Other 3121 Forms

3121 Beneficiary Form

Use this form if you are a participant to indicate who should receive your account balance if you die before fully liquidating your account.  California is a community property state so married participants should name their spouse as 100% primary beneficiary.

3121 Catch-up Form

Use this form if you wish to make additional deferrals out of your paycheck above and beyond the required contributions of 7.50% that is set for the Part-Time Plan.

3121 Certificate of Disability Form

Use this form if you are a former County of Tulare employee and you are retired under the IRS definition of Full and Permanent Disability.  This form will have to be signed by both you and your physician and you are both verifying under penalty of perjury that you meet the IRS definition of Full and Permanent Disability.

3121 Contribution Election Form

Use this form if you are electing to use the special catch-up election.  The table attached to this form should be completed in full to document that you are eligible for the special catch-up, and you should provide you selection of your normal retirement year.  If you are a participant making normal deferrals under age 50 or using the age 50 Catch-up election you should make your changes electronically on the website, or you should call the Great-West Customer Service Center to increase, decrease, stop or restart your contribution amounts.

3121 Direct Deposit Form

You should use this form if you want your distribution from the plan to go as a direct deposit to your saving or checking account.  If the deposit is going to your checking account, please provide a voided check with this form.  If the deposit is going to your savings account  your request will need to accompany a letter from your financial institution receiving the deposit, on their letterhead, indicating your name, your address, your SSN and the routing number and account number for your checking account.

3121 Enrollment Form

Use this form to do your initial enrollment into the plan.  You should not submit this form again after your initial enrollment into the plan.

3121 Incoming/Rollover Form

Use this form if you are rolling money from a prior 401(k), 401(a), 403(b), IRA, or any other qualified pension program into the Tulare County program.

3121 Personal Information Change form

You should use this form if you are making changes to your name, your date of birth, your marital status, your gender, or your social security number.  Address changes can be made on this form if you no longer work for Tulare County.  If you are still employed by Tulare County, update your address with the payroll department at the County and they will send the updated address to Great-West.

3121 Purchase of Service Credits Form

Use this form when you are requesting a transfer to purchase permissible service credits with your employer's governmental defined benefit plan.