Can this form be signed electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and retention are documented.

Is additional authentication required?

Stronger authentication (SMS code, ID verification) is recommended for payroll-sensitive forms; require methods consistent with your internal policies and vendor capabilities.

What if the SSN is entered incorrectly?

An incorrect TIN can trigger 24% backup withholding and reporting mismatches; correct promptly and maintain documentation of the correction.

Do I need a notary for this authorization?

Not typically for standard election authorizations, but certain state rules or employer policies may require notarization; confirm with plan counsel or state guidance.

How long must I keep signed forms?

Retain signed authorizations per IRS and industry rules—at least three years generally, and longer for HIPAA or plan audit requirements.

What if a participant revokes an election?

Document revocations in writing or electronically; note the effective date and process changes in payroll and plan records immediately.

Electronic Signature
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Nationwide Retirement Solutions Election Authorization

Nationwide Retirement Solutions Election Authorization

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Election of Coverage by Employer; and
Employer Withdrawal of Election of Coverage

Pursuant to NRS 616B.656

Employer Name:

Employer Address:

Employer Telephone No.:

Federal Identification No.:

Employee Name:

Employee Excluded Profession:

Insurer:

Date Notice Received to Administrator accepting provisions of NRS 616A to 616D.

Effective Date:

Policy #:

Date Notice to Insurer:

Employer Representative Signature:

Title:

Date of Signature:

Withdrawal of Employer Election

Date Notice to Administrator:

Date Notice to Insurer:

Employer Representative Signature:

Title:

Date of Signature:

FOR WCS USE ONLY

Method of Transmission First Class Mail Electronic Transmission/Fax Personally Served

Date Notice Received:

D-44 (Rev.02/04)

What the Nationwide Retirement Solutions Election Authorization is

The Nationwide Retirement Solutions Election Authorization is a participant-signed form used to record an employee's retirement plan elections, such as salary deferral type, contribution amount or percentage, and effective date. It documents consent for payroll withholding and for plan recordkeeping, and it becomes part of the participant's plan file for administrative and tax reporting purposes.

Why this election authorization matters for plan accuracy

A properly completed election authorization creates a clear record of participant intent, supports compliant payroll withholding, and reduces audit exposure. Electronic execution is acceptable under ESIGN (15 U.S.C. ch. 96) and UETA when consent, attribution, intent, and retention requirements are met.

Who typically completes and processes this authorization

Employers and plan administrators collect the form from employees to set or change retirement contributions and to maintain plan compliance.

Plan participants submitting new or changed contribution elections within payroll cycles
HR or benefits administrators validating elections and updating payroll systems
Third-party recordkeepers and payroll vendors implementing withholdings and reporting

Typical document signers and their responsibilities

Plan Participant

Employee who elects contribution type and amount. Participant must enter accurate legal name, Social Security number, effective date, and sign to authorize payroll withholding and plan record updates.

Plan Administrator

Employer or recordkeeper official who reviews and accepts elections, applies payroll changes, and retains the signed form in the plan file for compliance and IRS recordkeeping.

Step-by-step: complete and submit an election authorization

Follow these core steps to finish the form and ensure prompt payroll processing.

01

Gather information: Collect legal name, SSN, plan name, and payroll schedule.
02

Choose election: Select contribution type and enter amount or percentage.
03

Sign and date: Sign using the required method and add the effective date.
04

Submit to HR: Send to HR or recordkeeper before payroll cutoff.

Configuring the online completion workflow

Set up the digital workflow so elections route correctly, authenticate signers, and trigger payroll updates.

Field	Configuration
Upload document	PDF or DOCX accepted; upload master form template.
Place fields	Add name, SSN, selection, signature, and date fields.
Authentication	Use email link, SMS code, or stronger ID verification.
Notifications	Auto-notify HR, payroll, and recordkeeper on completion.

Typical e-signing flow for election authorizations

The online workflow follows a short sequence from sender to completed record.

Sender prepares: Upload form and assign signer fields.
Signer receives: Email or link delivers the document for review.
Signer authenticates: Complete required verification and apply signature.
Record saved: Signed copy and audit trail stored for compliance.

Technical requirements and common integrations

Ensure the platform supports required file formats, signer authentication methods, and integration with payroll or recordkeeping systems.

Supported formats: PDF, DOCX, HTML supported
Integrations: Salesforce, NetSuite, Google Workspace, Microsoft 365
Auth methods: Email, SMS code, KBA or SSO

Security and compliance features to look for

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit trail: Timestamps, IP, and action logs

HIPAA support: BAA available where required

Regulatory compliance: ESIGN, UETA, 21 CFR Part 11

Access control: SSO, role-based permissions

Certification: SOC 2 Type II and ISO 27001

Core elements contained in a professional election authorization

A complete form contains participant identifiers, clear election options, and administrative details needed for payroll and plan records.

Participant information

Full legal name, Social Security number, and contact details used to match payroll and plan files accurately.

Election options

Explicit selection of pre-tax, Roth, or after-tax contributions and the choice between percentage or dollar amount.

Contribution details

Specific deduction amount per pay period and indication of each pay frequency to avoid interpretation errors.

Effective date

Date field in MM/DD/YYYY format that determines the payroll cycle when withholding begins.

Signature and consent

Signed authorization block confirming participant intent and consent to electronic delivery when applicable.

Administrator section

Space for HR or recordkeeper validation, processing date, and internal reference numbers for audit trails.

Timing considerations and payroll cutoffs

Be aware of payroll cutoffs, plan processing windows, and reporting deadlines that affect when elections take effect.

Effective timing:

Election effective date governs first payroll deduction.

Payroll cutoff:

Submit before payroll cutoff to apply election for the next pay period.

Plan processing:

Recordkeeper processing may require 1–2 payroll cycles.

IRS reporting:

Maintain records for tax reporting periods and audits.

Retention:

Retain signed authorizations per regulatory timelines.

Key milestones from election to payroll implementation

A straightforward timeline helps track progress from submission to deduction start.

01

Submission

Participant submits signed election to HR or the recordkeeper.

02

Validation

Administrator verifies identity and data against payroll files.

03

Payroll update

Payroll system receives change and schedules the first deduction.

04

Record retention

Signed form and audit trail stored for compliance and future audits.

How this authorization differs from similar document types

Compare the Nationwide election authorization with other common forms to avoid confusion about purpose and requirements.

Criteria	Election Authorization	Payroll Authorization
Purpose	set retirement contributions	authorize general wage deductions
Signature required
Tax impact	direct retirement reporting	varies by deduction
Recordkeeper use		sometimes

eSignature vendor pricing and capability snapshot for election authorizations

Platform selection affects cost, HIPAA support, and envelope limits; signNow is shown first for comparison across common criteria.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Common mistakes to avoid when preparing the authorization

Mismatched participant name or SSN that prevents payroll or tax matching and triggers backup withholding concerns.
Entering contribution frequency without specifying pay period leads to incorrect withholding amounts being applied.
Ambiguous selection between percentage and dollar amount, causing payroll to default to an unintended calculation.
Failing to record the effective date or missing the payroll cutoff, delaying implementation and creating reconciliation work.

Practical tips for accurate, efficient processing

Adopt standard templates, clear field labels, and automated validation to reduce errors and speed implementation.

Standardize templates

Use a single verified form version to avoid inconsistent fields and to simplify recordkeeping and audits.

Validate data

Automate checks for valid SSNs and required fields before submission to avoid rework and backup withholding risks.

Align payroll schedule

Coordinate effective dates with payroll cutoffs and communicate timelines to participants clearly.

Keep audit trails

Store signed copies with timestamped audit logs and admin notes for future verification and compliance.

Realistic examples of form use and outcomes

These scenarios show how timely and correct completion affects payroll and plan records.

Case Study 1

A mid-size employer rolled out online elections to new hires

Average processing time shortened to under 48 hours
Reduced payroll setup errors and improved participant satisfaction while ensuring standardized retention of signed records.

Case Study 2

A healthcare provider required BAAs for vendors handling forms

Implemented two-factor authentication for signers
Resulted in consistent HIPAA-aligned processing and clear audit trails for benefits administration.

Frequently asked questions about election authorizations and e-signing

Answers to common questions about validity, signatures, retention, and processing for the Nationwide Retirement Solutions Election Authorization.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and retention are documented.
Is additional authentication required?
Stronger authentication (SMS code, ID verification) is recommended for payroll-sensitive forms; require methods consistent with your internal policies and vendor capabilities.
What if the SSN is entered incorrectly?
An incorrect TIN can trigger 24% backup withholding and reporting mismatches; correct promptly and maintain documentation of the correction.
Do I need a notary for this authorization?
Not typically for standard election authorizations, but certain state rules or employer policies may require notarization; confirm with plan counsel or state guidance.
How long must I keep signed forms?
Retain signed authorizations per IRS and industry rules—at least three years generally, and longer for HIPAA or plan audit requirements.
What if a participant revokes an election?
Document revocations in writing or electronically; note the effective date and process changes in payroll and plan records immediately.

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