Line 1a.
Enter the name, address, and telephone number of the plan sponsor.
“
Plan Sponsor” for a plan that is:
- Covering the employees of one employer, the employer;
- Maintained by two or more employers (other than a plan
sponsored by a group of entities required to be combined under section
414(b), (c) or (m)), is the association, committee, joint board of
trustees or other similar group of representatives of those who
established or maintain the plan; or
- Sponsored by two or more entities required to be combined
under section 414(b), (c) or (m), is one of the members participating
in the plan.
The name of the plan sponsor/employer should be the same name that
was used or will be used when the Form 5500 series returns/reports are
filed for the plan.
Address.
Include the suite, room, or other unit number after the street
address. If the Post Office does not deliver mail to the street
address and the plan has a P.O. box, show the box number instead of
the street address.
Line 1b. Employer Identification Number (EIN).—
Enter the 9-digit EIN assigned to the plan sponsor. This should be
the same EIN that was or will be used when Form 5500 series
returns/reports are filed for the plan.
For a multiple employer plan, the EIN should be the same EIN that
was or will be used by the participating employer when Form 5500 is
filed by the employer.
Do not use a social security number or the EIN of the
trust. Use
Form SS-4, Application for Employer
Identification Number, to apply for an EIN. Form SS-4 can be obtained
at most IRS or Social Security Administration (SSA) offices or by
calling 1-800-TAX-FORM (1-800-829-3676).
The plan of a group of entities required to be combined under
section 414(b), (c) or (m) whose sponsor is more than one of the
entities required to be combined should only enter the EIN of one of
the sponsoring members. This EIN must be used in all subsequent
filings of determination letter requests and annual returns/reports
unless there is a change of sponsor.
Line 1c.
Enter the two digits representing the month the employer's tax year
ends. This is the employer whose EIN was used on line 1b. For plans of
more than one employer, enter N/A.
Line 2.
The contact person will receive copies of all correspondence as
authorized in a power of attorney or other written designation. This
line must be completed as described; a reference such as “
see
attached” is not acceptable.
Line 3a.
In the box in the left margin, enter the number(s) that correspond
to the request(s) being made.
Enter 1 if the IRS has not issued a determination letter
for this plan.
Enter 2 if this application is for a plan for which the
IRS has previously issued a determination letter.
If this application is for initial qualification or entire plan as
amended, also enter the date the plan or amendment was signed. If a
plan or amendment is proposed, enter 9/9/9999. Also enter effective
dates where requested.
Enter 3 if a determination letter is requested on the
termination of a multi-employer plan covered by PBGC insurance. Also
enter the date the termination is effective.
Enter 4 if a determination letter is requested on the
effect of a potential partial termination on the plan's qualification.
Also, enter the date(s) the partial termination is effective.
“
Date amendment effective,” “
Date termination effective,”
or “
Date effective” means the date the plan, amendment, or
partial termination becomes operative, takes effect, or changes.
Line 3b.
If “
Yes” is checked and you do not have a copy of the latest
determination letter, explain this in the cover letter.
Line 3c.
Section 3001 of ERISA requires the applicant to provide evidence
that each employee who qualifies as an interested party has been
notified of the filing of the application. If “
Yes” is checked,
it means that you have notified each employee as required by
regulations under section 7476 or you have a one-person plan.
Rules defining “
interested parties” and the form of
notification are contained in Regulations section 1.7476-1. For an
example of an acceptable format, see Rev. Proc. 98-6 1998–1
I.R.B. 183. If “
No” is checked or this line is blank, your
application will be returned.
Note:
Rev. Proc. 98–6 is updated annually and can be found in the
Internal Revenue Bulletin.
Line 3e.
If this plan benefits noncollectively bargained employees
or
if more than 2% of the employees covered under a CBA are
professional employees, check “
Yes.” See the instructions for
Schedule Q (Form 5300) for the definition of collectively bargained
employee and professional employee.
Line 4a.
Enter a name for your plan.
Line 4b.
Assign and enter a three-digit number, beginning with “
001”
and continuing in numerical order for each plan you adopt. This
numbering will differentiate your plans. The number assigned to a plan
must not be changed or used for any other plan.
Line 4c.
Plan year means the calendar, policy, or fiscal year on which the
records of the plan are kept. Enter four digits in month-day order.
For example, March 31 would be 0331.
Line 4d.
Enter the year the plan
originally became effective.
Line 4e.
Enter the total of:
- the number of employees participating in the plan. Include
employees under a section 401(k) qualified cash or deferred
arrangement who are eligible but do not make elective
deferrals,
- retirees and former employees who have a nonforfeitable
right to benefits under the plan, and
- any beneficiary of a deceased employee who is receiving or
will in the future receive benefits under the plan. (This means one
beneficiary for each deceased employee regardless of the number of
individuals receiving benefits.)
Example:
A payment of a deceased employee's benefit to three children is
considered a payment to one beneficiary.
Line 5a.
If the plan is not described in 1, 2, or 3, enter 4 for “
other”
plan.
Example:
If this is a cash balance plan, enter 4 and write “Cash Balance”
where noted. A cash balance plan is a DBP that defines an employee's
benefit by reference to hypothetical allocations and interest
adjustments.
Line 6. Type of Plan.
Enter 1 if this is a governmental plan.
Enter 2 if this is a nonelecting church plan (i.e., the
church plan has not made an election under section 410(d)).
Enter 3 if this is a
multiple-employer-collectively-bargained plan other than a
multi-employer plan. Plans making the election in section 414(f)(5)
should enter 3 in the space provided.
Enter 4 if this is a multi-employer plan (as described
in section 414(f)).
For this purpose, a multi-employer plan is one to which more than
one employer is required to contribute and which is maintained under
one or more collective bargaining agreements between one or more
employee organizations and more than one employer.
Enter 5 if this is a section 412(i) plan.
Enter 6 if this plan is not one described above.
Line 10a.
Section 411(d)(6) protected benefits include:
- The accrued benefits of a participant as of the later of the
amendment's adoption date or effective date; and
- Any early retirement type subsidy or optional form of
benefit for benefits from service before such amendment.
If the answer is “
Yes” explain on an attachment how the
amendment satisfies one of the exceptions to the prohibition on
reduction or elimination of section 411(d)(6) protected benefits.
