Fla. Admin. Code R. 69C-6.003 – The Plan; Prescribed Forms

(1) Form DFS-J3-1176 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05104" http://www.flrules.org/Gateway/reference.asp?No=Ref-05104, State of Florida Employees Deferred Compensation Plan, is hereby established and incorporated into this rule by reference as the “plan of deferred compensation” contemplated in Section 112.215, F.S. The form can be obtained from the Deferred Compensation Section, Division of State Treasury, 200 East Gaines Street, Tallahassee, Florida 32399-0346.
(2) The forms listed below are incorporated into and made a part of this rule chapter by reference and shall take effect on the effective date of this rule. The forms can be obtained from investment providers servicing the plan. A listing of authorized investment providers and the forms can be obtained from the Deferred Compensation Section, Division of Treasury, 200 East Gaines Street, Tallahassee, Florida 32399-0346. The State of Florida Employees Deferred Compensation Plan may also be referred to as the “457b Plan.”

(a) Form DFS-J3-1163 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05093" http://www.flrules.org/Gateway/reference.asp?No=Ref-05093	Participant Action Form – (Used for most participants requests, including enrollment and account changes)
(b) Form DFS-J3-1164 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05094" http://www.flrules.org/Gateway/reference.asp?No=Ref-05094	Enrollment Information Form ‒ (General enrollment form identifying important provisions and restrictions of the 457b Plan)
(c) Form DFS-J3-1165 (rev. 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02713" http://www.flrules.org/Gateway/reference.asp?No=Ref-02713	Company to Company Transfer ‒ (Used when a participant wants to transfer funds between Investment Providers)
(d) Form DFS-J3-1166 (rev. 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02714" http://www.flrules.org/Gateway/reference.asp?No=Ref-02714	Company to Company Transfer Invoice ‒ (Used to inform Investment Providers of participant’s request to transfer account to another Investment Provider within the Plan)
(e) Form DFS-J3-1169 (rev. 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02715" http://www.flrules.org/Gateway/reference.asp?No=Ref-02715	Transfer/Rollover Invoice – (Used to inform Investment Providers to distribute funds from the Plan to another tax sheltered pension plan)
(f) Form DFS-J3-1152 (rev. 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02710" http://www.flrules.org/Gateway/reference.asp?No=Ref-02710	Application for Standard Catch-Up ‒ Used for participants to request to catch up the difference between the maximal deferrals that could have been contributed and what was actually contributed as a State employee)
(g) Form DFS-J3-1171 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05095" http://www.flrules.org/Gateway/reference.asp?No=Ref-05095	Request for Unforeseeable Emergency Withdrawal ‒ (Used to request a distribution due to an unforeseeable emergency)
(h) Form DFS-J3-1172(GWRS) (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05096" http://www.flrules.org/Gateway/reference.asp?No=Ref-05096	Request for Distribution ‒ (Used by Great West participants to request a distribution from the Plan after they have left employment)
(i) Form DFS-J3-1172(NRS) (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05097" http://www.flrules.org/Gateway/reference.asp?No=Ref-05097	Request for Distribution ‒ (Used by Nationwide Retirement Services participants to request a distribution from the Plan after they have left employment)
(j) Form DFS-J3-1172(VAL) (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05099" http://www.flrules.org/Gateway/reference.asp?No=Ref-05099	Request for Distribution ‒ (Used by Valic participants to request a distribution from the Plan after they have left employment)
(k) Form DFS-J3-1172(VOYA) (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05100" http://www.flrules.org/Gateway/reference.asp?No=Ref-05100	Request for Distribution ‒ (Used by VOYA participants to request a distribution from the Plan after they have left employment)
(l) Form DFS-J3-1172(TRP) (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05098" http://www.flrules.org/Gateway/reference.asp?No=Ref-05098	Request for Distribution ‒ (Used by T. Rowe Price participants to request a distribution from the Plan after they have left employment)
(m) Form DFS-J3-1174 (rev. 4/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02723" http://www.flrules.org/Gateway/reference.asp?No=Ref-02723	Frequently Asked Questions with Answers ‒ (Answers to the most frequently asked questions about the Plan)
(n) Form DFS-J3-1175 (rev. 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02724" http://www.flrules.org/Gateway/reference.asp?No=Ref-02724	Forms Procedures ‒ (Procedures and guidelines for completing specific forms of the Plan)
(o) Form DFS-J3-1525 (rev. 04/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02726" http://www.flrules.org/Gateway/reference.asp?No=Ref-02726	Purchase of Prior Service Credits ‒ (Used by participants to transfer funds from their Deferred Compensation accounts to purchase prior years of service from previous Florida employment, military time, or employment with other states and/or counties)
(p) Form DFS-J3-1526 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05101" http://www.flrules.org/Gateway/reference.asp?No=Ref-05101	Rollover Into/Out of Florida Plan ‒ (Used to transfer funds from their State of Florida 457(b) Plan to another tax shelter pension plan)
(q) Form DFS-J3-1541 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16960"http://www.flrules.org/Gateway/reference.asp?No=Ref-16960	State of Florida Employees Deferred Compensation Plan Investment Policy for Product Selection and Retention ‒ (Establishes the standards for the State of Florida Employees Deferred Compensation Plan; adopts criteria for the selection and retention of the Plan’s investment options; and provides a method for the quarterly evaluation and monitoring of the investment options)
(r) Form DFS-J3-1173 (new 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02722" http://www.flrules.org/Gateway/reference.asp?No=Ref-02722	Deferrals for Special Supplemental Pay ‒ (Used for a participant to defer special supplemental pay (accrued annual/sick leave) to the Plan)
(s) Form DFS-J3-1796 (new 04/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02729" http://www.flrules.org/Gateway/reference.asp?No=Ref-02729	Loan Application ‒ (Used by participants to request a loan from the 457b Plan)
(t) Form DFS-J3-1956 (rev. 03/15) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05103" http://www.flrules.org/Gateway/reference.asp?No=Ref-05103	EZ Enrollment Form ‒ (Abbreviated form for participants to enroll in the Deferred Compensation Program via the internet)
(u) Form DFS-J3-1954 (new 01/13) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-02730" http://www.flrules.org/Gateway/reference.asp?No=Ref-02730	Loan Frequently Asked Questions ‒ (Answers to the most frequently asked questions about the State 457b Loan Program)
(v) Form DFS-J3-1256 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16955"http://www.flrules.org/Gateway/reference.asp?No=Ref-16955	Roth EZ Enrollment Form ‒ for participants to enroll in the Deferred Compensation Program
(w) Form DFS-J3-1263 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16956"http://www.flrules.org/Gateway/reference.asp?No=Ref-16956	Roth Participant Action Form – used for most participant requests, including enrollment and account changes
(x) Form DFS-J3-1265 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16957"http://www.flrules.org/Gateway/reference.asp?No=Ref-16957	Roth Company to Company Transfer ‒ used when a participant wants to transfer funds between Investment Providers
(y) Form DFS-J3-1273 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16958"http://www.flrules.org/Gateway/reference.asp?No=Ref-16958	Roth Deferrals from Supplemental Pay ‒ used for a participant to defer special supplemental pay (accrued annual/sick leave) to the Plan
(z) Form DFS-J3-1289 (effective 09/24) HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-16959"http://www.flrules.org/Gateway/reference.asp?No=Ref-16959	In Plan Roth Conversion – used to for the conversion from pretax to Roth

(3) The State of Florida Employees’ Deferred Compensation Plan shall be construed to conform to the requirements of 26 USC 457 (2008), which is hereby incorporated by reference into this rule, and a copy of 26 USC 457 (2008) can be obtained at www.gpo.gov.
(4) The following portions of the Internal Revenue Code, Code of Federal Regulations and Act of the United States Congress are also hereby incorporated by reference, and a copy of the Codes, Regulations, and Act may be obtained at www.gpo.gov. The Internal Revenue Procedure is hereby incorporated by reference, and a copy of it may be obtained at http://www.irs.gov/pub/irs-drop/rp-13-12.pdf:
1. (a) 26 USC 401 (2010);
2. (b) 26 USC 403 (2011);
3. (c) 26 USC 911 (2007);
4. (d) 26 USC 408 (2011);
5. (e) 26 USC 414 (2011);
6. (f) 26 USC 1402 (2011);
7. (g) 26 USC 112 (2011);
8. (h) 26 USC 3401(h)(2) (2011);
9. (i) 26 CFR 1.457-2 (August 27, 2003);
10. (j) 26 CFR 1.401(a)(9) (April 1, 2011 Edition);
11. (k) 26 CFR 1.457-9 (August 27, 2003);
12. (l) Rev. Proc. 2013-12, 2013-4, I.R.B. 313;
13. (m) Pension Protection Act of 2006, Pub. L. No. 109-280, Sec. 845 (2006)
  HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-05164" http://www.flrules.org/Gateway/reference.asp?No=Ref-05164;
14. (n) Worker, Retiree, and Employer Recovery Act of 2008, Pub. L. No. 110-458, Sec. 125 (2008).

Rulemaking Authority 112.215(12) FS. Law Implemented 112.215 FS. History–New 1-1-87, Amended 10-7-87, 2-14-88, 2-19-89, 6-21-89, 8-7-95, 9-21-98, 6-11-02, Formerly 4C-6.003, Amended 8-26-04, 2-21-05, 7-9-06, 4-8-07, 6-26-13, 3-24-15, 3-20-16, 9-10-24.