Salary Reduction Agreement For The Chemeketa CC 403(b) Plan

Chemeketa CC Employee Menu:
403(b) PLAN AT-A-GLANCE	ELIGIBILITY & LIMITS
403(b) Information	403(b) Enrollment Procedures
403(b) List of Vendors	403(b) Salary Reduction Agreement
403(b) Plan Document	403(b) Frequently Asked Questions
Chemeketa CC Employee 457(b) Sub-Menu:
457(b) Information

Blank Salary Reduction Form

If you prefer not to complete the fillable SRA Form on this page, and click the ‘Generate BLANK SRA Form’ button below, complete the form by hand, sign, date, and deliver to Chemeketa CC:

Fillable Salary Reduction Agreement

By entering your information into the fillable form below, and then clicking the 'Generate Printable SRA Form' button, you will generate a printable Salary Reduction Form which should be printed out, signed by you, and then submitted to Chemeketa CC with documentation that you have established an account with each selected Vendor:

Your Information

Your Name, Address, and Contact information is required.

Name
Street Address
Apt, Suite, or Unit (if applicable)
City
State
Zip
Telephone (home or mobile)
Email
Employee ID Number
Agent Name and Telephone (If Applicable)

Effective Dates

Implementation: This Salary Reduction Agreement (the 'Agreement') supersedes any previous Salary Reduction Agreement for the person named below (the "Employee") under the 403(b) Tax Sheltered Annuity Plan (the "Plan") offered by Chemeketa Community College (the "Employer"), also known as Chemeketa Community College. The salary reduction specified in this agreement will begin with the first paycheck on or after the "Effective Begin Date" specified below, provided this form is received by the Employer before the Payroll cutoff date for that paycheck. This Agreement will remain effective until a new Agreement is submitted.

Begin Date

Employee's Details:

Select the Appropriate Type of Agreement Below:

Replace/Override a Previous 403(b) Plan Salary Reduction Agreement
Start/Initiate a Very First (new) 403(b) Plan Salary Reduction Agreement
Cancel/Discontinue an Existing 403(b) Plan Salary Reduction Agreement (Cancels Deductions to All Vendors)

Distribution Among Vendors

If selecting a new Vendor, you MUST include documentation that an account has been established with the new Vendor that is linked to Chemeketa CC. Vendor accounts linked to former employers may not be used for contributions at Chemeketa CC. Chemeketa CC allows you to contribute to a maximum of 3 different vendors. If Replacing/Overriding a Previous Salary Reduction Agreement or Starting/Initiating a New Salary Reduction Agreement, you must select at least one Vendor. Finally, if this is one of 12 forms to be submitted as a group to establish an Active Payroll Slot for a new Vendor, then select "Other" from the pull-down box and write in the Vendor Name on the printed version of the form (all 12 forms should be submitted to CCC).

$ Traditional Dollars per Paycheck

Clicking the button below will Generate a printable PDF form populated with the information entered above. You must still sign, date, and submit the form to Chemeketa CC :


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