Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Nationwide Retirement Solutions DC-3653 form and open it in your preferred editing platform.
2. Fill out the 'Account Holder Information' section. Include the employer name, social security number, full name, date of birth, mailing address, city, state, and ZIP code, primary phone number, work phone number, and email address. Indicate your preferred method of contact.
3. In the 'Rollover Funds From' section, select the type of plan you are rolling over from, such as 401(k), 403(b), or 457(b). Specify the source of the funds or select 'All' if applicable.
4. Complete the 'Employer Information' section with the employer name, plan number, and your date of severance from employment. Ensure the authorized personnel from your payroll or personnel department signs and dates the form.
5. Proceed to 'New Carrier Information'. Provide the new carrier's name and the rollover amount or percentage. Remember to note that a Letter of Acceptance from the new carrier is required to process your request. Indicate if you want the check mailed to your address of record.
6. Review the 'Overnight Check Option' and specify if you require overnight delivery, noting any applicable fees.
7. Fill out the 'Life Insurance Information' section if you have life insurance through the plan and decide your preference regarding coverage cancellation.
8. In the 'Certification' section, ensure you accurately complete the certification statements regarding your taxpayer identification number and any backup withholding status.
9. Sign and date the 'Authorization' section to authorize the rollover and affirm you understand the tax implications and minimum distribution requirements.
10. Finalize your form by choosing to save changes, download the document, or print it for submission. Ensure you return the completed form via mail or fax as instructed.

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