Model Provisions for Qualified domestic relations Order (QDRO) Awarding Alternate Payee a Separate Interest in Participant's Retirement Benefits

These Model Provisions apply only if the Participant has not begun receiving payments, or the Plan has been withholding benefits on behalf of Alternate Payee since Participant’s Pension Effective Date.

Model Provisions for Qualified Domestic Relations Order (QDRO)

Once you download the form to your computer, you can fill it in, print it, and mail it back to an Area Administrative Office. (You cannot send the form via e-mail.)

Having trouble seeing this PDF form? Click here for more information.