Forms

Access your account online – or download these forms – to manage your PA ABLE Savings Program account.

Enrollment Guide

View a brief description of the PA ABLE Savings Program.

Enrollment Guide (PDF)
Enrollment Guide (docx)
Enrollment Guide (txt)

Disclosure Statement

View the complete Disclosure Statement for the PA ABLE Savings Program.

Disclosure Statement (PDF)
Disclosure Statement (docx)
Disclosure Statement (txt)

Enrollment Form

Use the enrollment form to open a PA ABLE Savings Program account.

Please note: You MUST read the Disclosure Statement and sign the Program Contract before opening an account.

Enrollment Form (PDF)

Incoming Rollover Form

Use this form to request a direct rollover from another qualified ABLE plan or 529 plan to an existing PA ABLE Savings Program account.

Incoming Rollover Form (PDF)

ABLE TO WORK SELF CERTIFICATION FORM

Use this form to certify that you are eligible for an increased annual contribution limit as a result of your earned income.

ABLE TO WORK SELF CERTIFICATION FORM (PDF)

Account Financial Features Form

Use this form to add, change, or delete a recurring contribution, Electronic Funds Transfer (EFT), Systematic Withdrawal Program (SWP), Systematic Exchange Program (SEP), and banking information on a PA ABLE Savings Program account.

Account Financial Features Form (PDF)

Account Information Change Form

Use this form to update existing Account Owner information, transfer Account ownership to a new Account Owner, update existing Authorized Individual information, add or change an email address, change eligibility basis, add or update a Successor Account Owner, add or update a Successor Authorized Individual, or add or update an Interested Party.

PLEASE NOTE: Only a sibling of the current Account Owner may be named as a new Account Owner or a Successor Account Owner.

Account Information Change Form (PDF)

Additional Contribution Form

Use this form to make additional contributions to a PA ABLE Savings Program account by check.

Additional Contribution Form (PDF)

Payroll Direct Deposit Form

Use this form to start, change, or stop payroll direct deposit instructions to a PA ABLE Savings Program account.

Payroll Direct Deposit Form (PDF)

Withdrawal Request Form

Use this form to make full or partial withdrawals from a PA ABLE Savings Program account.

Withdrawal Request Form (PDF)

Investment Option Change/Future Contribution Allocation Change Form

Use this form to request a twice per calendar year Investment Option change or to change the future contribution allocations.

Investment Option Change/Future Contribution Allocation Change Form (PDF)

Add an Authorized Individual Form

Use this form to add an Authorized Individual to an existing ABLE Account.

PLEASE NOTE: If you are adding an Authorized Individual for an adult Account Owner with the capacity to enter into contracts please use the Power of Attorney/Authorized Individual Form.

Add an Authorized Individual Form

Authorized Entity Signatory Form

Use this form if you are a company or organization serving as the Authorized Individual for one or more Eligible Individuals, to designate a representative or representatives to act on behalf of the Entity with respect to PA ABLE Accounts (“Signatories”).

Authorized Entity Signatory Form (PDF)

Power Of Attorney/Authorized Individual Form

Use this form to designate someone as an Authorized Individual with authority to act as your Agent on your PA ABLE Account.

Power Of Attorney/Authorized Individual Form (PDF)

W-9 Form

Use this form to certify the account owner’s or authorized individual’s taxpayer identification number.

W-9 Form (PDF)

Business Continuity Plan

Business Continuity Plan (pdf)
Business Continuity Plan (docx)
Business Continuity Plan (txt)

Privacy Policy

Privacy Policy (pdf)
Privacy Policy (docx)
Privacy Policy (txt)
Link to the home page

Connect With Us

Phone: 855-529-ABLE (2253)
Email: info@paable.gov

 

PA ABLE Savings Program
607 South Drive | Room 529
Harrisburg, PA 17120