This is a sample letter to be sent with the QDRO fact sheet that follows. Allow at least thirty days for the plan administrator to respond. The purpose of the letter and fact sheet is to obtain information from the plan administrator to prepare a qualified domestic relations order dividing a private retirement plan qualified under the Internal Revenue Code and the Employee Retirement Income Security Act. The plan can be a defined benefit or defined contribution plan. The letter and fact sheet are not designed to be used for state retirement, military retirement, civil service retirement, postal service retirement, or railroad retirement.
If there are concerns that money has been withdrawn or there are outstanding loans, more information may need to be requested. This letter contains only a request for minimal basic information.
Letter to Plan Administrator
[Private Plan]
[Date]
[Name and address of plan administrator]
Re: Retirement benefits for [name of participant]
Social Security number [number]
In the Matter of the Marriage of [name] and [name]
[Salutation]
I represent [name of client] in a pending divorce action. [Include if applicable: In that connection, enclosed is a copy of Agreed Temporary Orders signed by the court, which (on page [specify]) enjoin [name of participant] from making any withdrawal for any purpose from any retirement, profit-sharing, pension, death, or other employee benefit plan or employee savings plan or from any individual retirement account or Keogh account, including but not limited to any retirement with [name of company].]
Enclosed is a “Records Authorization—Retirement and Employee Benefits” regarding an employee of [name of company], [name of participant]. In addition to the information requested on the authorization, please provide, for each plan, a valuation as of [date].
Please provide me with the following:
1.a copy of the formal plan documents;
2.a copy of the summary plan description;
3.a copy of the company’s written procedures for determining the qualified status of qualified domestic relations orders; and
4.a statement of accrued benefits for defined benefit plans or the most recent statement showing the total account balance for defined contribution plans.
I have enclosed a QDRO fact sheet necessary for me to prepare a qualified domestic relations order. If the participant has more than one plan, I will need information for each plan. If you need additional QDRO fact sheets, please copy this one. Please complete the QDRO fact sheet or provide documents containing the information requested, complete the enclosed business records affidavit, and return them to me in the stamped, self-addressed envelope I have enclosed for your convenience.
Your prompt attention to this matter is most appreciated. [Include if applicable: The Court has ordered this matter set for trial on [date] if the parties have not reached an agreement by that time, so time is of the essence in receiving the requested information from you.] Please contact me at your earliest convenience to advise me of the status of providing this information. If you have any questions, please contact me.
[Name of attorney]
Enc.
Records Authorization—Retirement and Employee Benefits
Employee’s Name:
Employee’s Social Security Number:
You are requested to supply the following information to [name of attorney], consisting of its attorneys and legal assistants, [address of attorney].
I authorize the pension administrator, trustee, or plan sponsor, payroll manager, human resources manager, and his or her agents, servants, or employees to release all requested information relating to payroll, employee benefits of any kind (whether qualified or nonqualified), and any retirement benefits or deferred benefit program (whether qualified or nonqualified) in which I am a participant or have the right to participate, including but not limited to a benefit under a plan, fund, program, or other arrangement under which compensation or benefits from my employment are expressly or as a result of surrounding circumstances deferred to a later date or the happening of a future event.
Such arrangement includes but is not limited to a pension plan, a profit-sharing plan, stock options, a stock bonus plan, an employee or stock purchase plan, a self-employed retirement plan, a simplified pension, a deferred compensation agreement or plan, and payroll information.
A photocopy of this authorization may be used instead of the original.
SIGNED on ________________________________.
[Name of employee]
State of Texas)
County of)
This instrument was acknowledged before me on ______________________________ by [name of employee].
Notary Public, State of Texas