HTML Preview Payroll Deduction Instruction Form page number 1.
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New York’s 529 College Savings Program Direct Plan
Payroll Deduction Instruction Form
NY529PDI
Complete this form to establish, change, or delete payroll deduction instructions on your existing accounts. You may also provide your
payroll deduction instructions by logging on to our Web site at www.nysaves.org.
After we process this form, you will receive a confirmation statement, which you must sign and submit to your employer’s payroll department.
Your payroll deduction instructions will not take effect until your employer has accepted your signed confirmation. You can receive this
confirmation immediately by accessing your account online.
Contributions made through payroll deductions are after-tax contributions.
Print clearly, preferably in capital letters and black ink.
Forms can be downloaded from our Web site at www.nysaves.org. Or you can call us toll-free to order any form—or get assistance in filling
out this one—at 1-877-NYSAVES (1-877-697-2837) on business days from 8 a.m. to 9 p.m., Eastern time. Return this form and any other required
documents in the enclosed postage-paid envelope, or mail to: New York’s 529 College Savings Program Direct Plan, P.O. Box 55441,
Boston, MA 02205-5441. For overnight delivery or registered mail, send to: New York’s 529 College Savings Program Direct Plan,
95 Wells Avenue, Suite 155, Newton, MA 02459-3204.
1. Account Owner Information
Account Number Last Four Digits of Social Security Number or Individual Taxpayer ID Number
Name of Account Owner (first, middle initial, last)
– – – –
Daytime Telephone Number Evening Telephone Number
2. Employer Information
Name of Employer
Mailing Address
City State Zip
– –
Payroll Department Contact Name Telephone Number Extension (if any)
Important: Check here if you are an employee of the State of New York.
00-66614-001
REMEMBER TO SIGN IN SECTION 4.
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