Looking for a Form 5300 Templates? Download it for free!

•

The private delivery service can

Completion of page 4 of Form 5300

All applications for plans that have

tell you how to get written proof of the

is optional. Complete page 4 for: (a) a

at any time in the past received a

mailing date.

request for a determination regarding

favorable determination letter must

the ratio percentage test under

include a copy of the plan’s latest

Regulations section 1.410(b)-2(b)(2),

determination letter and subsequent

How to Complete the

(b) a determination regarding one of

amendments and/or restatements.

•

Application

the special requirements under

Schedule Q (Form 5300), Elective

Regulations section 1.410(b)-2(b)(5),

Determination Requests, if you want

Applications are screened for

(6), or (7), or (c) a request for a

to broaden the scope of a

completeness. The application must

determination regarding the

determination letter by requesting a

be signed by the employer, plan

nondiscrimination design-based safe

determination that your plan satisfies

administrator or authorized

harbors of section 401(a)(4).

certain qualification requirements

representative. Incomplete

relating to minimum participation,

applications may be returned to the

Revenue Procedure 2004-6

coverage, and nondiscrimination.

applicant. For this reason, it is

TIP

publishes the guidance under

Schedule Q is optional.

important that an appropriate

which the determination letter

response be entered for each line

If Schedule Q is not filed, the

program is administered. It is updated

item (unless instructed otherwise). In

determination letter issued for

annually and can be found in the

completing the application, pay

this plan will not consider and

CAUTION

Internal Revenue Bulletin (I.R.B.).

careful attention to the following:

may not be relied upon with regard to

•

Example. Rev. Proc. 2004-6, 2004-1

N/A (not applicable) is accepted as

the general test and certain other

I.R.B. 197 superseded Rev. Proc.

a response only if an N/A block is

provisions under section 401(a)(4),

2003-6.

provided.

the average benefit test under section

•

If a number is requested, a number

410(b), and the definition of

What To File

must be entered.

compensation provisions of section

•

All applications must contain an

If an item provides a choice of

414(s).

original signature and must be

boxes to check, check only one box

accompanied by the following

unless instructed otherwise.

•

applicable items:

If an item provides a box to check,

Types of Determination

•

written responses are not acceptable.

A copy of the plan.

•

Letters

Governmental plans and

The appropriate user fee, if

nonelecting church plans do not have

applicable, and Form 8717, User Fee

Initial Qualification. For initial

to complete lines 10 and 12a.

for Employee Plan Determination

qualification of a plan or when

•

The IRS may, at its discretion,

Letter Request. Please submit a

requesting a determination letter after

require a plan restatement or

separate check for each application.

initial qualification for a plan that has

additional information any time it is

Make checks payable to the “United

not been amended (for example,

deemed necessary.

States Treasury.”

because of changes in employee

demographics), file one copy of all

Figure 1. Partial Termination Worksheet

instruments that make up the plan.

Entire Plan as Amended. When

Year of

requesting a determination letter on

partial

Partial Termination Worksheet

the entire plan as amended after

Year

Year termination Year

initial qualification file:

- - - -

- - -

1. One copy of the plan and trust

Participants employed: . . . . . . . . . . . . . . . . . .

plus all amendments made to date;

2. One copy of the latest

a Number at beginning of plan year . . . . . . . . . . .

determination letter, including

b Number added during the plan year . . . . . . . . .

caveats; and

3. A statement explaining how any

c Total, add lines a and b . . . . . . . . . . . . . . . . . .

amendments made since the last

d Number dropped during the plan year . . . . . . . .

determination letter affect this or any

other plan of the employer.

e Number at end of plan year, subtract d from c . .

f Total number of participants in this plan

Complex amendments. Use Form

separated from service without full vesting . . . .

5300, as described under Entire Plan

as Amended above, for complex

Present value (as of month

amendments, including amendments

day during the year of): . . . . . . . . . . . . . . . . . .

with significant changes to plan

a Plan assets . . . . . . . . . . . . . . . . . . . . . . . . . .

benefits or coverage. If there have

been four or more amendments to the

b Accrued benefits . . . . . . . . . . . . . . . . . . . . . . .

plan a restated plan is required. For

c Vested benefits . . . . . . . . . . . . . . . . . . . . . . . .

restatement purposes, do not count

an amendment making only minor

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

plan changes as a plan amendment.

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

Minor amendments. Use Form

of section 411(d)(3).

6406, instead of Form 5300 to

request a determination letter on the

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Instructions For Form 5300 - Application For Determination For Employee Benefit Plan - 2004 Page 2

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