403(b) PLAN DISBURSEMENT REQUEST FORM for Regional School District #17 [Higganum, CT]
TRANSACTION TYPE: Disability
Cash disbursement due to a permanent disability. Evidence of disability approval from the Social Security Administration would be required. For more details, please visit our Transaction Information page or contact OMNI.
Step 1 of 3: Supply Information
Step 2 of 3: Confirm Entries
Step 3 of 3: Submission Confirmation
- Please supply the information requested below.
- Read all agreements on the form before submitting.
- Fields having an asterisk notation are required.
- The tracking number for your request is .
- We will review your request and advise.