403(b) Voluntary Savings Form (VSF)

Fill out and submit a Voluntary Savings Form (VSF) and turn it in to your benefits office to sign up for the TDI 403(b) plan.

Please access our Forms page to download your VSF.


  1. General Limit - $22,500 for 2023
  2. Age 50+ Catch-Up Limit - $7,500 for 2022 if you are at least 50 by the end of the year

Note: The above $22,500 and $7,500 limits apply to the total of your salary deferrals for the 2023 calendar year to the 403(b) plan and to any other employer’s 403(b) or 401(k) plan, SEP IRA, or simple retirement account, or to the Federal Thrift Savings Plan. Your salary deferral may be limited by IRC 415(c).

MONTHLY DEFERRAL: In each month your Voluntary Savings Form is active and you receive pay, the percentage of gross pay you elect in section C will be deducted, up to the IRS limits.

EXAMPLES: In the following examples you expect your monthly gross pay will be $4,000.

Example 1: If you want to defer $2,000 pre-tax then write “50” on the pre-tax deferral line that corresponds to your Provider in section C ($2,000/$4,000 = 50%).

Example 2: If you would like to suspend your contributions as soon as administratively possible, write “0” on the deferral line that corresponds with your current Provider in section C.

Example 3: If you want to change your deferrals to 5% pre-tax and 10% Roth per paycheck, write “5” on the pre-tax deferral line, “10” on the Roth deferral line and “15” on the Total line (5+10 = 15) that corresponds to your Provider in section C.

Additional simple examples are provided on the back side of the VSF. If completing the VSF electronically, the numbers on the form can be changed to perform some basic calculations for your specific situation. This quick calculator is provided as a general tool for your use while planning your contributions. If you have any questions about what contribution level is best for your situation, please contact one of our providers or speak with your financial advisor.


GENERAL: All tax-deferred investment (TDI) new enrollments, restarts, changes, and stops require completion of the VSF. The completed VSF must be sent to the address of employee’s campus benefits office shown on this form, or submitted electronically if applicable. The VSF is an agreement between the employee and his/her employing institution. The salary deferral is a voluntary salary reduction from gross pay. The salary reduction amount is invested with one of the Providers, in an account in employee’s name, under provisions of IRC 403(b). The investment options under the plan are tax-sheltered annuities or mutual fund custodial accounts. Except for Roth contributions, state and federal income taxes are withheld only on remaining salary after the reduction. Other withholdings, deductions, and contributions, including Social Security taxes, apply to gross pay before the salary reduction. PERS and ORP contributions are not reduced by salary reductions under the 403(b) plan, (ORS 243.830). Court-ordered deductions from pay (e.g. garnishments) are based on gross pay; they are not affected by salary deferral under this VSF. For assistance in completing this form, employees should consult an investment, financial, or tax advisor to determine the correct deferral amount.

ONE VSF: No more than one VSF may be in effect at any time. Any prior VSF is replaced by the most recent VSF.

EFFECTIVE DATE: For the requested action to take effect on the month-end payroll, the campus benefits office must receive the VSF by the 10th calendar day of the month. The voluntary savings allocation will continue until:

  1. Employee terminates employment with Oregon Public Universities;
  2. Employee files a new VSF to change or terminate contributions; or
  3. Oregon Public Universities Retirement Plans gives advance written notice that the salary reduction is to stop.

DEFERRAL AUTHORIZATION: The Employee authorizes salary reduction by the amount indicated and authorizes his/her employing institution to transmit funds to the designated Provider. The salary reduction specified on the VSF will continue until a new VSF is submitted or participation ends. Employee is fully responsible for all computations in connection with the salary deferrals.

DEFERRAL LIMITS: The Employee understands that salary deferrals are limited by IRC 402(g) and IRC 414(v) and that these limits apply to the total salary deferrals made to the 403(b) plan and to any other employer’s 403(b) or 401(k) plan, SEP IRA, or simple retirement account, or to the Federal Thrift Savings Plan. Maximum annual salary deferrals allowed by the General Limit (IRC 402(g)) and the Age 50 Catch-Up Limit (IRC 414(v)) are shown in the table below. Contact the IRS for publications explaining applicable rules.

Maximum Annual Salary Deferral Amounts by Year

General Limit 402(g)

Age 50-Plus Catch-Up Limit IRC 414(v)





The employee also understands that IRC 415(c) limits the total annual additions for employee for a year. This limit for 2023 is the lesser of $66,000 or 100% of compensation plus another $7,500 if employee will be age 50 by December 31. The IRC 415(c) limit applies to the total annual additions for employee to all 403(b) plans and to all other types of retirement plans (but not including PERS, OPSRP, the Optional Retirement Plan, or the Oregon Savings Growth Plan) of all employers controlled by employee (such as the employee’s own business). IRS publications provide information on the maximum annual additions under IRC 415(c). Consult an investment, financial or tax advisor, or the IRS for advice.

PROVIDER SELECTION: Salary reduction amounts may be allocated to one Provider at a time. Failure to establish an account with a Provider or to provide investment direction may result in return of the contribution.

ROTH OPTION: A post-tax voluntary Roth option is available through Fidelity and TIAA. Roth deferrals reduce the amount that can be contributed pre-tax, and net pay is reduced more than with pre-tax 403(b) deferrals because income taxes are withheld. Consult a financial or tax advisor to determine if the Roth option is suitable for you.

ACKNOWLEDGEMENT OF RESPONSIBILITIES: The University of Oregon, your employing institution and employee acknowledge and understand that the employee has total responsibility for deciding to defer salary and for instructing your employing institution to provide the salary deferral for investment purposes through a Provider. The employee assumes full responsibility for the results of his or her investment choices, including the contribution limitations under the U.S. Internal Revenue Code. Further, an employee who elects optional services and investments offered by a Provider assumes full responsibility for fees and the performance of investment products and services.

The employee assumes full responsibility for the tax, processing, and investment consequences of the VSF, and releases the University of Oregon, your employing institution, and its officers, employees and agents from any liability for financial loss resulting from any calculations or from selection of a Provider or its investment vehicles, from incorrect evaluation of tax-deferred status, from processing delays or errors, from discontinuance of present legislation affecting such benefits, and from incorrect advice received from Oregon Public Universities Retirement Plans, the Provider, or their employees or representatives.