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QDRO Checklist

Qdro Form

This information is required for the Plan Participant:

  • Full Names of Petitioner and Respondent
  • Complete, and most recent, Addresses of each Petitioner
  • Social Security Numbers of each party Petitioner
  • Dates of Birth of each party Petitioner
  • Date of Divorce & Date of Division (if different)
  • Date of Marriage
  • County and State of Action
  • Case Number
  • Name of Plan Participant
  • Percentage/Dollar Amount of Award
  • Precise Name of Plan
  • Copy of applicable portion(s) of Judgment/Marital Settlement Agreement specific to retirement benefits
  • Account Statement or Benefit Statement
  • Summary Plan Description – if possible and if available
  • Fee

For Military Service Members

  • Reservist or Full-time Active?
  • Branch of Service
  • Date of Entry into Military (or Years of Service)
  • Date of Retirement

Additional Notes:

  • Reservist or Full-time Active?
  • Rank or Pay Grade

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