5308
Request for Change in Plan/Trust Year
OMB No. 1545-0201
Form
(Under section 412(c)(5) of the Internal Revenue Code)
File in
(Rev. November 2010)
Duplicate
Department of the Treasury
Internal Revenue Service
Before you complete this form, read the instructions on page 2 to see if your request for a change in plan/trust
year qualifies for automatic approval.
Employer identification number
Name of employer (or plan administrator if a multiple employer plan)
Number, street, and room or suite no. (If a P.O. box, see instructions.)
Check one or both:
Change in plan year .
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City or town, state and ZIP code
Change in trust year .
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$
1
Enter amount of user fee submitted
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2
Name of plan and/or trust
3
Plan number (Enter each
digit in a separate block.)
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Present plan and/or trust year ends
5 Permission is requested to change to a plan and/or trust year ending
4
6
The above change will require a return for a short period
7 Telephone number
beginning
,
, ending
,
8
Date of latest IRS determination letter (or opinion/advisory letter if the plan is a Master or Prototype/Volume Submitter Plan)
9
If this change affects the way deductions are taken for the tax year, please explain. (See Rev. Rul. 2002-73, 2002-45 I.R.B. 805)
10
If you do not meet all the requirements for automatic approval for change in plan/trust year listed below, indicate the requirements you
do not meet by checking the appropriate box(es). Explain on an attached statement why you cannot meet the requirement(s). If you
cannot comply with item a, your request for approval will not be granted.
a
d
All actions necessary to implement the change of plan
The trust, if any, retains its exempt status for the
year, including plan amendment and a resolution of the
short period required to effect the change as well as
Board of Directors, if applicable, have been taken on or
for the taxable year immediately preceding the short
before the last day of the short period.
period.
No plan year is longer than 12 months.
The trust, if any, has no unrelated business taxable income
b
e
under section 511 of the Code for the short period.
c
The requested change will not delay the time when the
plan would otherwise have been required to conform to
No change of plan year has been made for any of the 4
f
the requirements of any statute, regulation, or published
preceding plan years.
position of the IRS.
Defined benefit plan deductions are taken as described in
g
section 5 of Rev. Proc. 87-27, 1987-1 C.B. 769.
Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules and statements, and to the best of my
knowledge and belief it is true, correct, and complete.
Sign
Here
Print Name
Title
Signature
Date
Do not write in the space below—For IRS Use Only
Approval Action
Disapproval Action
This application cannot be approved for the following reason:
Based solely on the information furnished in this application, the
requested change in the plan and/or trust year indicated above is
Not timely filed
approved.
Other
Employee Plans Technical Manager
Date
Employee Plans Technical Manager
Date
Person to contact
Person to contact
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Phone
Phone
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Symbols
Symbols
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5308
For Paperwork Reduction Act Notice, see the instructions on page 2.
Form
(Rev. 11-2010)
Cat. No. 11834U