Specific Instructions

Table of Contents

    Line 1.   Enter the name, address, and telephone number of the plan sponsor/employer.

      A plan sponsor means:
    1. In the case of a plan that covers the employees of one employer, the employer;

    2. In the case of a plan sponsored by two or more entities required to be combined under sections 414(b), (c), or (m), one of the members participating in the plan; or

    3. In the case of a plan that covers the employees and/or partner(s) of a partnership, the partnership.

    Note.

    • The name of the plan sponsor/employer should be the same name that is used when the Form 5500 series annual return/report is filed for the plan. Line 1a is limited to 70 characters.

    Line 1f.   Enter the 9-digit employer identification number (EIN) assigned to the plan sponsor/employer. This should be the same EIN that is used when the Form 5500 series annual returns/report is filed for this 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.

      The plan sponsor/employer must have an EIN. A plan sponsor/employer without an EIN can apply for one.
    • Online—Generally, a plan sponsor/employer can receive an EIN by internet and use it immediately to file a return. Go to the IRS website at www.irs.gov/businesses/small and click on Employer ID Numbers (EINs).

    • By telephone—Call 1-800-TAX-FORM (829-4933).

    • By mail or fax—Send in a completed Form SS-4, Application for Employer Identification Number, to apply for an EIN.

      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 DL requests, and annual returns/reports unless there is a change of sponsor.

    Line 1i.   Enter the two digits representing the month the plan sponsor/employer's tax year ends.

    Lines 1j through 1m.   If a foreign entity, follow the country's practice for entering the name of the city or town, province/country, and the postal code.

    Line 2.   The contact person will receive copies of all correspondence as authorized in a Form 2848 or Form 8821. Either complete the contact's information on this line, or mark the box and attach a completed Form 2848 or Form 8821.

    Lines 2h through 2k.   If a foreign contact, follow the country's practice for entering the name of the city or town, province/country, and the postal code.

    Line 3a.   Enter the number(s) that correspond to the request(s) being made. The box under line 3a(1) must contain a 1, 2, or 3. Use the second box under line 3a(2) if a special ruling is requested.

    Line 3a(1).   
    • Enter 1 if, for this purpose, a new individually designed plan is a new plan with an initial remedial amendment period within the meaning of Regulations section 1.401(b)-1(d)(1).

    • Enter 2 if the IRS has not issued a DL for the plan or the plan sponsor previously did not rely on an opinion/advisory letter.

    • Enter 3 if the IRS has previously issued a DL for this plan or the plan sponsor previously relied on an opinion/advisory letter.

    Line 3a(2).   Special ruling request items 4-6 apply to both individually designed and pre-approved plans. Item 7 only applies to individually designed plans. See special instructions for pre-approved plans under What To File.
    • Enter 4 if requesting a letter concerning the effect of section 414(m), attach the following information.

      1. A description of the nature of the business of the employer. Specifically state whether it is a service organization or an organization whose principal business is the performance of management functions for another organization, including the reason for performing the management function or service.

      2. The identification of other members (or possible members) of the affiliated service group (ASG).

      3. A description of the nature of the business of each member (or possible member) of the ASG including the type of organization (corporation, partnership, etc.) and indicate whether such member is a service organization or an organization whose principal business is the performance of management functions for the other group member(s).

      4. The ownership interests between the employer and the members (or possible members) of the ASG (including ownership interests as described in section 414(m)(2)(B)(ii) or 414(m)(6)(B)).

      5. A description of services performed for employers by the members (or possible members) of the ASG, or vice versa. Include the percentage of each member's (or possible member's) gross receipts and service receipts provided by such services, if available, and data as to whether their services are a significant portion of the member's business and whether or not, as of December 13, 1980, it was unusual for the services to be performed by employees of organizations in that service field in the United States.

      6. A description of how the employer and the members (or possible members) of the ASG associate in performing services for other parties.

      7. A description of management functions, if any, performed by the employer for the members (or possible members) of the ASG, or received by the employer from any other members (or possible members) of the group (including data as to whether such management functions are performed on a regular and continuous basis) and whether or not it is unusual for such management functions to be performed by employees of organizations in the employer's business field in the United States.

        1. If management functions are performed by the employer for the members (or possible members) of the ASG, describe what part of the employer's business constitutes the performance of management functions for the members (or possible members) of the group (including the percentage of gross receipts derived from management activities as compared to the gross receipts from other activities).

      8. A brief description of any other plan maintained by the members (or possible members) of the ASG, if such other plan is designated as a unit for qualification purposes with the plan for which a DL has been requested.

      9. A copy of any ruling issued by the Washington, DC, office on whether the employer is an ASG; a copy of any prior DL that considered the effect of section 414(m) on the qualified status of the employer's plan; and, if known, a copy of any such ruling or DL issued to any other member (or possible member) of the same ASG, accompanied by a statement as to whether the facts upon which the ruling or DL was based have changed.

    • Enter 5 if requesting a letter concerning the effect of section 414(n), attach the following information.

      1. A description of the nature of the business of the recipient organization.

      2. A copy of the relevant leasing agreement(s).

      3. A description of the function of all leased employees in the trade or business of the recipient organization (including data as to whether all leased employees are performing services on a substantially full-time basis).

      4. A description of facts and circumstances relevant to a determination of whether such leased employees' services are performed under primary direction or control of the recipient organization (including whether the leased employees are required to comply with instructions of the recipient about when, where, and how to perform the services, whether the services must be performed by particular persons, whether the leased employees are subject to the supervision of the recipient, and whether the leased employees must perform services in the order or sequence set by the recipient).

      5. If the recipient organization is relying on any qualified plan(s) maintained by the employee leasing organization for purposes of qualification of the recipient organization's plan, a description of the plan(s) (including a description of the contributions or benefits provided for all leased employees that are for services performed for the recipient organization, plan eligibility, and vesting).

    • Enter 6 if this is a request for the effect a potential partial termination will have on the plan’s qualification. The “effective date” means the date the partial termination occurred. Enter this date on line 3c.

    Partial termination. For a partial termination submit:   
    1. A copy of the restated plan and trust plus all amendments made to the date the plan is adopted,

    2. A copy of the latest DL, including caveats,

    3. A statement explaining how any amendments made since the last DL affect this or any other plan of the employer,

    4. A statement indicating whether a partial termination may have occurred or may occur as a result of proposed actions and include a statement describing the applicable actions,

    5. A schedule of information for the plan year in which the partial (or potential partial) termination began, using the format in the Partial Termination Worksheet. Also include on the schedule data for the subsequent plan year, as well as for the 2 prior plan years,

    6. If the plan has more than one benefit computation formula, complete a Partial Termination Worksheet for each benefit formula, and

    7. Include an explanation of how the plan meets the requirements of section 411(d)(3).

    • Enter 7 if this is a termination of a multiemployer or a multiple employer plan covered by Pension Benefit Guaranty Corporation insurance. Insert date of termination.

        Partial Termination Worksheet Year Year Year of partial termination Year
      1 Participants employed:        
      a Number at beginning of plan year        
      b Number added during the plan year        
      c Total, add lines a and b        
      d Number dropped during the plan year        
      e Number at end of plan year, subtract d from c        
      f Total number of participants in this plan separated from service without full vesting        
      2 Present value (as of month / day) during the year of        
      a Plan assets        
      b Accrued benefits        
      c Vested benefits        
      3 Submit a description of the actions that may have resulted (or might result) in a partial termination. Include an explanation of how the plan meets the requirements of section 411(d)(3).
    Line 3b.   If the initial plan is a proposed plan document, enter “09/09/9999.

    Lines 3g(1) and (2).   See special instructions under What To File, for rules that apply to pre-approved plans asking for rulings under lines 3(a)(2), 3(g) and 6(i). In other circumstances where a pre-approved plan is asking for a determination under Form 5300, these special rules (reviewing on the basis of the underlying CL) do not apply. Attach an explanation explaining why the Form 5300 is being filed and see What To File.
    • Mark “Yes” in the applicable box if this is a multiple employer plan. For multiple employer plans that do not involve collective bargaining, submit either:

      1. An application for the plan in the name of the controlling member, or

      2. An application for the plan in the name of the controlling member and an application for each employer maintaining the plan who desires an individual DL. Each Form 5300 must be signed by the respective employers.

    • Mark “Yes” in the applicable box if this is a DL request required pursuant to published guidance by the Service, such as a minimum funding waiver. If this is a minimum funding waiver request, see section 15 of Rev. Proc. 2013-6.

    • Mark “Yes” in the applicable box if this is an M&P plan where the adopting employer has added language to satisfy the requirements of sections 415 and 416 because of the required aggregation of plans.

    • Mark “Yes” in the applicable box if the VS or M&P plan is a pension plan with a normal retirement age earlier than age 62. In this case the employer must submit a signed statement that this is a good faith determination of the typical retirement age for the industry in which the covered workforce is employed. See Regulations section 1.401(a)-1.

    Line 3h.   An individually designed plan is eligible for the 6-year RAC if the employer that sponsors the plan and the sponsor of a pre-approved M&P or VS plan document jointly executed Form 8905 before the end of the plan’s 5-year RAC which ends within the current 6-year RAC. An individually designed plan is also eligible for the 6-year cycle under certain other circumstances set forth in section 17 of Rev. Proc. 2007-44.

    Line 3i.   A VS plan may, but is not required to, contain a provision that authorizes the VS practitioner to amend the plan on behalf of employers who have previously adopted the plan. For purposes of reliance on the advisory letter, the practitioner will no longer have the authority to amend the plan on behalf of the employer as of the date of the adoption of an employer amendment to the plan to incorporate a type of plan not allowable in the VS program or as of the date the Service notifies the practitioner that the plan is an individually designed plan. See section 15.03 of Rev. Proc. 2011-49.

    Line 3j.   The plan sponsor is an “identical adopter” of a pre-approved M&P or VS plan and has made no changes to the pre-approved plan document other than to select among options provided under the plan or certain changes described in section 19.03 of Rev. Proc. 2011-49.

    Line 3m.   Use the table to list all the amendments to the plan that have been adopted during the RAC of the plan in which the application is submitted (the “current cycle”), other than amendments described in the following paragraph.  
    Do not list:
    1. Any amendment that was adopted during the current cycle as a condition of a DL for the preceding cycle (but include a copy of the amendment with the application);

    2. Any amendment to a pre-approved plan that was adopted by the sponsor on behalf of the employer and considered by the Service in issuing an opinion or advisory letter for the plan;

    3. If 4-7 is entered in line 3a(2) or if 1-4 is entered in line 3g, any amendment to a pre-approved plan that is effective after the year of the CL that was considered by the Service in issuing an opinion or advisory letter for the plan, regardless of whether the amendment was adopted by the sponsor of the pre-approved document or the employer;

    4. Any interim amendment not included on the CL for which this determination is being requested.

    Note.

    If the plan does not have a DL for the preceding RAC and the plan sponsor is not entitled to rely on an opinion or advisory letter for that cycle, the plan sponsor must include with the application copies of interim amendments adopted for the preceding cycle. See What To File. However, do not list these amendments in the table in line 3m.

    Column (i).

    Note each amendment using an identifying number or name (such as Amendment 1, or PPA Amendment). An amendment may consist of modifications made to several plan provisions that are adopted on the same date. Two or more amendments with the same adoption date may be grouped and listed on a single line of the table. In this case, enter in column (ii) the effective date of the amendment with the earliest effective date of any of the grouped amendments.

    Column (ii).

    Enter the date the amendment is actually effective under the plan. For example, if an amendment is effective on the first day of the first plan year beginning on or after January 1, 2013, and the plan year of the plan ends on June 30, the date to be entered in column (ii) is 07/01/2013.

    Column (iii).

    If the amendment is in proposed form enter 09/09/9999.

    Column (vi).

    For each individual amendment listed, did the pre-approved plan sponsor have the power to amend the plan on behalf of the adopting employer? If “Yes,” enter “X” in this column.

    Column (vii).

    Note the due date of the employer's tax return, including extensions, if applicable, for the year in which the amendments were adopted. If the relevant amendment is discretionary only, this field should be blank.

    Line 3n.   Enter number of amendments listed in the table in line 3m.

    Line 3o.   Designate the specific tax return that the employer uses to file its return. For example, Form 1120, 1040 or Form 990 series (in the case of a tax-exempt employer). For a tax-exempt employer, the section 990 series is a substitute for an income tax return. If no tax return is filed by the entity (such as a governmental employer) write “N/A” in the box. See section 5.06(2) of Rev. Proc. 2007-44 for details.

    Line 4a.   This field is limited to 70 characters, including spaces. Fill in the plan name as it should appear on the DL. Keep in mind that “Employees” and “Trust” are not necessary in the plan name and will be left off if space does not permit.

    Line 4b.   Enter the three-digit plan number, beginning with "001" and continuing in numerical order for each plan you adopt (001-499). The numbering will differentiate your plans. The number assigned to a plan must not be changed or used for any other plan. This should be the same number that is used when the Form 5500 series annual returns/report is filed.

    Line 4c.   Plan month means the month in which the plan year ends. Enter the two-digit month (MM).

    Line 4e.   Enter the total number of participants. A participant is:
    1. Any employee participating in the plan, including employees under a section 401(k) qualified cash or deferred arrangement who are eligible but do not make elective deferrals,

    2. Retirees and other former employees who have a nonforfeitable right to benefits under the plan, and

    3. The beneficiaries of a deceased employee who is receiving or will in the future receive benefits under the plan. Include one beneficiary for each deceased employee regardless of the number of individuals receiving benefits.

    Example.   Payment of a deceased employee's benefit to three children is considered a payment to one beneficiary.

    Lines 4f and 4g.   See Notice 2002-1, 2002-2 I.R.B. 283 (as amplified by Notice 2003-49, 2003-32 I.R.B. 294, and Notice 2011-86, 2011-45 I.R.B. 698) for further details, including how to determine compensation.

    Line 5a.   A Pension Equity Plan (PEP) is a DB plan which, rather than or in addition to expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee as an amount equal to an accumulated percentage of final pay. Benefits are generally described as a percentage of final average pay, with the percentage determined as the accumulation of percentage points or lump sum credits received for each year of service. Generally, the accumulated percentage points or lump sum credits are multiplied by final average or career average compensation to determine the lump sum amount.

      A “cash balance” plan is a DB plan which, rather than or in addition to expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a DC plan, that is, as a single sum amount equal to the employee’s hypothetical account balance. Benefits consist of an accumulation of hypothetical allocation credits to an account plus hypothetical accumulated interest credits on that account.

    Line 5b(2).   If the plan’s normal retirement age is below 62, the employer (or trustees in the case of multiemployer plan) must submit a signed statement that this is a good faith determination of the typical retirement age for the industry in which the covered workforce is employed. See Regulations section 1.401(a)-(1). If this is a governmental plan leave blank.

    Line 6a(1).   If the employer is a member of a controlled group of corporations, trades or businesses under common control, or an ASG, all employees of the group will be treated as employed by a single employer for purposes of certain qualification requirements. Attach a statement that provides the following in detail:
    1. All members of the group,

    2. The relationship of each member to the plan sponsor,

    3. The type(s) of plan(s) maintained by each employer, and

    4. Plans common to all members.

    Line 6a(2).    Mark "Yes" if the plan sponsor is a foreign entity or the plan sponsor is a member of an ASG, controlled group of corporations, or a group of trades or businesses under common control that includes a foreign entity; a nonresident alien individual; foreign corporation; foreign partnership; foreign trust; foreign estate or any other person that is not a United States person. See section 1473(5) and 7701(a)(30).

    Line 6b.   If “Yes,” complete only applicable sections of this form. Governmental plans under section 414(d) are exempt from certain qualification requirements and are deemed to satisfy certain other qualification requirements under certain conditions. For example, the nondiscrimination, minimum participation rules, top heavy rules, and minimum funding standards do not apply to governmental plans. In addition, such plans meet the vesting rules if they meet the pre-ERISA vesting requirements.

    Line 6c.   If a church plan has not made such an election, complete only the portions of this form that apply.

      A church plan (for which no special election under section 410(d) has been made) is ordinarily not subject to various qualification requirements. Section provisions that do not apply to a nonelecting church plan include section 410 (relating to minimum participation standards), section 411 (relating to minimum vesting standards), section 412 (relating to minimum funding standards for pension plans), and section 4975 (relating to prohibited transactions). In addition, provisions relating to joint and survivor annuities, mergers and consolidations, assignment or alienation of benefits, time of benefit commencement, certain social security increases, withdrawals of employee contributions, and distributions after plan termination, respectively, also do not apply.

    Line 6g or 6h.   Complete if this is a request with respect to whether the requirements of section 401(h) are satisfied in a plan with retiree medical benefits features and/or on plan language that permits, pursuant to section 420, the transfer of assets in a DB plan to a health benefit account described in section 401(h). Also submit a cover letter specifically providing the location of plan provisions for 401(h), and section 420, if applicable. See the Appendix in Rev. Proc. 2013-8, 2013-1 I.R.B. 237 available at www.irs.gov/irb/2013-01_IRB/ar13.html for additional instructions.

    Line 6i(4).   If the employer is submitting the controlling plan, use the EIN for the Form 5500. Otherwise use the EIN of the controlling plan.

    Line 7.   Section 3001 of the Employee Retirement Income Security Act of 1974 requires that applicants subject to section 410 provide evidence that each employee who qualifies as an interested party has been notified of the filing of the application. If “Yes” is marked, it means that each employee has been notified as required by Regulations section 1.7476-1. If this is a one-person plan or if this plan is not subject to section 410, a copy of the notice is not required to be attached to this application. If “No” is marked or this line is blank, the application will be returned. Rules defining “interested parties” and the form of notification are in Regulations section 1.7476-1.

    Line 12.   If “Yes,” attach a separate statement providing the name, EIN and plan type of the other plan and a copy of pertinent plan provisions from the related plan regarding the offset.

    Line 13.   If this is a request for an individually designed plan that consists of a DB plan and a qualified cash or deferred arrangement, submit two Forms 5300 and two applicable user fees.

    Line 14.   Attach a statement that provides the following:
    1. Name of plans involved,

    2. Type of plan,

    3. Date of merger, consolidation, spinoff, or a transfer of plan assets or liabilities, and

    4. Verification that each plan involved was qualified at the time of the merger, consolidation, spinoff, or a transfer of plan assets or liabilities.

    Note.

    Verification includes a copy of a prior DL, if any, interim and discretionary amendments, and the appropriate opinion or advisory letter and/or adoption agreement and plan document.

    If applicable, file Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities; Notice of Qualified Separate Lines of Business, 30 days prior to the merger, consolidation, or transfer of assets or liabilities.

    Line 15a.   If the plan has been restated to change the type of plan under Regulation section 1.401-1, answer this question "Yes" and attach a statement explaining the change.

    Line 16a.   Attach a statement for each plan, that includes the following information:
    1. Name of plan,

    2. Type of plan,

    3. Form of plan (standardized, nonstandardized, VS, or individually designed),

    4. Plan number,

    5. Vesting schedule, and

    6. Whether the plan has received a DL or an application for a letter is pending with IRS.

    Lines 16b and 16c.   See M-8, M-12, and M-14 of Regulations section 1.416-1.

    Line 17.   Section 411(d)(6) protected benefits include:
    • The accrued benefit of a participant as of the later of the amendment's adoption date or effective date; and

    • Any early retirement benefit, 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.

    Line 24.   Applicable DC plans are required to contain the participant diversification rights under section 401(a)(35). In general, an applicable DC plan means any DC plan that holds publicly traded employer securities. DC plans are required to have plan language reflecting the section 401(a)(35) rights, with exceptions including the following:
    1. The terms of the plan do not permit any investments in employer securities.

    2. The terms of the plan provide that the plan may invest in employer securities, but only if these securities are held indirectly as part of a broader fund that is:

      1. a regulated investment company described in section 851(a),

      2. a common or collective trust fund or pooled investment fund maintained by a bank or trust company supervised by a State or a Federal agency,

      3. a pooled investment fund of an insurance company that is qualified to do business in a State, or

      4. an investment fund managed by an investment manager within the meaning of section 3(38) of ERISA for a multiemployer plan.

    3. The terms of the plan state that the plan is a one-participant retirement plan as defined in section 401(a)(35)(E)(iv); or

    4. The plan is an ESOP, described in section 4975(e)(7), that does not hold any amounts subject to sections 401(k) or (m) and is separate from any other plan of the employer.


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