Retirement Forms
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:

Settlement Election Form: This form is given to employees who have left employment or retired in order to receive 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.

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. we can can perform testing and prepare your administration and 5500 tax forms

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.

COBRA Forms
HSA / FSA / HRA 

Employee Brochure: The employee fold-over brochure PBS provides for new employees. 

Claim Form: Used by participants on an annual basis or for enrolling new employees.

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.

Testing Questionnaire

1193 Royvonne Ave. SE, Suite 22

Salem, OR 97302

Office (503) 371-7622 | Fax (503) 364-6901 | Toll-free (800) 982-2012 | Email info@profben.com