Form 5310 - Application For Determination For Terminating Plan Page 6
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136
Form 5310 (Rev. 12-2013)
Page
(Line 7 continued)
(4)
Enter the EIN of the employer submitting the controlling plan.
(5)
Enter the 3-digit plan number of the controlling plan.
Yes
No
Have interested parties (as defined in Regulations section 1.7476-1(b)(5)) been given the required notification of
8a
this application?
If “Yes,” complete line 8b.
If “No,” go to line 9.
If line 8a is “Yes,” enter the date of notification.
b
Is a separate DL application for this plan currently pending before the IRS?
9
Does this plan satisfy one of the design-based safe harbor requirements for contributions or benefits
10a
under Regulations section 1.401(a)(4)-2(b) or 3(b)?
If “Yes,” go to line 10b.
If “No,” go to line 11a.
b
Is this an election for a determination regarding a design-based safe harbor?
If “Yes,” complete lines 10c through 10e.
If “No,” go to line 11a.
c
Enter the letter (“A” - “E”) from the list below that identifies the safe harbor intended to be satisfied.
A = 1.401(a)(4)-2(b)(2) defined contribution (DC) plan with uniform allocation formula
B = 1.401(a)(4)-3(b)(3) unit credit defined benefit (DB) plan
C = 1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit DB fractional rule plan
D = 1.401(a)(4)-3(b)(4)(i)(C)(2) flat benefit DB plan
E = 1.401(a)(4)-3(b)(5) insurance contract plan
Does this plan satisfy one of the safe harbor definitions of compensation under Regulations sections
d
1.414(s)-1(c)(2) or (3)?
e
List the plan section(s) that satisfy the design-based safe harbor (including, if applicable, the permitted disparity requirements):
11a
Does this plan have a cash or deferred arrangement (CODA)?
If “Yes,” go to line 11b(1).
If “No,” go to line 11e.
b (1)
Does the CODA satisfy a safe harbor?
If “Yes,” go to line 11b(2).
If “No,” go to line 11d.
(2)
Indicate by using the corresponding number from the instructions the type of 401(k) safe harbor that was
satisfied.
1. 401(k)(12)(B)
2. 401(k)(12)(C)
3. 401(m)(11)(B)
5310
Form
(Rev. 12-2013)
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