Yes! You can use AI to fill out A Place for Mom 401(k) Plan Request for Rollover Contribution Form
This form allows participants in the A Place for Mom 401(k) Plan to move funds from a previous retirement account, such as another 401(k) or a traditional IRA, into their current plan. Completing this form correctly is crucial for ensuring a smooth, tax-compliant transfer of retirement assets and consolidating savings. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
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Form specifications
| Form name: | A Place for Mom 401(k) Plan Request for Rollover Contribution Form |
| Number of pages: | 1 |
| Language: | English |
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How to Fill Out Request for Rollover Contribution Form Online for Free in 2026
Are you looking to fill out a REQUEST FOR ROLLOVER CONTRIBUTION FORM form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your REQUEST FOR ROLLOVER CONTRIBUTION FORM form in just 37 seconds or less.
Follow these steps to fill out your REQUEST FOR ROLLOVER CONTRIBUTION FORM form online using Instafill.ai:
- 1 Navigate to Instafill.ai and upload or select the 'Request for Rollover Contribution Form'.
- 2 Use the AI assistant to automatically fill in your personal details like Name, SSN, and Mailing Address.
- 3 Indicate the type of rollover contribution you are making by checking the appropriate box (Pre-tax or After-tax Roth 401(k)).
- 4 Enter the total dollar amount for the rollover. If it's a Roth rollover, also provide the basis amount and the year of the initial Roth contribution.
- 5 Review all the information pre-filled by the AI for accuracy, ensuring all amounts and personal data are correct.
- 6 Electronically sign and date the form in the designated fields to certify the information.
- 7 Download the completed form and follow the instructions to submit it to Randall & Hurley via email and provide the necessary details to your prior plan administrator.
Our AI-powered system ensures each field is filled out correctly, reducing errors and saving you time.
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Frequently Asked Questions About Form Request for Rollover Contribution Form
This form is used to initiate the process of rolling over funds from a previous employer's retirement plan or a Traditional IRA into your current A Place for Mom 401(k) Plan.
You should fill out this form if you are a participant in the A Place for Mom 401(k) Plan and want to transfer funds from a former retirement account into this plan.
Contact your former plan administrator for their distribution forms, use the information on page 1 to direct the rollover check, and then complete page 2 of this form and email it to Randall & Hurley.
The check must be made payable to 'Charles Schwab Bank; fbo: A Place for Mom, Inc. 401(k) Plan; Acct# 704705'. This ensures the funds are directed to the correct plan.
The memo line of the check must include 'Acct # 704705 fbo: [Your Name] and [Your SSN]' to ensure the funds are properly credited to your individual account.
After you complete and sign the second page, you must send a copy to Randall & Hurley via email at [email protected].
No, the form explicitly states that Roth IRAs cannot be rolled into this 401(k) Plan. However, you can roll over funds from a Roth 401(k), a Traditional IRA, or other qualified plans.
A 'Pre-Tax Rollover' is for funds from an account where taxes have not yet been paid. An 'After-Tax Roth 401(k) Rollover' is for funds from a designated Roth 401(k) account on which you have already paid taxes.
Your rollover contribution will be invested according to your current investment elections on file. If you don't have any elections set up, the funds will be placed into the plan's default investment.
You must contact your former employer or the financial institution that served as the plan administrator for your old retirement account. They will provide the necessary forms to start the distribution process.
Yes, services like Instafill.ai use AI to accurately auto-fill form fields, which can save you time and help reduce errors.
You can upload the PDF of this form to the Instafill.ai platform. The service will make the form fillable online, allowing you to enter your information easily before downloading the completed document.
If you have a non-fillable PDF, you can use a service like Instafill.ai. It can convert flat PDFs into interactive, fillable forms that you can complete on your computer.
Compliance Request for Rollover Contribution Form
Validation Checks by Instafill.ai
1
Participant Name Presence
Ensures the participant's full name field is not empty. The name is the primary identifier for the account holder and is essential for correctly attributing the rollover funds. Failure to provide a name will result in immediate rejection of the form, as the transaction cannot be assigned to any account.
2
SSN Format and Presence
Validates that the Social Security Number (SSN) is provided and adheres to the standard 9-digit format, with or without hyphens. The SSN is a unique identifier required by the IRS for tax reporting and by financial institutions for account verification. An invalid or missing SSN will cause the rollover to be rejected as it is a critical component for legal and financial processing.
3
Mailing Address Completeness
Checks that a complete mailing address, including street, city, state, and ZIP code, is provided. This address is used for all official correspondence regarding the rollover, including confirmation statements and tax documents. An incomplete address can lead to lost communications, delaying confirmation of the transaction and causing issues for the participant's records.
4
Rollover Type Selection
Verifies that the participant has selected at least one rollover type by checking either the 'PRE-TAX ROLLOVER' or 'AFTER-TAX ROTH 401(K) ROLLOVER' box. This selection is fundamental as it dictates the tax treatment and categorization of the incoming funds. If no type is selected, the form is considered incomplete because the plan administrator cannot determine how to process the contribution.
5
Pre-Tax Rollover Amount Validation
Checks that if the 'PRE-TAX ROLLOVER' option is selected, a corresponding positive monetary amount is entered. This value is essential for the financial transaction and for ensuring the correct pre-tax amount is moved into the new plan. A missing, zero, or negative amount when the box is checked will halt the processing of the pre-tax portion of the rollover.
6
Roth Rollover Amount Validation
Validates that if the 'AFTER-TAX ROTH 401(K) ROLLOVER' option is selected, a corresponding positive monetary amount is entered. This is critical for accurately tracking the Roth portion of the rollover, which has different tax implications than pre-tax funds. An omission or invalid entry will prevent the Roth rollover from being processed correctly.
7
Roth Basis Amount Consistency
Ensures that if a Roth rollover is indicated, the 'Amount ($) of Roth Contributions/Basis' is provided and is less than or equal to the 'total Roth 401(k) rollover amount'. The basis represents the non-taxable portion of the Roth rollover, and it's critical information for future tax calculations. An illogical or missing basis amount can lead to significant tax reporting errors for the participant.
8
Initial Roth Contribution Year Validity
Checks that if a Roth rollover is specified, the 'Year of Initial Roth Contribution' is a valid four-digit year that is not in the future. This date is crucial for determining when the five-year aging period for qualified Roth distributions began. An invalid or missing year will cause rejection as it directly impacts the tax-free status of future withdrawals from the plan.
9
Participant Signature Presence
Confirms that the participant has signed the form, either physically or via a valid electronic signature. A signature is a legal requirement that signifies the participant's authorization for the rollover transaction. A missing signature renders the entire form invalid and legally non-binding, and the request will be rejected outright.
10
Signature Date Validity
Validates that the date next to the participant's signature is present, in a valid format, and is not a future date. This date establishes when the authorization was given, which is important for legal and compliance records. An invalid, future, or missing date can call the timeliness of the authorization into question, potentially causing the request to be rejected.
11
Participant Account Verification
Verifies that the provided Name and SSN match an active or eligible participant account within the 'A Place for Mom 401(k) Plan'. This is a critical security check to ensure funds are being rolled into the correct person's account. A mismatch would indicate a serious error or potential fraud and must result in immediate rejection and follow-up.
12
Roth Rollover Plan Eligibility
Confirms that if a Roth 401(k) rollover is requested, the plan itself actually permits such contributions, as noted by the form's '(if allowed by plan)' text. This validation prevents attempts to roll over Roth funds into a plan that cannot administratively accept them. Attempting to do so would result in rejection of the funds and potential compliance issues.
Common Mistakes in Completing Request for Rollover Contribution Form
The form requires a very specific, multi-part payee name when instructing the prior administrator. People often abbreviate or miscopy this information, leading to the check being rejected by the receiving institution and causing significant delays. To avoid this, carefully copy the exact payee name: 'Charles Schwab Bank; fbo: A Place for Mom, Inc. 401(k) Plan; Acct# 704705'.
The memo line is crucial for matching the incoming check to the correct participant's account. Forgetting to instruct the prior administrator to include your name and SSN on the check's memo line can cause major delays while the receiving institution tries to identify the owner of the funds. Always provide the exact memo line instructions to your former plan administrator to ensure your funds are credited promptly.
The form explicitly states that Roth IRAs cannot be rolled into this 401(k) plan, but it does allow for Roth 401(k) rollovers. Participants often confuse the two and attempt to roll over an ineligible Roth IRA, which will be rejected by the plan. This wastes time and can have tax implications if not corrected quickly. Carefully verify the source of your funds before initiating the process.
A missing signature or date is one of the most frequent and easily avoidable errors. An unsigned or undated form is legally invalid and will be immediately rejected by the plan administrator, forcing you to resubmit it. This simple oversight can delay your entire rollover process by days or weeks, so always double-check that these required fields are completed.
Some participants mistakenly believe that submitting this form is the only step required. However, this form only notifies the new plan of incoming funds; it does not authorize the old plan to release them. You must also complete the separate distribution paperwork provided by your former employer or IRA custodian to actually start the process and have the check sent.
The instructions specify that this completed form must be returned to Randall & Hurley via email. Due to the multiple parties involved, people may mistakenly send it to their old plan administrator or mail it to Charles Schwab. This misrouting means the new plan administrator is not properly notified, causing confusion and delays in processing the rollover once the funds arrive.
When rolling over an After-Tax Roth 401(k), the form requires both the 'Amount ($) of Roth Contributions/Basis' and the 'Year of Initial Roth Contribution.' People often leave these fields blank because they don't have the information readily available. Missing this data will halt the rollover process, as it's essential for proper tax tracking, so obtain it from your prior administrator before filling out the form.
The instructions provide a specific P.O. Box for standard mail and a physical address for overnight delivery to Charles Schwab Bank. A common error is instructing the prior custodian to send the check to the plan administrator (Randall & Hurley) or using the wrong address for the chosen delivery method. This can result in lost checks or major processing delays, so ensure the correct address is used.
The Social Security Number (SSN) is the primary identifier for your account, and a number that is handwritten illegibly, transposed, or incorrect will cause a failure to match the rollover. This can cause extreme delays and require significant effort to resolve. To prevent this, it's best to type the information. AI-powered tools like Instafill.ai can make non-fillable PDFs fillable, ensuring your SSN is entered clearly and accurately.
Participants may enter an amount on this form that does not match the amount requested on the distribution form from their prior institution. This discrepancy can occur from simple typos or confusion about the total value. Any mismatch between the expected amount and the received check will trigger an investigation and delay the crediting of your funds, so ensure the amounts on all related paperwork are consistent.
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