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Salary Reduction Agreement Tax Deferred Annuity Program (403(b) Plan)

The purpose of the Salary Reduction Agreement Form is to enable employees to enroll in a Tax Deferred Annuity program (TDA) via payroll deduction.

The University currently has Tax Deferred Annuities providers and No-Load Mutual Funds providers approved for salary reduction on the payroll system. The Ohio Public Employees Deferred Compensation Program (IRC Section 457) is also available.

This is an online form; completing and submitting it will result in the requested change. By typing in your name in the Employee Signature field, you are authorizing a change in your records. If you wish to retain a copy of the completed form, please print a copy before submitting it. For questions email HR .

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Date: (mm/dd/yyyy)

Please provide Your UCID# in the text box provided below:

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Email Address:

Last Name:		First Name:		MI:
Dept.:		Mail Loc.:		Work Phone:

A separate agreement is required for each transaction, and is made by and between: (Please type/print employee name below):

Employee Name:

hereinafter designated as the Employee, and the University of Cincinnati, hereinafter designated as the University. The parties agree that:

1. Effective with amounts paid after: (Please type/print date below):

Date:(mmddyy)

(at least 30 days subsequent to the date of this Agreement)

the University shall reduce the Employee's compensation each pay period by:

Monthly Amount:

(paid monthly)
Bi-weekly Amount:

(paid bi-weekly)

2. The University agrees to remit this amount to: Complete Listing of Providers

Name of Tax Deferred Annuity:

for the purchase of a retirement annuity contract or fund shares, as applicable, with all rights to such contract or shares fully vested in the Employee. The Employee agrees to establish an account directly with the provider by submitting the necessary application.

3. This salary reduction is only for the purposes authorized by the Internal Revenue Code (IRC) and the tax laws of the State of Ohio. The salary reduction shall not occur during any pay period in which it would exceed the amount then due the Employee after all other applicable withholdings.

4. This Agreement shall remain in full force and effect during the continued employment of the Employee unless terminated in writing by either party or amended by proper submission of a revised Agreement by the Employee. No more than one such Agreement may be made within any taxable year, except to the extent otherwise permitted under IRC Section 403(b).

5. This agreement constitutes (please check one):

Stop this Agreement with	Name of Tax Deferred Annuity:
A new Agreement with	Name of Tax Deferred Annuity:
A revised Agreement with	Name of Tax Deferred Annuity:
A change to the distribution of the reduction between providers (with no change in the total reduction per pay period)
A revision based solely on a change in pay frequency

6. By processing this Agreement online, the Employee hereby certifies that the requested annual salary reduction does not exceed his/her deferral limits (the "maximum exclusion allowance" or MEA) under the provisions of IRC Sections 403(b), 415, and 402(g), or IRC Section 457 (applicable only when investing in the Ohio Public Employees Deferred Compensation Program) for the current taxable year. Further, the employee accepts full responsibility for the annual calculation of his/her MEA, and agrees to indemnify the University for any loss resulting from errors or misrepresentations in his/her calculation of the MEA. The University reserves the right to require documentation of this certification. Failure to provide such documentation upon request will result in termination of this Agreement.

Employee Signature:

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Human Resources
340 University Hall · 51 Goodman Drive · University of Cincinnati
PO Box 210039 · Cincinnati, OH 45221-0039 · 513-556-6381
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