Forms

The forms listed below are the most frequently used forms. Log in to your account or contact us if you have questions about which form to use.

Office

You can also stop in to see your local Retirement Specialists to pick up forms.

Patty Lundberg
707-565-3566
585 Fiscal Dr., Rm 100F
Santa Rosa, CA 95403
lundbp1@nationwide.com
Patty.Lundberg@sonoma-county.org

ACTTCPayrollDivision@sonoma-county.org
575 Administration Dr., Ste. 117A
Santa Rosa, CA 95043

Enroll

Sonoma County Deferred Compensation Plan Enrollment Request: Download and Print (PDF)
Sonoma EZ Enrollment Form: Download and Print (PDF)

Use these forms to:

  • Enroll in the plan
  • Change your contributions
  • Elect or change annual automatic contribution increase
  • Select or change beneficiaries
  • Select or change investment options

Manage my money

Incoming Assets Form (PDF)

Use this form to:

  • Roll money over from other retirement savings accounts into your Plan
  • Decide which investments you want the rollover money to go into
  • Decide if you want to enroll in Asset Rebalancing

457(b) Plan Distribution Request Form (PDF)

Plan to Plan Transfer Form (PDF)

Use this form to:

  • Transfer your Sonoma OBRA account to your Sonoma 457
  • Transfer a previous Nationwide 457 account with your Sonoma 457 account

OBRA Withdrawal (PDF)

Use this form to:

  • Request a full payout of your OBRA account

401(a)/403(b)/401(k) Plan Distribution Request Form (PDF)

Use this form to:

  • Select your payout options when you end your employment or retire
  • Request a payout
  • Stop current payouts
  • Change a current payout
  • Restart a payout
  • Defer payout until Required Minimum Distribution (RMD) is required at age 70½

Required Minimum Distribution (RMD) Form (PDF)

Use this form to:

  • Change your payout options for Required Minimum Distribution (RMD) required at age 70½

Deferred Compensation Unforeseeable Emergency Distribution Application (PDF)

Use this form to:

  • Apply for an unforeseeable emergency distribution

Manage my account

Beneficiary Change Form (PDF)

Use this forms to change beneficiary information:

  • Select primary and contingent beneficiaries
  • Change how your money will be divided between your beneficiaries
  • Remove and add beneficiaries

Automatic Deposit Authorization (PDF)

Use this form to:

  • Add or change your checking or savings information for automatic deposits to your bank account

Manage someone else's account

Divorce (Domestic Relations Orders)

Follow this link to view/print the information you and your attorney will need to provide in the event of a divorce.

Beneficiary Distribution Form (PDF)

Alternate Payee Claim Form (PDF)

Use these forms if you're a beneficiary or an alternate payee, such as a former spouse or a dependant of a Plan member:

  • Report the death of a Plan member. Please remember to submit a certified copy of the death certificate if you are reporting the death of a plan member.
  • Update your beneficiary information.
  • Request a payout.

Estimate my health care costs in retirement

Health Care Cost Assessment (PDF)

Use this form to:

  • Estimate your (and your spouse’s, if applicable) potential health care costs in retirement
  • Get a projection of your potential longevity based on the information you provide
  • Get a detailed report that can help you plan to cover those costs

Optimize my Social Security benefit

Social Security 360 Analyzer (PDF)

Use this form to:

  • Understand your filing options and how they impact your Social Security benefit
  • See a recommended strategy, based on your input, to optimize your lifetime benefit
  • Review alternative filing options and their impact on your benefit
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NRW-2891CA-SN.5
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