Form 25-25

The federal Thrift Savings Plan has promulgated model language used to draft the following Retire­ment Benefits Court Order, pursuant to 5 U.S.C. §§ 8435(c), 8467 and 5 C.F.R. pt. 1653, subpt. A. The model language, together with instructions and ancillary materials, may be found at https://qoc.rk.tsp.gov/qoc/b/alt-flow-federal.htm?execution=e1s1.

A retirement benefits court order must meet the requirements found at 5 U.S.C. §§ 8435(c), 8467 and 5 C.F.R. pt. 1653, subpt. A. The Thrift Savings Plan will honor any court order or court­approved prop­erty settlement agreement that meets these requirements. The following form is adapted from the model language. Use of a specific form, including the model form, is not required. Practitioners should review the model language for any updates before filing to ensure the form reflects the most up-to-date iteration of the model form.

Note that the form contains sensitive data. See section 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed records.

NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA

[Caption. See § 3 of the Introduction in volume 1 of this manual.]

Retirement Benefits Court Order

[Thrift Savings Plan]

This order is entered pursuant to the authority granted under the applica­ble domestic relations laws of the state of [state].

1.Plan Information

The Plan

This order applies to the Thrift Savings Plan (the “Plan”). Specifically, this Plan is a [civilian account/uniformed services account/beneficiary partici­pant account].

2.Participant Information

Participant Information

The participant (“Participant”) is identified as follows: [name], residing at [address].

The Participant’s Social Security number and date of birth are included on the attached Addendum.

3.Payee Information

Payee Information

The person named as payee (“Payee”) meets the requirements of the definition of payee as set forth in section 4 of this order. The Payee is identified as follows: [name], residing at [address].

The Payee’s Social Security number and date of birth are included on the attached Addendum.

Payee is the [spouse/former spouse/child/dependent] of Participant.

The Payee shall be responsible for notifying the Plan in writing of any changes in his or her mailing address after the submission of this order.

4.Definition of Terms

Definition of Terms

The “Payee” is any spouse, former spouse, child, or other dependent of the Participant who is recognized by a domestic relations order as having a right to receive all or a portion of the benefits payable under the Plan with respect to the Participant.

“Date of distribution” is the date on which the awarded benefit is distrib­uted to the Payee.

The “liquidation date” is the date the amount assigned to the Payee is transferred from the Participant’s vested account balance to a separate account established for the Payee in accordance with the terms of this order. An assign­ment as of the liquidation date assigns a portion of the Participant’s current vested account balance.

The “valuation date” is the date on which the Participant’s vested account balance will be valued to determine the Payee’s designated portion in accordance with the terms of this order. Accounts are valued daily.

The Participant’s “vested account balance” is the dollar amount the Par­ticipant has a nonforfeitable right to receive from the Plan.

5.Benefit Payable to the Payee

Benefit Payable to the Payee

5.A.Straight Percentage

The order assigns to the Payee an amount equal to [percent] percent of the Participant’s vested account balance under the Plan (identified in section 1) as of [applicable valuation date].

From the valuation date to the liquidation date, the amount assigned to the Payee [will/will not] include earnings and losses.

The Participant’s vested account balance [will/will not] include the value of outstanding loans before the Payee’s portion of the benefit is deter­mined.

5.B.Dollar Amount

This order assigns to the Payee an amount equal to $[amount] of the Par­ticipant’s vested account balance under the Plan (identified in section 1) as of the liquidation date.

If the amount assigned to the Payee exceeds the full vested value of the Participant’s account (less the amount of any outstanding loans, prior distribu­tions, or account losses) as of the valuation date preceding the liquidation date, the entire available balance will be assigned to the Payee.

The order assigns to the Payee an amount equal to $[amount] of the Par­ticipant’s vested account balance under the Plan (identified in section 1) as of [applicable valuation date].

From the valuation date to the liquidation date, the amount assigned to the Payee [will/will not] include earnings and losses.

6.Form of Payment to Payee

Form of Payment to Payee

The Payee shall receive the portion of the Plan benefits assigned to the Payee in a single lump-sum payment. Such amount shall be adjusted for earn­ings and losses from the liquidation date to the date of distribution to the Payee.

7.Commencement Date

Commencement Date

The Payee shall be eligible to receive payment as soon as administra­tively reasonable following the determination that this order is qualified, but in no event earlier than thirty days after the date of the decision letter.

8.Death Procedures

Death of Participant

If the Participant predeceases the Payee prior to payment of the Payee’s assigned benefits under this order, the Payee’s benefits will not be affected. In the event of the Participant’s death, the account balance, which remains the property of the Participant, will be payable to the Participant’s designated ben­eficiary or in accordance with Plan provisions. This order does not require the Participant to name the Payee as the beneficiary for the benefits not assigned to the Payee.

Death of Payee

In case of the death of the Payee prior to distribution of the Payee’s ben­efits under this order, the assigned benefits will be paid to the Payee’s estate, unless otherwise specified by the court order. A distribution to the estate of a deceased court order Payee will be reported as income to the decedent’s estate.

9.Retention of Jurisdiction

Continued Jurisdiction

This matter arises from an action for divorce or legal separation in this Court under the case number set forth at the beginning of this order. Accord­ingly, this Court has jurisdiction to issue this order.

In the event that this order is not a qualified Retirement Benefits Court Order, both parties shall cooperate with the Plan in making any changes needed for it to become qualified. This includes signing all necessary docu­ments. For this purpose, this Court expressly reserves jurisdiction over the dis­solution proceeding involving the Participant, the Payee, and the Participant’s interest in the Plan.

10.Limitations

Limitations Clause

Pursuant to Internal Revenue Code section 414(p)(3), and except as pro­vided by section 414(p)(4) of the Code, this order is not intended and shall not be construed in such a manner as to require the Plan to—

1.provide any type or form of benefit, or any option, not otherwise provided under the Plan;

2.provide increased benefits; or

3.require the payment of benefits to a payee that is required to be paid to another payee under another order previously determined to be a Retirement Benefits Court Order.

11.Tax Treatment

Tax Treatment of Distribution

For purposes of Internal Revenue Code sections 402 and 72, any Payee who is the spouse or former spouse of the Participant shall be treated as the dis­tributee of any distributions or payments made to the Payee under the terms of the order and, as such, will be required to pay the appropriate federal, state, and local income taxes on such distributions.

12.Constructive Receipt

Constructive Receipt

If the Plan inadvertently pays to the Participant any benefit that is assigned to the Payee pursuant to the terms of this order, the Participant will immediately reimburse the Plan to the extent the Participant has received such benefit payments from the Plan within ten days of receipt.

If the Plan inadvertently pays to the Payee any benefit that is actually payable to the Participant, the Payee must make immediate reimbursement. The Payee must reimburse the Plan to the extent he or she has received such benefit payments from the Plan within ten days of receipt.

13.Certification of Necessary Information

Certification

All payments made pursuant to this order shall be conditioned on the certification by the Payee and the Participant to the Plan of such information as the Plan may reasonably require from such parties to make the necessary cal­culation of the benefit amounts contained herein.

SIGNED on ___________________________________.

   
JUDGE PRESIDING