Tsp Form 77 Request – Fill Out and Use This PDF

3.

TSP Account Number

4.

/ /

Date of Birth (mm/dd/yyyy)

5.

Daytime Phone (Area Code and Number)

6.

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

8.

City

9.

State

10.

Zip Code

–

12.

I would like to transfer all or a portion of my withdrawal request to an IRA or eligible employer plan. (Note: You must include the completed applicable transfer page(s) from this form with your withdrawal request package.)

13. Type of Account: 14.

Checking

Name of Financial Institution

Savings

15.

17. In addition to the mandatory 20%, withhold this amount for federal income tax: $

,

.00

18.

Participant’s Signature

19./ /

Date Signed (mm/dd/yyyy)

Use this form if you are separated from federal service and you want to request a one­time­only withdrawal of part of your vested account balance and leave the remainder with the TSP. If you would like to request a withdrawal of your entire vested account balance now, do not complete this form; instead, complete Form TSP­70, Request for Full Withdrawal.

Before completing a withdrawal request, you should read the booklet Withdrawing Your TSP Account After Leaving Federal Service and the TSP tax notice Important Tax Information About Payments From Your TSP Account. If you do not have these materials, you can download them from the TSP website (tsp.gov) or ask your former agency or service for a copy. You can also request them by calling the ThriftLine.

First, make sure you are eligible for a partial withdrawal:

•Your vested account balance must be at least $1,000. Your vested account balance is the total amount of your traditional balance and your Roth balance (if any), less any Agency/Serv­ ice Automatic (1%) Contributions and earnings in your account that have not met the time­in­service requirement.

•The minimum amount for a partial withdrawal is $1,000.

•You cannot have previously made a partial withdrawal after separating from federal service. Only one partial withdrawal is allowed.

•You cannot have previously made an age­based in­service withdrawal.

•You must be separated from federal service for 31 or more days in order to be eligible for a post­employment withdrawal.

There are two ways to request a partial withdrawal:

1.Complete Form TSP­77 (this form) and mail or fax it to the TSP. Note: Your request cannot be processed until your agency or service submits conirmation of your separation to the TSP.

or

2.Use the TSP website (tsp.gov) to begin your withdrawal request. For security reasons, you cannot complete your request online. You will be asked to print out your partially completed with­ drawal request form at the end of your online session. Review the form, complete any missing information, and provide any required signatures and documentation before you mail or fax it to the TSP. Do not change or cross out any of the preilled infor- mation resulting from your entries on the website; the form may not be processed if you do so.

Note: This type of withdrawal cannot process until your agency or service reports your separation to the TSP.

If you are not married and you do not want to transfer any part of your partial withdrawal to a traditional IRA, an eligible employer plan, or a Roth IRA, you only have to complete Page 1 of this form. Sign the form, have it notarized, and submit it to the TSP at the address indicated on the last page of this form.

SECTION I. Complete Items–10. Check whether you are with­ drawing money from a civilian or uniformed services account in Item 1. Check only one box. You cannot withdraw from both accounts using one form. Also, be sure to only check the box for the account representing the employment from which you are separated. If you have two TSP accounts, and you do not check a box, your form will not be processed.

Your TSP account number is the 13­digit number that was issued to you. The address you provide on this form will be used to update the address in your TSP account record. If you have a foreign ad­ dress, check the box in Item 6 and enter the foreign address in Items 7–10 as follows:

First address line: Enter the street address or post ofice 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 ields: Enter the entire country name in the City ield; leave the State and Zip Code ields blank.

If you use an Air/Army Post Ofice (APO) or Fleet Post Ofice (FPO) address, enter that address in the two available address lines (in­ clude the unit designation). Enter APO or FPO, as appropriate, in the City ield. In the State ield, enter AE as the state abbreviation for Zip Codes beginning with 090­098, AA for Zip Codes beginning with 340, and AP for Zip Codes beginning with 962­966. Then enter the appropriate Zip Code.

SECTION II. You may withdraw $1,000 or more. Use a whole dollar amount only. Note: Your withdrawal will be disbursed pro rata (i.e., proportionally) from any traditional (non­Roth) and Roth balances in your account. If your vested account balance is less than $1,000, submit a full withdrawal request using Form TSP­70.

SECTION III. Check the box in this section if you want all or a part of the withdrawal amount you elected in Section II to be transferred to an IRA or eligible employer plan.

To transfer all or a part of the vested, traditional (non­Roth) portion of your withdrawal, you and the IRA trustee or plan administrator must complete Page 3. To transfer all or any part of the Roth portion of your withdrawal, you and the IRA trustee or plan administrator must complete Page 4. To transfer the traditional and Roth portions of your withdrawal, you and the IRA trustee or plan administrator must complete Pages 3 and 4. Note: You must include the complet­ ed applicable transfer pages with your withdrawal request package.

SECTION IV. This section is optional. Complete this section only if you want the TSP to send your partial withdrawal directly to your checking or savings account by means of a direct deposit (electronic funds transfer (EFT)). Provide all of the requested information in this section. If you do not know the 9­digit ACH Routing number or your checking or savings account number, contact your inancial institution for this information. Direct deposits will be made only to inancial institutions in the United States. Note: Only the portion of your withdrawal that is not being transferred to a traditional IRA, eligible employer plan, or Roth IRA can be paid by EFT.

Note: If the TSP determines that the EFT 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 you.

SECTION V. This section is optional. Complete this section if you want the TSP to withhold additional federal income tax from your withdrawal. If you do not complete this section, you will still be subject to the mandatory 20% federal income tax withholding on the TAXABLE portion of payments that you do not transfer directly to a traditional IRA, eligible employer plan, or Roth IRA. The man­ datory withholding tax cannot be waived. If you are a uniformed services participant with a tax­exempt balance, the tax­exempt portion of your withdrawal will not be subject to the mandatory 20% withholding tax. Roth contributions and qualiied Roth earn­ ings are also not subject to mandatory tax withholding. If you complete this section requesting additional tax withholding, you should not complete IRS Form W-4P. Read the TSP tax notice, Important Tax Information About Payments From Your TSP Account for detailed tax rules.

SECTION VI. Read the certiication carefully and sign and date the form. Your signature must be notarized; otherwise, your request cannot be processed. Because the form will be iled with a federal agency in Washington, D.C., the notary must complete the notariza­ tion in Item 20. No other acknowledgement is acceptable.

Form TSP­77 (1/2018)

PREVIOUS EDITIONS OBSOLETE

22.

Spouse’s Signature

23.

/ /

Date Signed (mm/dd/yyyy)

25.Participant: If you cannot obtain your spouse’s signature, provide your spouse’s name (Item 21) and Social Security number on the right, and submit Form TSP­16, Exception to Spousal Requirements (TSP­U­16 for uniformed services), with the required documentation.

Spouse’s Social Security Number

28.

Spouse has

foreign address? 29. Street Address or Box Number (For a foreign address, see instructions.) Check here.

30.

City

31.

State

32.

Zip Code

–

Spouses’ rights apply to all partial withdrawals from your TSP account. If you are married (even if separated from your spouse), you must comply with the spouses’ rights require­ ments outlined below:

Spouses’ Rights for Partial Withdrawals

SECTION VII—Married FERS and uniformed services partici- pants. By law, your spouse has the right to a joint and survivor annuity with a 50% survivor beneit, level payments, and no cash refund, unless your spouse waives the right to that annu­ ity. By consenting to the partial withdrawal on this form, your spouse acknowledges that any amount disbursed now will not be available later for the purchase of such an annuity.

Your spouse gives consent to a partial withdrawal from your TSP account by completing, signing, and dating Items 21–23. Your spouse’s signature must be notarized (Item 24). Because this form will be iled with a federal agency in Washington, D.C., the notary must complete the information in Item 24. No other acknowledgement is acceptable.

If you cannot obtain your spouse’s signature, please provide your spouse’s Social Security number in Item 25. The TSP cannot process your withdrawal unless you have an excep­ tion on ile or if you apply for—and receive—an exception to the spouses’ rights requirements. Exceptions are granted in RARE circumstances. If you wish to apply for an exception, you can do so by submitting Form TSP­16 (TSP­U­16 for uni­ formed services), Exception to Spousal Requirements, along with this form.

SECTION VIII—Married CSRS participants. By law, the TSP must notify your spouse of your partial withdrawal. Provide your spouse’s name in Item 26. If your spouse’s address is the same as your address in your TSP record, check “Yes” in Item 27. Otherwise, check “No” in Item 27 and complete Items 28–32. If you do not know your spouse’s whereabouts, check the third box in Item 27 and provide your spouse’s Social Secu­ rity number. The TSP cannot process your withdrawal unless you have an exception on ile or if you apply for—and receive— an exception to the spouses’ rights requirements. Exceptions are granted in RARE circumstances. If you wish to apply for an exception, you can do so by submitting Form TSP­16, Exception to Spousal Requirements, along with this form.

If your spouse has a foreign address, check the box in Item 28 and enter the foreign address in Items 29–32 as follows:

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

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

City/State/Zip Code ields: Enter the entire country name in the City ield; leave the State and Zip Code ields blank.

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

34.

35.

36.

37.

IRA/Plan Account Number or Other Customer ID

Check this box if tax­exempt balances are accepted into the account identiied above.

Provide the name and mailing address information below exactly as it should appear on the front of the check.

Make check payable to

City

38.

Typed or Printed Name of Certifying Representative (Last, First, Middle)

39.

Signature of Certifying Representative

Do Not Write Below This Line

()

Daytime Phone (Area Code and Number)

40. / /

Date Signed (mm/dd/yyyy)

You may elect to transfer all or part of your partial withdrawal to a traditional IRA, an eligible employer plan, or a Roth IRA. The type of plan to which you can transfer your withdrawal depends on whether your withdrawal consists of a traditional (non­Roth) balance, a Roth balance, or both.

If you would like to transfer all or any part of the traditional (non-Roth) portion of your withdrawal to an IRA or eligible employer plan, complete Page 3.

If you would like to transfer all or any part of the Roth portion of your withdrawal to a Roth IRA or eligible employer plan, complete Page 4.

If you would like to transfer all or any part of both the tradi­ tional and Roth portions of your withdrawal to separate plans or to the same plan, you must complete Page 3 and Page 4.

SECTION IX. You may transfer all or any part of the traditional (non-Roth) portion of your withdrawal to a traditional IRA, eli­ gible employer plan, or Roth IRA. Enter a percentage between 1 and 100% in Item 33. Do not enter decimals or a percentage over 100%. If you decide to transfer to a Roth IRA, be aware that Roth IRAs accept only after­tax dollars. As a result, you must pay tax on the amount you transfer and the tax liability is incurred for the year of the transfer. We strongly encourage you to consult with a tax advisor regarding your eligibility for, and the tax consequences of, making the transfer.

Payments that are not transferred directly to a traditional IRA, eligible employer plan, or Roth IRA are subject to mandatory 20% federal income tax withholding. (See Section V.) Read the TSP tax notice Important Tax Information About Payments From Your TSP Account for detailed tax rules.

SECTION X. If you choose to transfer all or any part of the traditional (non-Roth) portion of your withdrawal to a tradi­ tional IRA, eligible employer plan, or Roth IRA, your inancial institution or plan administrator must complete this section before you submit this form to the TSP.

Do not submit transfer forms of inancial institutions or plans; the TSP cannot accept them.

The institution or plan to which the payment is to be trans­ ferred must be a trust established inside the United States (i.e., the 50 States and the District of Columbia).

The inancial institution or plan should retain a copy of Page 3 to identify the account to which the check should be deposited when it is received. If the transfer is to a traditional IRA or Roth IRA, the institution accepting the transfer should submit Form 5498, IRA Contribution Information, to the IRS. The TSP will report all payments and transfers to you and to the IRS on Form 1099­R, Distributions From Pensions, Annuities, Retire­ ment or Proit­Sharing Plans, IRAs, Insurance Contracts, etc.

Information for the IRA or Plan: Complete Section X and return this form to the participant identiied at the top of the page. The inancial institution or plan administrator must ensure that the account described here is a traditional IRA, eligible employer plan, or Roth IRA.

Type of Account and Account Number. Indicate whether the transfer is to a traditional IRA, eligible employer plan, or Roth IRA in Item 34. In Item 35, enter the account num­ ber, if available, of the IRA or plan to which the money is to be transferred. If an account number is not available, pro­ vide information that will help you identify the check when it is sent to you.

Transfer of Tax-Exempt Balances. A uniformed services participant may have contributed tax­exempt money from pay earned in a combat zone to his or her traditional bal­ ance. Check the box in Item 36 if tax­exempt balances are accepted into the account identiied in Item 34. If the participant’s traditional balance includes tax­exempt con­ tributions, the taxable portion of the withdrawal from the traditional balance will be transferred irst. Tax­exempt money will be transferred only if the taxable portion of the withdrawal does not satisfy the participant’s transfer elec­ tion and the plan or IRA accepts tax­exempt balances. If the plan or IRA does not accept tax­exempt balances, that por­ tion of the payment will be paid directly to the participant.

Name and Mailing Address. Provide the name and mailing address information in the boxes provided exactly as you want it to appear on the front of the transfer check. You will need to identify the account to which the transfer should be deposited from the information contained in these boxes.

The certifying representative must provide the requested information in Items 38–40. If we need to contact the inancial institution or plan for more information, the individual named here will be used as the contact person.

42.Type of Account:

Roth IRA

Eligible Employer Plan—Roth Account

Make check payable to

City

45.

Typed or Printed Name of Certifying Representative (Last, First, Middle)

46.

Signature of Certifying Representative

Do Not Write Below This Line

()

Daytime Phone (Area Code and Number)

47. / /

Date Signed (mm/dd/yyyy)

SECTION XI. You may transfer all or any part of the Roth por­ tion of your withdrawal to a Roth IRA or to a Roth account maintained by an eligible employer plan. Enter a percentage between 1 and 100% in Item 41. Do not enter decimals or a percentage over 100%.

Roth contributions are not subject to mandatory federal income tax withholding because they are not taxable upon distribution. However, if you have not met the conditions nec­ essary for your Roth earnings to be qualiied (i.e., paid tax­ free), any Roth earnings that are not transferred directly to a Roth IRA or to a Roth account maintained by an eligible em­ ployer plan are taxable and are subject to the mandatory 20% federal income tax withholding. Roth earnings become quali­ ied when the following two conditions are met: (1) 5 years have passed since January 1 of the calendar year in which you made your irst Roth contribution and (2) You have reached age 59½ or have a permanent disability. Note: The TSP cannot certify to the IRS that you meet the Internal Revenue Code’s deinition of a disability when your taxes are reported. There­ fore, you must provide the justiication to the IRS when you ile your taxes.

Read the TSP tax notice Important Tax Information About Payments From Your TSP Account for detailed tax rules.

SECTION XII. If you choose to transfer all or any part of the Roth portion of your withdrawal to a Roth IRA or to a Roth ac­ count maintained by an eligible employer plan, your inancial institution or plan administrator must complete this section before you submit this form to the TSP.

Do not submit transfer forms of inancial institutions or plans; the TSP cannot accept them.

The institution or plan to which the payment is to be trans­ ferred must be a trust established inside the United States (i.e., the 50 States and the District of Columbia).

The inancial institution or plan should retain a copy of Page 4 to identify the account to which the check should be deposited when it is received. If the transfer is to a Roth IRA, the insti­ tution accepting the transfer should submit Form 5498, IRA Contribution Information, to the IRS. The TSP will report all payments and transfers to you and to the IRS on Form 1099­R, Distributions From Pensions, Annuities, Retirement or Proit­ Sharing Plans, IRAs, Insurance Contracts, etc.

Information for the IRA or Plan: Complete Section XII and return this form to the participant identiied at the top of the page. The inancial institution or plan administrator must en­ sure that the account described here is a Roth IRA or a Roth account maintained by an eligible employer plan.

Type of Account and Account Number. Indicate whether the transfer is to a Roth IRA or to a Roth account main­ tained by an eligible employer plan in Item 42, and in Item 43 enter the account number, if available, of the IRA or plan to which the money is to be transferred. If an account num­ ber is not available, provide information that will help you identify the check when it is sent to you.

Name and Mailing Address. Provide the name and mailing address information in the boxes provided exactly as you want it to appear on the front of the transfer check. You will need to identify the account to which the transfer should be deposited from the information contained in these boxes.

The certifying representative must provide the requested information in Items 45–47. If we need to contact the inan­ cial institution or plan for more information, the individual named here will be used as the contact person.

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 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 ofices, private sector audit irms, spouses, former spouses, and beneiciaries, and their attorneys. We may disclose relevant portions of the information to appropriate parties engaged in litigation and for other routine uses as speciied 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 TSP­77 (1/2018)

PREVIOUS EDITIONS OBSOLETE