Form 5434 - Application For Enrollment - Joint Board For The Enrollment Of Actuaries Page 3

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Instructions for Form 5434, Joint Board for the Enrollment of Actuaries Application for Enrollment

General Instructions

Before filling out Form 5434, Application for Enrollment, read the regulations (Parts 901 and 902 of Title 20 of the Code of Federal

Regulations). Unless otherwise indicated, section numbers (e.g., 901.12(b)) cited on the form and in the instructions refer to the

regulations. You may download a copy of the regulations from

You should not complete Form 5434 until you have satisfied the qualifying experience in section 901.12(b), the basic actuarial

knowledge requirement in section 901.12(c), and the pension actuarial knowledge requirement in section 901.12(d).

To register for a Joint Board examination, please contact the Society of Actuaries ( ).

If you send us a check for the application fee, your check will be converted into an electronic fund transfer. The electronic fund transfer

from your account will usually occur within 24 hours of receipt. For more information, see

Instructions for Certain Line Items

Items 6 and 13

As part of the application process, we may check your Federal tax history to verify that you have timely filed and paid your

Federal taxes.

Item 8

You must have, within the 10-year period immediately preceding the date of application, either

(1) a minimum of 36 months of certified responsible pension actuarial experience or

(2) a minimum of 60 months of certified responsible actuarial experience including at least 18 months of responsible pension

actuarial experience.

The terms "responsible actuarial experience," "responsible pension actuarial experience," "certified responsible actuarial experience,"

and "certified responsible pension actuarial experience" are defined in section 901.1. You should account in Schedule A (Employment

Record) for all such experience within the last 10 years or, if shorter, since your completion of full-time studies.

Item 9

If you are claiming transition credit for an examination taken prior to January, 2001, please so indicate. You may review the transition

rules at

Schedule A (Employment Record)

You must complete and attach Schedule A for your application to be complete. If employment for an employer consisted of two (or

more) periods, one of which consisted of responsible pension actuarial experience and the other(s) did not, treat this as different

periods of employment in separate blocks of Schedule A. Attach additional Schedules A if needed. In general, the individual asked to

certify your experience should be your immediate supervisor. However, if your immediate supervisor is not an enrolled actuary, both

your immediate supervisor and an enrolled actuary must certify your responsible pension actuarial experience.

In addition, if you believe that another individual is better able to certify your experience, please explain and provide the individual's

name, position title, address, and telephone number in addition to the same information provided for your immediate supervisor. If you

believe it is appropriate for several individuals to certify your experience for different periods of time with the same employer, provide

the names of such individuals, their position titles, addresses and telephone numbers

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Privacy Act and Paperwork Reduction Act Notice

Section 1242, United States Code, authorizes the Joint Board for the Enrollment of Actuaries (Joint Board) to collect this information. The primary use of

the information is to enforce and administer the regulations of the Joint Board governing the practice of an actuary under the Employee Retirement

Income Security Act of 1974 (ERISA). Information may be disclosed to: the Department of Justice when seeking advice or for use in any proceeding;

courts and other adjudicative bodies; public authorities for their use in connection with employment, contracting, licensing, and other benefits; public

authorities for their use in connection with their regulatory, enforcement, investigative, or prosecutorial responsibilities; contractors as necessary for

performance of the contract; third parties as necessary during an investigation; the Department of Labor, the Department of the Treasury, and the

Pension Benefit Guaranty Corporation for administering and enforcing ERISA or in connection with maintaining standards of integrity, conduct, and

discipline on the part of individuals who practice before such agencies; the general public (including disclosures via web sites) for the purpose of

publicizing or verifying the enrollment status and location of individuals who are, or were, enrolled actuaries; professional organizations or associations

for their use in connection with maintaining standards of integrity, conduct, and discipline; appropriate agencies, entities, and persons when the Joint

Board suspects or confirms that the security or confidentiality of information in a system of records has been compromised as necessary to prevent,

minimize, or remedy harm. Applying for enrollment is voluntary; however, providing the information requested on this form is a requirement to obtain the

benefit of enrollment. Failure to provide the requested information could delay or prevent processing of your application. Providing false information

could subject you to penalties.

Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a

collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB

Control Number. Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for

reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of

information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this

burden to: Joint Board for the Enrollment of Actuaries c/o IRS/Office of Professional Responsibility; SE:OPR; 1111 Constitution Avenue, NW;

Washington, DC 20224.

5434

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Department of the Treasury - Internal Revenue Service

Form

(Rev. 3-2012) Cat. Num. 42528L