Retirement Plan QDRO Request Form
Submit a request for assistance with a QDRO and retirement-plan benefit division.
Requester role
*
Participant
Alternate Payee
Attorney or Representative
Other
Participant full name
*
First Name
Last Name
Alternate payee full name
*
First Name
Last Name
Contact email
*
example@example.com
Retirement plan name
*
Plan type
*
Please Select
401(k)
Pension
403(b)
457
Other
Not sure
Order status
*
Please Select
Draft
Submitted to court
Court-approved or entered
Not sure
Date the order was entered
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload a redacted court order or draft order, if available. Do not include sensitive identifiers or financial account information.
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Request details — describe the assistance you are seeking. Do not include sensitive identifiers or financial account information.
*
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