The withdrawals are also subject to state income tax. To initiate a hardship withdrawal, participants complete a Hardship Distribution Request form and submit to Empower.Ordinary income tax will apply to each distribution. In lieu of a deferred allowance, you may withdraw your member contributions with interest upon your termination. If you have any questions about completing this form, or about applying for a withdrawal on your own behalf, please contact Carolina Lopez at (510) 464-6208. Log into a 401(k), 403(b), 457, or other workplace plan. Log into retirement plan. But, she needs to be aware of the tax consequences.