Smithsonian Tax-Deferred Annuity Employee Plan

Smithsonian Institution
Tax Deferred Annuity Retirement Plan
Salary Reduction Agreement
This form is the only form required to enroll in the Tax Deferred Annuity (TDA) plan
BY THIS AGREEMENT, made between the employee and The Smithsonian Institution, we agree as follows:
Effective for amounts paid on or after ______________ , ______ , which date is subsequent to the execution of this
Agreement, the Employee's salary will be reduced by the amount indicated below. This agreement will enroll the
employee in the Tax Deferred Annuity (TDA) plan.
Employee: Please complete Sections I, II and sign/date the form and forward to the Human Resources Benefits Office
Section I Employee information______________________________________________________________________
Name __________________________ Social Security Number _______________ Date of Birth _____________
SI Organization/Office _____________________________ Please check one:
New enrollment
Change
Section II Deferral Amount __________________________________________________________________________
The amount of the salary reduction shall be: (check one)
_______ % of gross annual base salary (you can contribute up to 99% per pay period) OR
$ ________per pay period (you can contribute up to $9,999 per pay period)
Current calendar year contributions with a prior employer (including other federal agencies) or as a Smithsonian Institution federal
employee
Have you made any pre-tax contribution in this calendar year to a prior employer 401 (k) or 403(b) plan?
Yes
No
If yes, please indicate the total amount of your contribution this year $ ___________ .
The total 401(k) and/or 403(b) deferrals in a calendar year cannot exceed the limits as set forth by the IRS.
The IRS limit will produce a total Institution contribution that does not exceed the Employee's statutory limitation under IRC
Section 415 or Section 402(g), whichever is less. For employees age 50 and over, this amount will include any additional
catch-up contribution permitted under IRC 414(v).
Employee Name ______________________________
Benefits Specialist Name ______________________________
Employee Signature ___________________________
Benefits Specialist Signature _________________________
Date
Date
________________________________________
____________________________
This Salary Reduction Agreement shall be legally binding for both the Institution and the Employee while employment
continues, unless and until this Agreement is modified. This Agreement will be effective the first day of the pay period
following the date in which the Agreement is accurately completed and received by your designated benefit
office/representative. The Employee may modify this Agreement in any subsequent pay period by completing a new
Agreement.
Revised January 2015