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Internal Revenue Bulletin:  2004-7 

February 17, 2004 

Appendix B


The Service will be able to respond more quickly to your waiver of minimum funding standard request if it is carefully prepared and complete. To ensure your request is in order, use this checklist. Answer each question in the checklist by inserting Y for yes, N for no, or N/A for not applicable, as appropriate, in the blank next to the item. Sign and date the checklist (as taxpayer or authorized representative) and place it on top of your request.
You must submit a completed copy of this checklist with your request. If a completed checklist is not submitted with your request, substantive consideration of your submission will be deferred until a completed checklist is received.
  1. If you want to designate an authorized representative, have you included a properly executed Form 2848 (Power of Attorney and Declaration of Representative)?
  2. Have you satisfied all the requirements of Rev. Proc. 2003-4 or its successors (especially concerning signatures and penalties of perjury statement)? (See section 2.02(1) & (2))
  3. Have you included statement of proposed deletions? (See §2.02(3))
  4. Have you included the user fee required under Rev. Proc. 2003-8 or its successors? (See section 2.01 & 2.02(3))
  5. Have you included a copy of the written notification that an application for a waiver has been submitted and a statement that such notice was delivered to each employee organization, participant, beneficiary and alternate payee? (See section 2.02(4) and Appendix A)
  6. Have you included the general facts concerning the employer? (See section 2.03(1))
  7. Have you included a description of the employer’s financial condition? (See section 2.03(2)).
  8. If the plan is not a multiemployer plan, have you included a description of the employer’s executive compensation arrangements? (See section 2.03(3))
  9. Have you included an explanation of the nature and extent of the business hardship, including financial projections if the waiver request exceeds $1,000,000 and the plan is not a multiemployer plan? (See section 2.03(4))
  10. Have you included information concerning the pension plan? (See section 2.03(5))
  11. Have you included information concerning other pension, profit-sharing, or stock bonus plans of the employer? (See section 2.03(6))
  12. Have you included information concerning other matters pertaining to the plan? (See section 2.03(7))
  13. Have you provided a digest of financial information? (See section 2.03(8))
  14. Have you provided 2 copies of the necessary waiver information described in section 2.03 if the waiver request exceeds $1,000,000? (See section 2.04)
  15. If the waiver request pertains to a defined contribution pension plan, have you provided a copy of the plan amendment or determination letter request, if applicable? (See section 3.01-3.04)
  16. Have you submitted the request for a waiver no later than the 15th day of the 3rd month following the close of the plan year if the plan is not a multiemployer plan, or no later than the close of the plan year following the plan year for which the waiver is requested if the plan is a multiemployer plan? (See section 4)
Signature Date
Title or Authority
Typed or printed name of person signing checklist

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