Hardship Documentation Guide

The following information is provided for guidance purposes only. It is intended to support your decision-making. As the plan sponsor, you retain full discretion to determine whether or how to apply this guidance based on your specific circumstances.

REASON FOR HARDSHIP WITHDRAWAL AND CHECKLIST
REASON	REQUIRED DOCUMENTATION AND INFORMATION THAT MUST BE REFLECTED ON DOCUMENTATION	UNACCEPTABLE REASONS/DOCUMENTATION
Unreimbursed medical expenses for medical care previously incurred or anticipated by: You Your spouse Your child Your dependent	Explanation of Benefits (EOB) from provider dated within the past 12 months that reflects the amount paid by the insurance company and reflects the amount owed by the insured, OR A bill from provider dated within the past 12 months that indicates the amount still owed and indicates the costs not reimbursed by the insurance company, OR A bill from provider dated within the past 12 months that indicates the amount still owed, and the Explanation of Benefits (EOB) from provider dated within the past 12 months that reflects the amount paid by the insurance company and the amount owed by the insured, OR A bill dated within the past 12 months that indicates the amount still owed, and a letter written and signed by me to certify that I do not have insurance.	Medical bills that do not show portion paid by insurance Collection agency notices Bills already paid
Tuition, related educational fees, room and board for the next 12 months post- secondary education for: You Your spouse Your child Your dependent	Itemized tuition bill, and/or Room and Board statement provided by the school, which must: be dated within 4 months of the beginning of the quarter or semester, and provide an actual amount due, and contain student’s name, and be due in the next 12 months AND/OR Related Educational Fees Textbooks bill or receipt dated within the last 4 months, or Off campus lease agreement signed and within the same time as the tuition bill, or Miscellaneous fees charged by the school - provide supporting documentation	Estimate for tuition with no student name (general estimate from school). You need to provide an actual tuition bill. Student loans Financial aid award letters Bills already paid (except for textbooks)
Purchase of your principal residence or costs directly related to your purchase (excluding mortgage payments)	If borrowing, loan estimate from lender, and Signed purchase contract or intent-to-purchase agreement The above documents must: be dated within last 60 days, and reflect the address of the residence being purchased, and reflect the purchase price, and reflect the amount of the down payment, and reflect a closing date in the future, and reflect signatures of both buyer and seller If building, you must also provide a copy of the signed builder’s permit or builder’s contract If purchasing a mobile home, you must also provide a copy of the Deed to show that you own the land	Rental/lease agreement for purchase of a primary residence Mortgage applications Truth in lending disclosures Bills already paid Land purchases only
Repair of principal residence, that would qualify as a casualty deduction under the Internal Revenue Code, such as a fire or storm	Letter explaining what caused the casualty, and Statement from your insurance company stating the loss is not covered, and Billing statement or cost estimate The above documents must: be dated within last 4 months, and reflect the amount necessary to repair principal residence, and include the property address, and have a future payment due date	General estimate for repair (no property address, not dated or amount owed) Routine maintenance, remodeling, additions, non-attached buildings and garages Bills already paid
Prevention of mortgage foreclosure or eviction from your principal residence	Proof of pending foreclosure or pending eviction Tax lien, or Bank/mortgage statement, or Letter from bank/mortgage company, or Copy of the court document substantiating the eviction or foreclosure legal proceedings, or a Notice to Quit in the case of evictions. If the Notice to Quit does not state the amount owed to prevent eviction, then you must include a signed and dated letter from the landlord either notarized or on company letterhead The above documents must: be dated within last 4 months, and reflect the amount necessary to prevent eviction/ foreclosure, and contain eviction/foreclosure date. This date must be in the future, and include the property address, and have a future payment due date If the current address on record is a PO Box, a document from a municipal or government agency providing proof of physical address. (Example: Utility bill or drivers license)	IRS tax liens that do not specify address of property to be foreclosed Late payment statements that do not threaten eviction or foreclosure Lease agreements Bills already paid
Funeral/Burial expenses for: Your spouse Your child Your parent Your dependent	Copy of death certificate, and Funeral/burial statement which must: reflect name of deceased, and reflect date of services provided within the past 90 days, and reflect your name as individual billed, and include itemized funeral/burial expenses, and have a future payment due date	Pre-purchase of lot or headstone Bills already paid
If you selected an immediate and heavy financial need for your dependent: A dependent is anyone who meets the definition of a Qualifying Child or Qualifying Relative as described in Section 152 of the Internal Revenue Code, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof.