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    TSP-92D: Request For Participant Account Information

    Uploaded by

    Marsha Maines
    This form allows certain parties such as current or former spouses, their attorneys, or authorized benefits specialists to request a participant's Thrift Savings Plan account information. The requesting party provides their relationship to the participant and the specific account information needed, such as account balances on certain dates, loan or withdrawal histories, or annual statements. They must sign acknowledging the information will only be used for drafting a valid retirement benefits court order related to a divorce, separation, or annulment proceeding. No subpoena is required to request this information.

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    TSP-92D: Request For Participant Account Information

    Uploaded by

    Marsha Maines
    361 views2 pages
    This form allows certain parties such as current or former spouses, their attorneys, or authorized benefits specialists to request a participant's Thrift Savings Plan account information. The requesting party provides their relationship to the participant and the specific account information needed, such as account balances on certain dates, loan or withdrawal histories, or annual statements. They must sign acknowledging the information will only be used for drafting a valid retirement benefits court order related to a divorce, separation, or annulment proceeding. No subpoena is required to request this information.

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    This form allows certain parties such as current or former spouses, their attorneys, or authorized benefits specialists to request a participant's Thrift Savings Plan account information. The requesting party provides their relationship to the participant and the specific account information needed, such as account balances on certain dates, loan or withdrawal histories, or annual statements. They must sign acknowledging the information will only be used for drafting a valid retirement benefits court order related to a divorce, separation, or annulment proceeding. No subpoena is required to request this information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    361 views2 pages

    TSP-92D: Request For Participant Account Information

    Uploaded by

    Marsha Maines
    This form allows certain parties such as current or former spouses, their attorneys, or authorized benefits specialists to request a participant's Thrift Savings Plan account information. The requesting party provides their relationship to the participant and the specific account information needed, such as account balances on certain dates, loan or withdrawal histories, or annual statements. They must sign acknowledging the information will only be used for drafting a valid retirement benefits court order related to a divorce, separation, or annulment proceeding. No subpoena is required to request this information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    TSP-92D

    REQUEST FOR PARTICIPANT ACCOUNT INFORMATION


    Certain Thrift Savings Plan (TSP) account information is available to current or former spouses to assist in developing a valid retirement
    benefits court order and protecting his or her rights. The participant’s (or beneficiary participant’s) current or former spouse, either
    party’s attorney, or an authorized Retirement Benefits Specialist (RBS), may obtain TSP account balances and transaction history by
    submitting this form. A subpoena is not required.

    This form should only be submitted to the TSP for the purposes of drafting a valid retirement benefits court order.

    Please note: If it is determined that the requesting party is entitled to a participant’s TSP account information, in accordance with the
    Privacy Act of 1974, as amended, 5 U.S.C. §552a, the TSP will not release information beyond what is specifically indicated on this form.

    Mail or fax this form to: TSP Service Bureau


    P.O. Box 385021
    Birmingham, AL 35238
    Fax number: (866) 817-5023

    If you have questions about this form, call the toll-free ThriftLine at 877-968-3778. Outside the U.S. and Canada, please call 404-233-
    4400 (not toll free). For specific questions related to your indivdual situation, please consult your personal or legal representative.

    I. INFORMATION Please type or print:


    ABOUT THE TSP
    PARTICIPANT 1.
    First Name Middle Name Last Name

    2. This request applies to the participant’s:

    ££ Civilian Account

    ££ Uniformed Services Account } Account Number: ______________________________

    ££ Beneficiary Participant Account Account Number: ______________________________


    II. INFORMATION ££ Account balance as of_


    REQUESTED mm/dd/yyyy
    (Check all that apply)
    ££ Account balances from to
    mm/dd/yyyy mm/dd/yyyy

    ££ Outstanding loan balances as of


    mm/dd/yyyy

    ££ Loan history from to


    mm/dd/yyyy mm/dd/yyyy

    ££ Annual statement(s) as of
    year(s)

    ££ Quarterly statements from to


    mm/dd/yyyy mm/dd/yyyy

    ££ Withdrawal history from to


    mm/dd/yyyy mm/dd/yyyy

    ££ Other ___________________________________

    FORM TSP-92D, Page 1 (7/2018)


    TSP-92D
    REQUEST FOR PARTICIPANT ACCOUNT INFORMATION
    III. INFORMATION 3. What is your relationship to the participant? ££ Current Spouse
    ABOUT YOU ££ Former Spouse ________________________
    Divorce or Separation Date
    ££ Attorney
    ££ RBS (must submit a TSP-92B, Retirement Benefits
    Specialist Authorization Form)

    4.
    First Name Middle Name Last Name

    5.
    Address Line 1

    Address Line 2

    City State Zip Code

    6.
    Phone Number

    IV. SIGNATURE The requested TSP account information is provided in accordance with the Privacy Act of 1974, as
    amended, 5 U.S.C. §552a. By signing and submitting this request, I acknowledge that I am requesting
    this information for the purpose of drafting a retirement benefits court order pursuant to a divorce,
    separation, or annulment proceeding.

    7. _______________________________________________ 8. _________________________
    Signature Date Signed (mm/dd/yyyy)

    FORM TSP-92D, Page 2 (7/2018)

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