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A.M., UPS Worldwide Express Plus,

Partial Termination Worksheet

Year Year

Year of partial termination

Year

and UPS Worldwide Express.

1 Participants employed:

The private delivery service can tell

a Number at beginning of plan year

you how to get written proof of the

mailing date.

b Number added during the plan year

c Total, add lines a and b

How To Complete the

d Number dropped during the plan

Application

year

Applications are screened for

e Number at end of plan year,

completeness. The application must be

subtract d from c

signed by the employer, plan

f Total number of participants in this

administrator, or authorized

plan separated from service without

representative.

full vesting

Note. Stamped signatures are not

acceptable; see Rev. Proc. 2011-4,

2 Present value (as of month

2011-1 I.R.B. 123 available at

day during the year of

gov/irb/2011-01_IRB/index.html.

a Plan assets

Incomplete applications may be

returned to the applicant. For this

b Accrued benefits

reason, it is important that an

c Vested benefits

appropriate response be entered for

each item. In completing the

3 Submit a description of the actions that may have resulted (or might result) in a

application, pay careful attention to the

partial termination. Include an explanation of how the plan meets the requirements of

following:

section 411(d)(3).

•

N/A (not applicable) is accepted as a

response only if an N/A block is

provided.

Fee for Employee Plan Determination,

Entire Plan as Amended

•

If a number is requested, a number

Opinion, and Advisory Letter Request.

must be entered.

When requesting a DL on the entire

Please submit a separate check for

•

If an item provides a choice of boxes

plan as amended after initial

each application. Make checks payable

to check, check only one box unless

qualification file:

to the “United States Treasury.”

instructed otherwise.

1. One copy of the restated plan

•

If an item provides a box to check,

2. A completed Form 5300, which

and trust plus all amendments made to

written responses are not acceptable.

consists of pages 1 – 11.

date;

•

Governmental plans and non-electing

2. One copy of the latest DL,

3. Schedule Q (Form 5300), if any

church plans do not have to complete

including caveats; and

elective determinations are being

lines 10 and 12a.

3. A statement explaining how any

requested, and any additional

•

The application has formatted fields

amendments made since the last DL

schedules or demonstrations required

that will limit the number of characters

affect this or any other plan of the

by these instructions or by the

entered per field.

employer.

instructions for Schedule Q.

•

All data input will need to be entered

4. A copy of the plan’s last DL.

in Courier 10 point font.

Other Amendments

•

Alpha characters should be entered

5. A copy of the plan and all

•

in capital letters.

Complex amendments. Use Form

required attachments and statements.

•

Enter spaces between any words.

5300, as described under Entire Plan

6. A copy of all amendments,

Spaces do count as characters.

as Amended on this page, for complex

including a copy of the Good Faith

•

All date fields are entered as an

amendments, including amendments

Economic Growth and Tax Relief

eight-digit field (MMDDYYYY).

with significant changes to plan benefits

Reconciliation Act of 2001 (EGTRRA)

•

Rev. Proc. 2007-44 requires a plan

or coverage.

amendments and all interim

restatement and the IRS may, at its

amendments.

Note. Rev. Proc. 2007-44 requires

discretion, require additional

that all plan documents must be

information any time it is deemed

7. Any other information or material

restated for the current cumulative list.

necessary. See section 7.05 of Rev.

required by the IRS.

•

Partial termination. For a partial

Proc. 2011-6, 2011-1 I.R.B. 195

8. A copy of any compliance

termination you must:

available at

gov/irb/

statement or closing agreements

2011-01_IRB/index.html.

1. File the application form and the

entered into in regards to this plan.

appropriate documents and statements.

Note. Rev. Proc. 2011-6 publishes the

(See the Procedural Requirements

2. Attach a statement indicating if a

guidance under which the DL program

Checklist on Form 5300 to ensure

partial termination may have occurred

is administered. It is updated annually

that your submitted package is

or might occur as a result of proposed

and can be found in the Internal

complete.)

actions.

Revenue Bulletin (I.R.B.). Example:

3. Using the format in the Partial

Rev. Proc. 2011-6 superseded Rev.

Termination Worksheet above, submit a

Proc. 2010-6.

schedule of information for the plan

Type of Determination

year in which the partial (or potential

What To File

partial) termination began. Also, submit

Letter Requested

a schedule for the next plan year, as

Note. Payments for sanction fees,

well as for the 2 prior plan years, to the

compliance fees, etc. should be

Initial Qualification

extent information is available.

submitted on separate checks.

For initial qualification of a plan file

If the plan has more than one benefit

one copy of all instruments that make

1. A check for the appropriate user

computation formula, complete the

up the plan.

fee, if applicable, and Form 8717, User

Partial Termination Worksheet. Also

-2-

Instructions For Form 5300 - Application For Determination For Employee Benefit Plan - Department Of Treasury Page 2

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