Hardship Distribution Forms

Select your appropriate Hardship Distribution Form:
  1. There are three options for Multiple Fund Plan Participants:
    1. Online Hardship Form Submission
    2. Download and Print
    3. PEO Specific Hardship Request Form

      Please enter your PEO password
      (Call your PEO for password)
  2. DWS Scudder Plan Hardship Request Form
  3. Lincoln Plan Hardship Request Form
  4. John Hancock Plan Hardship Request Form Part 1 Part 2

Please Note: Hardship Withdrawals are regulated by the Internal Revenue Service.

Acceptable reasons for a Hardship Withdrawal:

  1. Medical Expenses (copy of medical bill(s) not covered by insurance)
  2. Purchase of a Primary home (copy of good faith note or sales contract)
  3. Tuition for a participant or dependent of a participant (copy of tuition bill(s))
  4. To avoid eviction or foreclosure from the primary home (copy of eviction/foreclosure notice from mortgage company or the court)
  5. Funeral Expenses (copy of funeral bill(s))

Proof of hardship must include the amount owed.

Most hardship distributions are subject to a 10% penalty and the distribution amount is taxable as income. Both are reported on your Federal Income tax return, Form 1040. Your employee contributions to your 401(k) must cease for 6 months from the date you take a hardship distribution. It is your responsibility to start contributions again.

Completed forms should be mailed or faxed to:

Slavic Integrated Administration
Attn: Distributions Department
1075 Broken Sound Parkway NW
Suite 100
Boca Raton, FL 33487-3540
Fax: (561) 241-1070

*This form is in the Adobe Acrobat Portable Document Format (.pdf) and requires the free Adobe Acrobat Reader to view and print so that you may complete the form before submitting it to Slavic Investments.