don’t Know

If you answered “Yes” or “Don’t Know” to any of the questions in 20 – 22, complete the rest of this form. If you an- swered “No” to every question in Section III, skip to Section VII; you may be contacted for additional information.

Form TSP-17 (3/2015)

PREVIOUS EDITIONS OBSOLETE

Page 3 of 8

INFORMATION AND INSTRUCTIONS

IV. DETAILED INFORMATION ABOUT POTENTIAL BENEFICIARIES

The information in this section will be used to locate potential beneficiaries. Be sure to fill in the deceased participant’s name and Social Security number at the top of the page. If you need to list more than four per- sons, make as many photocopies of the page as you need. Check the box at the bottom of the page and indicate the number of additional pages attached.

If you cannot provide all of the requested information, provide as much information as you can. Write “Don’t Know” on any line for which you do not have information. If the information that you are able to provide is not enough to contact the potential beneficiary (that is, if you cannot provide a full address or telephone number) or if you only have information about some of the beneficiaries, complete Section V also.

When providing information about a potential beneficiary who was living at the time of the participant’s death but who died after the participant, be sure to provide the date of death for that person.

If you are providing information about children of the participant, be sure to include natural children (including those who were born out of wedlock) and those who were adopted by the participant. Do not provide infor- mation for natural children who were adopted by someone other than the participant’s spouse.

In the following (correctly filled-out) example, the participant was not married at the time of death, but the participant had two living children, a deceased child who had a son, and a surviving father. Because the participant was not married at the time of death, the applicant provided information about the participant’s living children and the grandchild (from the participant’s deceased child) identified in Item 20. There was no need to provide information about the deceased child identified in Item 20B because that child predeceased the participant. There was also no need to provide information about the surviving parent, because the living children and the grandchild will be the beneficiaries according to the statutory order of precedence.

Example

III.

INFORMATION ABOUT POTENTIAL BENEFICIARIES

19.Participant’s Spouse—Was the participant married at the time of death?

Yes

No

Don’t Know

If Yes, skip to Section IV; if “No” or “Don’t Know,” complete questions 20 – 22 below.

20.Participant’s Children—

A. Were there any living children of the participant at the time of death?

Yes

No

Don’t Know

If “Yes,” how many? __2__

Check here if the number of children you identified is an estimate.

B.Were there any children of the participant who died before the participant died?

Yes

No

Don’t Know

 

If “Yes,” please complete the following:

 

1. How many children died before the participant? __1__

Check here if the number of children

you identified is an estimate.

 

2.Were there any descendants of those deceased children (i.e., the participant’s grandchildren) living at the time of the participant’s death?

Yes

No

Don’t Know If “Yes,” how many? __1__

Check here if the number

of children you identified is an estimate.

 

21.Participant’s Parents—Did the participant have at least one living parent at the time of death?

Yes

No

Don’t Know

22.Executor or Administrator of Participant’s Estate—Is there an executor or administrator for the estate of the participant? If yes, please provide the court documentation appointing the executor or administrator and a copy of the Taxpayer Identifi cation Number (TIN) on IRS letterhead.

Yes

No

Don’t Know

If you answered “Yes” or “Don’t Know” to any of the questions in 20 – 22, complete the rest of this form. If you an- swered “No to every question in Section III, skip to Section VII; you may be contacted for additional information.

IV.

Name

 

Stanek

 

 

Brad

Scott

 

 

 

Son

DETAILED

 

 

 

 

 

Last

 

 

 

 

 

First

 

 

Middle

 

 

Relationship to Deceased Participant

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

123 Main Street

Chicago

IL

60612

ABOUT

Address

POTENTIAL

 

 

Street Address or Box Number

 

 

City

 

 

 

State/Country

 

 

Zip Code

 

 

312

) 555

 

 

 

1985

 

912 34

5678

02 / 24 / 1970

BENEFICIARIES

Phone (

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one:

Daytime

Evening

Social Security Number

 

 

 

 

Date of Birth (mm/dd/yyyy)

 

If this person died after the participant, provide the date of death.

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm dd

 

yyyy

 

Name

 

Jones

 

 

Linda

Leslie

 

 

 

Daughter

 

Last

 

 

 

 

 

First

 

 

Middle

 

Relationship to Deceased Participant

 

Address

13 H Street

 

 

Pottstown

PA

19464

 

 

 

Street Address or Box Number

 

 

City

 

 

 

State/Country

 

 

Zip Code

Phone ( 610

Check one:

)555

Daytime

9432

923 45 6789

08 / 18 / 1972

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy)

Evening

Social Security Number

If this person died after the participant, provide the date of death.

/

/

 

mm

dd

yyyy

Name

 

Stanek

omas

Arthur

 

 

Grandson

Last

First

Middle

 

Relationship to Deceased Participant

Address

921 North Avenue

Gaithersburg

MD

20878

 

 

Street Address or Box Number

City

 

State/Country

Zip Code

Phone ( 301

Check one:

)555

Daytime

1980

 

934

56

7890

 

Don't/

Know/

Evening

Social Security Number

Date of Birth

(mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

If this person died after the participant, provide the date of death.

 

/

/

 

mm

dd

yyyy

Page 4 of 8

Form TSP-17 (3/2015)

 

PREVIOUS EDITIONS OBSOLETE

Deceased Participant’s Name

 

SSN

 

 

 

 

 

 

 

 

 

 

 

 

IV.

If the participant was married at the time of death, provide the requested information for the deceased par-

DETAILED

ticipant’s spouse only. Otherwise, provide the requested information for all living children of the participant,

INFORMATION

all children who died after the participant, and all living children of deceased children whom you identified in

ABOUT

Item 20 in Section III. (You do not need to provide this information for any children identified in Item 20B who

 

 

 

 

 

 

 

 

 

POTENTIAL

died before the participant.) When providing a phone number for a person living outside the United States or

Canada, enter the number exactly as you would if you were calling it from the United States.

BENEFICIARIES

 

 

If you answered “No” to all questions related to the spouse and children, provide the requested information

 

for parent(s) of the participant identified as living in Item 21. If there were no living parents, provide informa-

 

tion about the executor or administrator identified in Item 22.

Name

LastFirstMiddle Relationship to Deceased Participant

Address

 

 

 

Street Address or Box Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State/Country

 

 

 

 

Zip Code

 

Phone

(

 

 

)

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

(mm/dd/yyyy)

 

Check one:

 

 

Daytime

Evening

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this person died after the participant, provide the date of death.

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm

dd

 

yyyy

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

First

 

 

Middle

 

 

 

Relationship to Deceased Participant

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address or Box Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State/Country

 

 

 

 

Zip Code

 

Phone

(

 

 

)

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

(mm/dd/yyyy)

 

Check one:

 

 

Daytime

Evening

 

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this person died after the participant, provide the date of death.

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm

dd

 

yyyy

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

First

 

 

Middle

 

 

 

Relationship to Deceased Participant

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address or Box Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State/Country

 

 

 

 

Zip Code

 

Phone

(

 

 

)

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one:

 

 

Daytime

Evening

Social Security Number

 

 

 

 

 

 

 

 

Date of Birth

(mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this person died after the participant, provide the date of death.

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm

dd

 

yyyy

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

First

 

 

Middle

 

 

 

Relationship to Deceased Participant

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address or Box Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State/Country

 

 

 

 

Zip Code

 

Phone

(

 

 

)

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one:

 

 

Daytime

Evening

Social Security Number

 

 

 

 

 

 

 

 

Date of Birth

(mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this person died after the participant, provide the date of death.

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm

dd

 

yyyy

 

Check here if additional pages are used. Number of additional pages

 

 

 

.

 

 

 

 

Form TSP-17 (3/2015)

PREVIOUS EDITIONS OBSOLETE

Page 5 of 8

INFORMATION AND INSTRUCTIONS

V. REFERRAL FOR INFORMATION

If you answered “Don’t Know” about potential beneficiaries in Section III, or you cannot provide a name, address, or telephone number for any individual you identified in Section IV, provide in this section the name, address, and telephone number of anyone else whom the TSP can contact to obtain this information. If you cannot provide the address and telephone number, provide any information that you can.

VI. ADDITIONAL INFORMATION

You can use this section to expand upon or clarify any information provided on this form. You can also use this space to provide additional information not covered elsewhere on this form which is relevant to the disposition of the deceased participant’s account. (If you need additional space, continue on a blank sheet of paper.)

VII. CERTIFICATION

You must sign and date this form in Items 23 and 24.

Page 6 of 8

Form TSP-17 (3/2015)

 

PREVIOUS EDITIONS OBSOLETE

Deceased Participant’s Name

SSN

 

 

 

 

 

 

 

 

 

 

 

 

V.

Complete this section if:

 

 

 

 

 

 

 

REFERRAL

You cannot provide a current address or telephone number for a potential beneficiary whom you listed in

FOR

Section IV.

 

 

 

 

 

 

 

INFORMATION

There is no spouse and you believe there may be additional children about whom you have limited

 

knowledge.

You answered “Don’t Know” about potential beneficiaries in Section III.

Please refer us to someone who may be able to provide this information. (For more space, use Section VI.)

Name

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

Daytime Phone

 

 

Address

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

Relationship to Participant

 

 

 

 

 

 

 

 

 

 

To which potential beneficiary(ies) does this referral apply?

VI.

Use this space to provide any information that may be relevant to the disposition of the deceased participant’s

ADDITIONAL

account and that you did not furnish elsewhere on this form.

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VII.

I certify that the information I have provided is true and complete to the best of my knowledge. Warning: Any

CERTIFICATION

intentional false statement in this form or willful misrepresentation concerning it 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).

 

23.

 

24.

 

 

 

Your Signature

 

Date Signed

PRIVACY ACT NOTICE. We are authorized to request this information under

5 U.S.C. chapter 84. We are authorized by Executive Order 9397 to ask for the de- ceased participant’s Social Security number and your Social Security number and by 26 U.S.C. 6109 to ask for Taxpayer ID Numbers. We will use the information you provide on this form to identify the deceased participant’s account(s) and to process death benefit payments from that account. This information may be shared with other Federal agencies for statistical, auditing, or archiving purposes. In addition, we may

Form TSP-17 (3/2015)

PREVIOUS EDITIONS OBSOLETE

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 ben- eficiaries, and their attorneys. We may also disclose relevant portions of the informa- tion to appropriate parties engaged in litigation. You are not required by law to provide this information, but if you do not provide it, we will not be able to process this form or make payment.

Page 7 of 8

Remember to attach a copy of the participant’s death certificate when you submit this form.

The death certificate must state the cause or manner of death.

Page 8 of 8

Form TSP-17 (3/2015)

 

PREVIOUS EDITIONS OBSOLETE

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government form tsp 17 writing process explained (part 1)

2. Immediately after this selection of blanks is completed, go on to type in the relevant details in these - III INFORMATION ABOUT POTENTIAL, Participants SpouseWas the, Yes, Dont Know, If Yes skip to Section IV if No or, Participants Children, A Were there any living children, Yes, Dont Know, If Yes how many, Check here if the number of, B Were there any children of the, Yes, Dont Know, and If Yes please complete the.

Step # 2 for submitting government form tsp 17

3. This next stage is usually easy - fill in all the empty fields in the participant If yes please, Yes, Dont Know, If you answered Yes or Dont Know, Form TSP PREVIOUS EDITIONS, and Page of in order to finish this part.

government form tsp 17 conclusion process outlined (stage 3)

4. To go ahead, the next form section will require typing in a couple of form blanks. These comprise of Deceased Participants Name, SSN, IV DETAILED INFORMATION ABOUT, If the participant was married at, If you answered No to all, Name, Last, Address, First, Middle, Relationship to Deceased, Street Address or Box Number, City, StateCountry, and Zip Code, which are vital to going forward with this particular PDF.

Writing part 4 of government form tsp 17

It is easy to make an error when filling in the Name, thus be sure you go through it again before you send it in.

5. This pdf has to be finalized by dealing with this segment. Below one can find a full set of fields that need to be completed with correct details in order for your document usage to be faultless: Check one, Daytime, Evening, If this person died after the, yyyy, Name, Last, Address, First, Middle, Relationship to Deceased, Street Address or Box Number, City, StateCountry, and Zip Code.

Writing part 5 of government form tsp 17

Step 3: When you've looked over the information you filled in, click "Done" to complete your FormsPal process. Join FormsPal today and immediately use tsp form 17, available for downloading. Every single edit made is conveniently preserved , making it possible to customize the file at a later stage as required. Here at FormsPal.com, we endeavor to make sure that all of your details are kept protected.