Tsp Form 76 – Fill Out and Use This PDF

SECTION I. Calculation for Negative Cash Flow

A.To determine your allowance for ordinary monthly household expenses, first determine your gross monthly income as explained in the instructions below and enter that amount on the line provided. Then, locate your income in the chart on the right and move across to choose the factor that correlates to your family size. Enter that factor on the line provided and multiply it by the amount of your gross monthly income.

Enter the result (rounded to the nearest whole dollar) on Line A.

You will be unable to make any TSP contributions for 6 months. This means that you cannot make traditional, Roth, or catch-up contributions, or contribute from incentive, special, or bonus pay during that time.

If you are eligible for matching contributions from your agency or service, you will not receive them during the 6-month period that you cannot contribute.

The amount you withdraw combined with 6 months of missed contributions and matching can reduce your retirement savings by thousands of dollars over time.

You may have to pay taxes and a 10% early withdrawal penalty on the money you withdraw.

Be aware that if you have a significant financial hardship and are in pay status and eligible for a TSP loan, you can request a loan rather than a withdrawal. If you take a loan from your TSP account:

•You can pay yourself back with interest; your loan pay- ments go directly into your TSP account.

•You can continue your contributions, and your matching contributions will not be affected.

•However, your long-term retirement savings will be negatively impacted because you will not accrue earnings on your loan amount.

•You must pay a $50 loan fee.

•You will not pay taxes on your loan amount.*

To ensure that your request is not delayed, carefully type or print the requested information using black or dark blue ink. If printing, please use simple block letters and numbers. Keep all letters and numbers inside the boxes.

Be certain to provide all the information requested on the form. If you do not, your form may be rejected.

SECTION I. Check whether you are withdrawing money from your civilian or uniformed services account in Item 1. Check only one box. You cannot withdraw from both accounts using one form. If you have two TSP accounts, and you

do not check a box, your form will not be processed.

SECTION II. If you are a FERS or uniformed services partici- pant, your spouse must consent to your financial hardship withdrawal by providing his or her name and signature in Item 6, and by dating the form in Item 7. The signature must be notarized. Because the form will be filed with a Federal agency in Washington, D.C., the notary must complete the information in Item 8. No other acknowledgement is acceptable. If you cannot obtain your spouse’s signature, provide your spouse’s name in Item 6 and Social Security number in Item 9, and submit Form TSP-16, Exception to Spousal Requirements (or TSP-U-16 for uniformed services).

SECTION III. If you are a CSRS participant, the TSP must notify your spouse of your hardship withdrawal. Provide your spouse‘s name in Item 10. If your spouse’s address is the same as your address in your TSP record, check “Yes” in Item 11 and go to Section IV on Page 2. If your spouse’s address is

not the same as yours, check “No” in the second box and complete Items 12-16. If you do not know your spouse’s address, check the third box in Item 11, provide your spouse’s Social Security number, and submit Form TSP- 16, Exception to Spousal Requirements.

If your spouse has a foreign address, check the box in Item 12 and enter the foreign address as follows in Items

13-14:

First address line: Enter the street address or post office box number, and any apartment number.

Second address line: Enter the city or town name, other principal subdivision (e.g., province, state, county), and postal code, if known. (The postal code may precede the city or town.)

City/State/Zip Code Fields: Enter the entire country name in the City field; leave the State and Zip Code fields blank.

If your spouse uses an Air/Army Post Office (APO) or Fleet Post Office (FPO) address, enter that address in the two available address lines (include the unit designation). Enter APO or FPO, as appropriate, in the City field. In the State field, enter AE as the state abbreviation for Zip Codes beginning with 090-098, AA for Zip Codes begin- ning with 340, and AP for Zip Codes beginning with 962- 966. Then enter the appropriate Zip Code.

Skip SECTIONS II and III if you are not married. You will certify that you are not married on Page 2 of this form.

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 request. In addition, this information may be shared with other Federal agen- cies 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 congres- sional offices, private sector audit firms, spouses, former spouses, and beneficia- ries, and their attorneys. We may disclose 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.

Spouse’s Name (Last, First, Middle)

Spouse’s Signature

Check here.

Street Address or Box Number (For a foreign address, see instructions.)

Street Address Line 2

14.

City

Do Not Write Below This Line

–

* P I I S 0 0 2 3 0 0 0 1 2 0 0 0 0 0 0 0 0 P I I S

*

FORM TSP-76, Page 1 (8/2015)

PREVIOUS EDITIONS OBSOLETE

SECTION IV. Before you complete this section, read the follow- ing information carefully. After completing the form, you will have to sign it and certify that the information you are providing is true. Your signature must be notarized.

We recommend that you use the worksheet at the front of this package to determine the amount of your financial hardship.

To receive a hardship withdrawal from your TSP account, your need must arise out of one or more of the following situations:

1)On a recurring basis, your monthly cash flow is negative. That means that your net income is less than your ordinary monthly household expenses. This situation does not apply if you are in chapter 13 bankruptcy. (This is because the court has shielded you against a negative cash flow position.)

2)You have incurred (or will incur within the next 6 months) one of the following extraordinary expenses, which you have not paid and for which you will not be reimbursed (for example, by insurance):

•Medical expenses. These expenses should be payable by you, your spouse, or your dependents and should be deductible by you for Federal income tax purposes without regard to any income limit on deductibility. They include, but are not limited to, expenses for physician visits, prescription drugs, hospitalization, and eyeglasses. Medical expenses also include the cost of structural changes to your home re- quired for medical care, or the installation of special equip- ment necessary to accommodate an incapacitated person (for example, a wheelchair ramp or a chair lift). Medical expenses do not include health insurance premiums.

•Personal casualty loss. This is the cost of making repairs to or replacement of property that would be deductible by you for Federal income tax purposes, but without regard to any income limit on deductibility, or the fair market value of the property, or the number of loss-producing events. Personal casualty loss includes — but is not limited to — damage, destruction, or loss of property resulting from a sudden, unexpected, or unusual event such as a flood, earthquake, hurricane, fire, tornado, or theft.

•Legal expenses for attorney fees and court costs associ- ated with separation or divorce. Note that court-ordered payments to a spouse or former spouse (e.g., alimony or property settlement, child support payments, costs of ob- taining prepaid legal services, and other coverage for legal services) are not allowed.

Provide the amount of the withdrawal you are requesting in Item 17, and the reason or reasons for your financial hardship in Item 18. You can request an amount of $1,000 or more of your own contribu- tions and earnings on those contributions. However, the amount you request cannot be more than the amount of your hardship. If your employee contributions and earnings are less than your re- quested amount, but are at least $1,000, you will be paid the lesser amount.

Note: Your withdrawal will be disbursed pro rata (i.e., propor- tionally) from any traditional and Roth balances in your account at the time of your withdrawal. Similarly, if your uniformed ser- vices TSP account contains tax-exempt or Roth contributions, your withdrawal will be disbursed pro rata from taxable and nontaxable amounts.

SECTION V. This section is optional. The taxable portion of your withdrawal is subject to Federal income tax and, if you are younger than age 59½, possibly a 10% early withdrawal penalty tax. (It may also be subject to state and local tax; check with your tax advisor or taxing authority.)

Note: Withdrawals of tax-exempt contributions in a traditional balance and any Roth contributions are not subject to Federal income tax. However, if you have not met the conditions necessary for your Roth earnings to be qualified (i.e., paid tax-free), any Roth earnings included in the withdrawal will be subject to Federal income tax. (See General Information.)

We must withhold 10% of the taxable portion of your withdrawal for Federal income tax unless you waive withholding (or request more than 10% withholding) by completing the appropriate box in Item 19. If you complete Item 19 incorrectly, we will process your withdrawal using the standard 10% withholding. For example:

For more information about tax withholding and the tax penalty, be sure to read the tax notice “Important Tax Information About Pay- ments From Your TSP Account.”

SECTION VI. Complete this section only if you want the TSP to send your financial hardship withdrawal directly to your check- ing or savings account by direct deposit. If you do not know the

9-digit ACH Routing Number or your checking or savings account number, contact your financial institution for this information. Direct deposits will be made only to financial institutions in the United States. Note: If the TSP determines that the direct deposit information you provided is incomplete or invalid, your request will be processed, but you will receive your payment in the form of a check mailed to your address of record.

SECTION VII. Please sign and date this form. Your signature must be notarized; otherwise your request cannot be processed. Be- cause the form will be filed with a Federal agency in Washington, D.C., the notary must complete the notarization in this section. No other acknowledgement is acceptable.

The address you provide in Item 26 will not be used to update the address in your TSP record. We will use this address only to notify you if we cannot locate your account based on the information you provided on this form. If the address in your TSP record is not correct, contact your agency or service immediately — only your agency or service can change your address for your TSP account while you are employed by the Federal Government or are a mem- ber of the uniformed services. If you are not sure what address is shown for your TSP account, check your most recent participant statement. It is available on the TSP website. To access your ac- count record, you will need your TSP account number (or user ID) and your Web password. Correct your address before submitting your withdrawal request.

After completing the form, make a copy for your records.

Either mail the original to:

Note: Do not mail and fax your request. The TSP will automatically cancel your second request. If you need to make a change or cor- rection on your form, call the TSP to cancel your first request.

If you have questions, call the 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).

FORM TSP-76 (8/2015)

$

,

,

.00 (amount must be $1,000 or more)

Negative monthly cash flow

Personal casualty loss

Medical expenses

Legal expenses for separation or divorce

Savings 22.

23.

ACH Routing Number (Must be 9 digits)

Checking or Savings Account Number