This form is used to authorize the direct rollover of assets from a workplace retirement plan to a Traditional IRA. It is designed to help individuals avoid the 20% federal income tax withholding requirement applicable to certain retirement plan distributions by directly rolling over the funds to a Traditional IRA. This form has a section that is completed by the IRA trustee/custodian to accept the funds. Two-part, one-sided, black ink, 8 1/2 x 11.