FBC 403(b) Hardship Authorization Form


 San Diego & Imperial County

    FBC 403(b) Hardship & SRA Forms

 Riverside County

    FBC RC 403(b) Hardship & SRA Forms


    FBC CN 403(b) Hardship & SRA Forms

 Desert Sands

    FBC DS 403(b) Hardship & SRA Forms


Participants desiring to take a hardship from any non-Empower 403(b) account should use this form.  This form provides the non-Nationwide approved vendor (investment provider) the authorization for them to process hardship requests on behalf of the participant.  The approved vendor will likely require their own Hardship Form to be completed in order to process the authorized request.

In addition, an SRA is required to be completed and submitted to the District Payroll/Benefits Office to stop contributions. The IRS requires a 6 month suspension period after taking a Hardship. Once the 6 month period has been satisfied, a new SRA will need to be completed in order for contributions to begin.

Fax the completed Hardship form to (800) 597-8206 and submit the SRA to your District Payroll/Benefits Office.


For questions concerning this form please contact National Benefit Services, LLC at 1-800-274-0503 ext. 5.