FORMS

 

Cafeteria Forms

The list below has the most commonly used Cafeteria Forms.  Just click on the name of the form and print it off on your printer.

• Employee Brochure:  The employee foldover brochure PBS provides for new employees.
• Claim Form:  Used by participants to send in their receipts to PBS, Inc. for reimbursement of eligible expenses.
• Enrollment Form:  Used to enroll participants on an annual basis or for enrolling new employees.
• Change Form:  Used by participants during the plan year to change their election if they experience an IRS-approved Family Status Change.
• Termination/Layoff Form.   Used by the employer to report terminations and layoffs to PBS, Inc.
• Employee Worksheet: Used by participants to plan their expenses and  estimate their tax savings from participating in the Cafeteria Plan.
• EFT Authorization Form (Not available on all plans.)
• HRA EFT Authorization Form
• Document Preparation Sheet
• Testing Questionnaire

For assistance contact our Cafeteria Plan staff at cafeteria@profben.com.

Related Information

• Check back frequently because only the most current forms will be accepted.
• Employee Brochures and Eligible Expenses are in a pdf format that can be conveniently emailed to your employees.
• The Employee Worksheet can be used by employees to plan their expenses and estimate their tax savings.

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Retirement Forms

Most Retirement Forms are customized to the client. Several forms, however, are generic and may be downloaded.  They include:

DOCUMENT FORMS:

• The 401(k) Checklist:  This form is completed by a trustee to install a new retirement plan.
• 401(k) Takeover Checklist:  This form is completed by a trustee with an existing 401(k) plan switching to PBS, Inc. TPA services.

DISTRIBUTION FORMS:

• Distribution Election Form:  This form is given to employees who have left employment or retired in order to receive their funds or roll them over to another qualified plan.  This form includes the distribution tax notice required by the IRS.
• Application for Participant Loan.  Not all retirement plans allow loans.  Please check the plan's document or contact Professional Benefit Services, Inc. if you don't know whether the plan allows loans or not.
• Hardship (general information) and the Application for Hardship.  Not all retirement plans allow hardship distributions.  Please check the plan's document or contact Professional Benefit Services, Inc. if you don't know whether the plan allows hardships or not.

ANNUAL ADMINISTRATION FORMS:

• Census Form (Excel Spreadsheet Format).  This spreadsheet is used to report your annual employee information to PBS, Inc. so we can perform testing and prepare your administration and 5500 tax forms and
• Plan Data Sheet (PDF with Entry Fields Format).  This form provides additional required information to PBS, Inc. so we can perform testing and prepare your administration and 5500 tax forms.

Please check the plan's document or contact Professional Benefit Services, Inc. if you don't know whether the plan allows loans or not. If you need a form not published on our website, please call or email us.  We will have the forms that you need sent to you.

Related Facts

• Only the most current forms will be accepted.  Please check back frequently for the most current forms.
• Distribution, loan and hardship forms require a trustee signature.
• The census and plan data sheet must be received annually within one month after the plan year end.