How to Fill Out and Submit the OneAmerica Distribution Request Form

The OneAmerica distribution request form (Form R-33640) is what you complete to withdraw money from an employer-sponsored retirement plan or individual annuity contract administered by OneAmerica. You can submit it online through the participant portal at login.oneamerica.com, by fax to 317-285-1728, or by mail to American United Life, P.O. Box 6010, Indianapolis, IN 46206-6010.¹ Before you start, have your plan number, Social Security number, and bank account details ready. Missing any of these is the fastest way to get the form kicked back.

Where To Get the Form

The form is available through the OneAmerica participant portal at login.oneamerica.com under the Employee Benefits Forms section. If you can’t access the portal, your employer’s HR department can provide the form directly or request it from OneAmerica on your behalf. You can also call customer service: 800-858-3829 if your policy number starts with a number, or 800-249-6269 if it starts with a letter.²

Confirm You Have a Qualifying Reason

OneAmerica will only process your request if you have a qualifying event, and you select the one that applies on the form. Each reason carries different tax consequences.

Separation from service — resignation, layoff, or termination. If you separated during or after the year you turned 55, you can withdraw from that employer’s plan without the 10% early withdrawal penalty.³
Retirement from your employer.
Total and permanent disability.
Reaching age 59½. Most plans allow penalty-free in-service withdrawals at this point even if you’re still working.³
Hardship withdrawal for an immediate, heavy financial need while still employed. IRS safe harbor reasons include unreimbursed medical expenses, costs to prevent eviction or foreclosure, funeral expenses, certain home repairs, and postsecondary tuition and room and board for you or a dependent. Your plan may not allow all of these.⁴
Unforeseeable emergency, which applies only to governmental 457(b) plans.
Required minimum distribution once you reach age 73.⁵

If you take money out before age 59½ and no exception applies, expect a 10% additional tax on top of regular income tax.³ That alone should make you double-check whether a rollover makes more sense than a cash distribution.

If a court has issued a Qualified Domestic Relations Order assigning part of a participant’s account to a spouse or former spouse, the alternate payee uses this same form to claim their share, and the QDRO must already be on file with OneAmerica before funds are released.⁶

Filling Out the Form Section by Section

The form has eight sections. Your employer completes the last one; the rest are on you.

Plan and Participant Information

Enter your plan number and plan name exactly as they appear on your account statements. The participant section asks for your full legal name, Social Security number, date of birth, current mailing address, phone number, and email. A mismatch between the name or Social Security number on the form and OneAmerica’s records will stop processing immediately. If you’ve recently changed your name, update it with the plan first.

Type of Distribution

Check the box that matches your qualifying event. If you hold an IRA with OneAmerica, select “Individual Retirement Account.” For employer-sponsored plans, choose between options for separated employees (no longer employed, retired, or disabled) and options for active employees (hardship, in-service age withdrawal, or other in-service). The wrong category here can trigger incorrect tax withholding, not just a delay.

Distribution Amount

You have three choices: a full lump-sum withdrawal of your entire vested balance, a partial withdrawal of a specific dollar amount, or a hardship or emergency withdrawal. For partial and hardship requests, write the dollar amount clearly. Hardship withdrawals also require you to select the specific qualifying reason on the form. An optional checkbox lets you increase a hardship amount to cover federal and state tax withholding, so the net deposit equals what you actually need.

Payment and Rollover Instructions

This is the most consequential section. Your first decision is whether the money goes to you as cash or rolls into another retirement account.

For a cash distribution (labeled “Lump Sum/Cash Distribution” on the form), provide your bank’s name, city, state, routing number, and account number, and indicate whether it’s a checking or savings account. OneAmerica will deposit the net amount after tax withholding via ACH transfer. Double-check the routing number. A single wrong digit sends your money into limbo.

For a rollover, you get additional options: roll the full amount, roll a partial amount and take the rest in cash, or specify separate destinations for pre-tax, Roth, and after-tax sources. An external rollover requires the receiving institution’s name, account number, full mailing address, and phone number. An internal rollover to another American United Life Insurance Company account only needs the receiving account number.

Direct Rollover vs. Indirect Rollover

A direct rollover sends the money straight from OneAmerica to the receiving institution. No taxes are withheld, and the funds keep their tax-deferred status without interruption.⁷ This is the option most people should pick.

An indirect rollover means the check is made payable to you. OneAmerica is then required to withhold 20% for federal income taxes, even if you plan to deposit the full amount into another retirement account within 60 days.⁸ To complete the rollover without owing tax on the full amount, you’d need to come up with that 20% out of pocket and deposit it alongside the check proceeds into the new account. If you don’t replace the withheld portion, the IRS treats it as a taxable distribution. Miss the 60-day deadline entirely, and the whole amount becomes taxable, plus the 10% early withdrawal penalty if you’re under 59½.⁷

Tax Withholding Elections

For any amount paid directly to you rather than rolled over, the form requires federal and state withholding elections.

Federal withholding on eligible rollover distributions paid to you is a flat 20%, and you can’t opt out.⁸ For payments that aren’t rollover-eligible (like hardship withdrawals or RMDs), you submit IRS Form W-4R with the distribution request to specify your withholding rate. The 20% default is a prepayment against your actual tax bill. Depending on your total income for the year, you might owe more or get some back when you file.

State withholding varies. The form includes a field for a total state withholding percentage. Some states mandate withholding on retirement distributions, others have no income tax at all. If your state requires it and you leave the field blank, OneAmerica will apply the state’s default rate.

Spousal Consent

If you’re married and your plan is subject to qualified joint and survivor annuity rules, your spouse must consent in writing before OneAmerica will process the distribution. Federal law requires that the spouse’s signature be witnessed by either a plan representative or a notary public.⁹ This requirement traces back to the Retirement Equity Act of 1984.¹⁰

The consent must acknowledge the effect of the election, meaning your spouse understands they’re giving up rights to survivor benefits. If your spouse can’t be located or you’re unmarried, you certify that on the form. Not every plan requires spousal consent (profit-sharing plans that pay the full balance to a surviving spouse are often exempt), so check your plan’s summary plan description or ask HR. When in doubt, get the signature. A missing spousal consent is one of the most common reasons distribution requests get rejected.¹¹

Employer Authorization

The final section is completed by your employer, not you. Your employer’s designated representative verifies your termination date (if applicable), your vested percentage for each money type in the plan, and any default dates. Until this section is filled in, OneAmerica cannot process the request. If your former employer is slow to respond, follow up with their HR or benefits department directly. Some plan sponsors pre-authorize OneAmerica to verify eligibility on their behalf, which speeds things up.

How To Submit the Form

You have three submission options:

Online: upload the completed form through the participant portal at login.oneamerica.com. This is the fastest method and gives you immediate confirmation of receipt.
Fax: send to 317-285-1728.¹
Mail: send to American United Life, P.O. Box 6010, Indianapolis, IN 46206-6010. Use a trackable shipping method; you’re mailing a document with your Social Security number and bank details on it.¹

Sign and date the form before sending. The participant signature section also includes an optional checkbox to wait 30 days before processing the payment, which some participants use to align the distribution with a specific tax year. If you don’t check that box, processing begins as soon as the form clears review.

What Happens After You Submit

OneAmerica reviews the form for completeness and checks it against your plan’s rules. The employer authorization is verified, and the compliance team confirms your distribution reason qualifies. If anything is missing or inconsistent, you’ll get a notification through your online account or by mail explaining what needs to be corrected.

Once the form is in good order, direct deposits typically arrive within 5 to 7 business days from the approval date. Physical checks take longer, usually 10 to 14 calendar days from the payment issue date. OneAmerica sends a confirmation letter detailing the gross distribution amount and the taxes withheld.

By January 31 of the year after your distribution, OneAmerica will mail you a Form 1099-R reporting the total amount distributed, the taxable portion, and any federal and state taxes withheld.¹² You’ll need this when filing your federal and state income tax returns. If you completed a direct rollover, a 1099-R is still issued but with a distribution code indicating the rollover, and no tax is owed on that amount.

Common Mistakes That Delay Processing

Most requests that get sent back have the same handful of problems.

Missing employer authorization. Submit the form to your HR department first so Section 8 gets completed, then send it to OneAmerica.
No spousal consent when the plan requires it, or a signature that isn’t properly witnessed.
Wrong bank routing or account number. Verify both against a voided check or your bank’s online portal, not from memory.
Incomplete rollover details. Every field must be filled in: institution name, full address, account number, and phone number.
Missing Form W-4R. Cash distributions require it for federal withholding elections.
Unsigned or undated form. OneAmerica cannot legally process an unsigned request.

If you’re unsure whether your form is complete before submitting, call OneAmerica at 800-858-3829 or 800-249-6269 and ask them to walk through it with you. Catching a problem before submission is always faster than fixing a rejected form after the fact.²

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OneAmerica Financial. eSponsor – Administration Forms
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OneAmerica Financial. Contact Us
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Internal Revenue Service. Retirement Topics – Exceptions to Tax on Early Distributions
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Internal Revenue Service. Retirement Topics – Hardship Distributions
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Internal Revenue Service. Retirement Topics – Required Minimum Distributions (RMDs)
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Internal Revenue Service. Retirement Topics – QDRO Qualified Domestic Relations Order
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Internal Revenue Service. Rollovers of Retirement Plan and IRA Distributions
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Office of the Law Revision Counsel. 26 USC 3405 – Special Rules for Pensions, Annuities, and Certain Other Deferred Income
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Office of the Law Revision Counsel. 26 USC 417 – Definitions and Special Rules for Purposes of Minimum Survivor Annuity Requirements
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Congress.gov. 98th Congress – Retirement Equity Act of 1984
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Internal Revenue Service. Fixing Common Plan Mistakes – Failure to Obtain Spousal Consent
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Internal Revenue Service. About Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.