Form 5300, Application for Determination for Employee Benefit Plan, Schedule Q (Form 5300), Elective Determination Requests

Instructions for Form 5300
(Rev. December 2013)

Department of the Treasury
Internal Revenue Service

Application for Determination for Employee Benefit Plan
Section references are to the Internal Revenue
Code unless otherwise noted.

Future Developments

For the latest information about
developments related to Form 5300 and
its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form5300.

What's New

The form and the instructions have
undergone revisions in the format and
the information required. Some of the
revisions were made under
Announcement 2011-82, 2011-52 I.R.B.
1052, which eliminated demonstrations
regarding coverage and
nondiscrimination requirements and
limited Form 5307, Application for
Determination for Adopters of Modified
Volume Submitter (VS) Plans
applications.
Note. Rev. Proc. 2013-6, 2013-1 I.R.B.
198, available at www.irs.gov/irb/
2013-01_IRB/ar11.html as updated by
Ann. 2013-13, 2013-9 I.R.B. 532,
available at www.irs.gov/irb/
2013-09_IRB/ar11.html and Ann.
2013-15, 2013-11 I.R.B. 652, available
at www.irs.gov/irb/2013-11_IRB/
ar19.html contains the guidance under
which the determination letter (DL)
program is administered. The Rev.
Proc. is updated annually and can be
found in the Internal Revenue Bulletin
(I.R.B.). The application should be filed
under Rev. Proc. 2007-44, 2007-28
I.R.B. 54 available at www.irs.gov/irb/
2007-28_IRB/ar12.html (as revised by
Ann. 2011-82), and Rev. Proc. 2013-6.
Review these documents before
completing the application.
Disclosure Request by Taxpayer. A
taxpayer can authorize the IRS to
disclose and discuss the taxpayer's
return and/or return information with any
person(s) the taxpayer designates in a
written request. Use Form 2848, Power
of Attorney and Declaration of
Representative, if the representative is
qualified to sign, or Form 8821, Tax
Information Authorization, for this
purpose. See Pub. 947, Practice Before
the IRS and Power of Attorney, for more
information.

Dec 20, 2013

Public Inspection. Form 5300 is open
to public inspection if there are more
than 25 plan participants. The total
number of participants must be shown
on line 4e. See the instructions for
line 4e for a definition of participant.

General Instructions
Purpose of Form

File Form 5300 to request a DL from the
IRS for the qualification of a defined
benefit (DB) or a defined contribution
(DC) plan and the exempt status of any
related trust.

Who May File

This form may be filed by any:
Employer, including a sole
proprietor, partnership, plan sponsor, or
a plan administrator that has adopted an
individually designed plan to request a
DL on:
1. Initial qualification of a plan; or
2. Qualification of an entire plan as
amended.

Employer, plan sponsor, or plan
administrator, requesting a DL for
compliance with the applicable
requirements of a foreign situs trust for
the taxability of beneficiaries (section
402(c)) and deductions for employer
contributions (section 404(a)(4)).
File Form 5307 instead of Form
5300, if this is a VS plan that has made
limited modifications to an approved
specimen plan (that does not create an
individually designed plan).
Note. Adopters of Master and
Prototype (M&P) plans may not use
Form 5307.
In certain circumstances as noted in
instructions to lines 3a(2), 3g and 6i, an
application for a DL for a VS or M&P
plan must be filed on Form 5300 and the
plan will be reviewed on the basis of the
Cumulative List (CL) that was
considered in issuing the opinion or
advisory letter for the plan. For all other
pre-approved plan submissions on
Form 5300, follow the applicable
procedures for individually designed
plan submissions, except as specifically
noted in these instructions.
Cat. No. 10932P

Note. If no changes have been made
by an adopting employer other than to
select among options in the adoption
agreement or make other permitted
changes as specified in section 19.03 of
Rev. Proc. 2011-49, 2011-44 I.R.B. 608
available at www.irs.gov/irb/
2011-44_IRB/ar08.html (and if the
special requests described under lines
3(a)(2), 3g and 6i do not apply) an
adopting employer can rely on a
favorable opinion or advisory letter for
the plan and a DL is not required for
reliance.

Type of Plan

A DC plan is a plan that provides an
individual account for each participant
and for benefits based only on:
1. The amount contributed to the
participant's account, and
2. Any income, expenses, gains and
losses, and any forfeiture of accounts of
other participants that may be allocated
to the participant's account.
A DB plan is any plan that is not a DC
plan.
Termination of Plan. If the plan is
terminated, file Form 5310, Application
for Determination For Terminating Plan.
If benefit accruals or contributions
have ceased, the plan and trust will not
be considered terminated until an
official action to terminate has occurred.
Note. A DB plan cannot be amended to
become a DC plan. If a sponsor of a DB
plan attempts to amend the plan to
become a DC plan, or if the merger of a
DB plan with a DC plan results solely in
a DC plan, the DB plan is considered
terminated.

Where To File

File Form 5300 at the address indicated
below:
Internal Revenue Service
P.O. Box 12192
Covington, KY 41012-0192
Requests shipped by express mail or
a delivery service should be sent to:

Internal Revenue Service
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011
Private delivery services. In addition
to the United States mail, you can use
certain private delivery services
designated by the IRS to meet the
“timely mailing as timely filing/paying”
rule for tax returns and payments. The
list of designated private delivery
services includes only the following:
DHL Express (DHL): DHL Same Day
Service.
Federal Express (FedEx): FedEx
Priority Overnight, FedEx Standard
Overnight, FedEx 2Day, FedEx
International Priority, FedEx
International First.
United Parcel Service (UPS): UPS
Next Day Air, UPS Next Day Air Saver,
UPS 2nd Day Air, UPS 2nd Day Air
A.M., UPS Worldwide Express Plus,
and UPS Worldwide Express.
For the IRS mailing address to use if
you are using a private delivery service,
go to IRS.gov and enter “private delivery
service” in the search box.
The private delivery service can tell
you how to get written proof of the
mailing date.

How To Complete the
Application

The application must be complete and
signed by the employer, plan
administrator, or authorized
representative.
Note. Stamped signatures are not
acceptable.
Incomplete applications may be
returned to the applicant. It is important
that an appropriate response be entered
for each line item (unless instructed
otherwise). When completing the
application:
N/A (not applicable) is accepted as a
response only if an N/A block is
provided.
If a number is requested, a number
must be entered.
If an item provides a choice of boxes
to mark, mark only one box unless
instructed otherwise.
If an item provides a box to mark,
written responses are not acceptable.
The IRS may require additional
information.
The application has formatted fields
that will limit the number of characters
entered per field.

All data input should be entered in
Courier 10 point font.
Alpha characters should be entered
in capital letters.
Enter spaces between any words.
Spaces do count as characters.
All date fields are entered as an
eight-digit field (MM/DD/YYYY).
Any attachment should refer to the
form and the line item.

What To File

All applications (including applications
for pre-approved plans, except as
otherwise noted) must contain an
original signature and be accompanied
by the following:
1. A completed Form 5300.
2. A Form 8717, User Fee for
Employee Plan Determination Letter
Request, and, if applicable, a check for
the appropriate user fee. Submit a
separate check for each application.
Make checks payable to the “United
States Treasury.”
Note. Payments for sanction fees,
compliance fees, etc. should be
submitted on separate checks.
3. Form 8905, Certification of Intent
To Adopt a Pre-Approved Plan, if
applicable as determined under Part III
of Rev. Proc. 2007-44.
4. A copy of the plan (all instruments
that make up the plan in the case of
initial qualification and a copy of the
restated plan and trust, in the case of an
amended plan where a DL is requested
on the plan after initial qualification). A
plan must be restated except for certain
requests related to pre-approved plans.
See lines 3a(2), 3g, and 6i.
5. A copy of the latest DL if the plan
has received one. If not available,
explain why and include a copy of the
prior plan or adoption agreement
(including the opinion letter or advisory
letter, if applicable).
6. Submit copies of all signed and
dated interim and other plan
amendments since the last restatement.
If the plan does not have a DL for the
preceding remedial amendment cycle
(RAC), the plan sponsor must include
with this application filing, copies of
interim and discretionary amendments
adopted for the preceding cycle.
However, do not list these amendments
in the table in line 3m.
Note. If the plan is a pre-approved
(M&P or VS) plan, do not submit any
interim or other amendments to the plan
that were adopted by the M&P sponsor
or VS practitioner on behalf of the
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employer and considered by the Service
in issuing an opinion or advisory letter
for the plan.
7. A copy of any compliance
statement(s) or closing agreement(s)
regarding this plan issued during the
current RAC.
8. When requesting a DL on the
entire plan as amended after initial
qualification, attach a statement
explaining how any amendments made
since the last DL affect this or any other
plan of the employer.
9. In the case of a pre-approved
plan not requesting a special ruling
under lines 3a(2), 3g, and 6i, attach an
explanation why Form 5300 is being
filed. In this case, the plan will be
reviewed on the basis of the CL in effect
when the application is filed (the
“current list”). The application must
include all interim amendments to the
plan for qualification changes and
guidance on the current list (as well as
all discretionary amendments adopted
by the date of the application) that were
not considered in the current opinion or
advisory letter for the plan, regardless of
whether those amendments were
adopted by the sponsor of the
pre-approved plan document on the
employer’s behalf.
10. If this is a special ruling request
for a DL for an adopting employer of a
pre-approved plan as described under
lines 3a(2), 3g, and 6i, include a copy of
the opinion or advisory letter and except
in the case of a VS plan that does not
authorize the practitioner to amend the
plan on behalf of adopting employers do
not include any interim amendments.
The plan will be reviewed on the basis
of the CL that was considered in issuing
the opinion and advisory letter for the
plan and the plan need not be restated.
For an employee stock ownership
plan (ESOP), attach Form 5309,
Application for Determination of
Employee Stock Ownership Plan.
Note. Do not use staples (except to
attach the check to the Form 8717),
paper clips, binders, or sticky notes. Do
not punch holes in the documents.
Note. See the Procedural
Requirements Checklist to ensure that
the application package is complete
before submitting it.

Specific Instructions
Line 1. Enter the name, address, and
telephone number of the plan sponsor/
employer.

A plan sponsor means:
1. In the case of a plan that covers
the employees of one employer, the
employer;
2. In the case of a plan sponsored
by two or more entities required to be
combined under sections 414(b), (c), or
(m), one of the members participating in
the plan; or
3. In the case of a plan that covers
the employees and/or partner(s) of a
partnership, the partnership.
Note.
The name of the plan sponsor/
employer should be the same name that
is used when the Form 5500 series
annual return/report is filed for the plan.
Line 1a is limited to 70 characters.
Line 1f. Enter the 9-digit employer
identification number (EIN) assigned to
the plan sponsor/employer. This should
be the same EIN that is used when the
Form 5500 series annual returns/report
is filed for this plan. For a multiple
employer plan, the EIN should be the
same EIN that was or will be used by
the participating employer when Form
5500 is filed by the employer.

!

Do not use a social security
number or the EIN of the trust.

CAUTION

The plan sponsor/employer must
have an EIN. A plan sponsor/employer
without an EIN can apply for one.
Online—Generally, a plan sponsor/
employer can receive an EIN by internet
and use it immediately to file a return.
Go to the IRS website at www.irs.gov/
businesses/small and click on Employer
ID Numbers (EINs).
By telephone—Call
1-800-TAX-FORM (829-4933).
By mail or fax—Send in a completed
Form SS-4, Application for Employer
Identification Number, to apply for an
EIN.
The plan of a group of entities
required to be combined under section
414(b), (c), or (m), whose sponsor is
more than one of the entities required to
be combined, should only enter the EIN
of one of the sponsoring members.
This EIN must be used in all
subsequent filings of DL requests, and
annual returns/reports unless there is a
change of sponsor.
Line 1i. Enter the two digits
representing the month the plan
sponsor/employer's tax year ends.
Lines 1j through 1m. If a foreign
entity, follow the country's practice for

entering the name of the city or town,
province/country, and the postal code.
Line 2. The contact person will receive
copies of all correspondence as
authorized in a Form 2848 or Form
8821. Either complete the contact's
information on this line, or mark the box
and attach a completed Form 2848 or
Form 8821.
Lines 2h through 2k. If a foreign
contact, follow the country's practice for
entering the name of the city or town,
province/country, and the postal code.
Line 3a. Enter the number(s) that
correspond to the request(s) being
made. The box under line 3a(1) must
contain a 1, 2, or 3. Use the second box
under line 3a(2) if a special ruling is
requested.
Line 3a(1).
Enter 1 if, for this purpose, a new
individually designed plan is a new plan
with an initial remedial amendment
period within the meaning of
Regulations section 1.401(b)-1(d)(1).
Enter 2 if the IRS has not issued a
DL for the plan or the plan sponsor
previously did not rely on an opinion/
advisory letter.
Enter 3 if the IRS has previously
issued a DL for this plan or the plan
sponsor previously relied on an opinion/
advisory letter.
Line 3a(2). Special ruling request
items 4-6 apply to both individually
designed and pre-approved plans. Item
7 only applies to individually designed
plans. See special instructions for
pre-approved plans under What To File.
Enter 4 if requesting a letter
concerning the effect of section 414(m),
attach the following information.
1. A description of the nature of the
business of the employer. Specifically
state whether it is a service organization
or an organization whose principal
business is the performance of
management functions for another
organization, including the reason for
performing the management function or
service.
2. The identification of other
members (or possible members) of the
affiliated service group (ASG).
3. A description of the nature of the
business of each member (or possible
member) of the ASG including the type
of organization (corporation,
partnership, etc.) and indicate whether
such member is a service organization
or an organization whose principal
business is the performance of
-3-

management functions for the other
group member(s).
4. The ownership interests between
the employer and the members (or
possible members) of the ASG
(including ownership interests as
described in section 414(m)(2)(B)(ii) or
414(m)(6)(B)).
5. A description of services
performed for employers by the
members (or possible members) of the
ASG, or vice versa. Include the
percentage of each member's (or
possible member's) gross receipts and
service receipts provided by such
services, if available, and data as to
whether their services are a significant
portion of the member's business and
whether or not, as of December 13,
1980, it was unusual for the services to
be performed by employees of
organizations in that service field in the
United States.
6. A description of how the
employer and the members (or possible
members) of the ASG associate in
performing services for other parties.
7. A description of management
functions, if any, performed by the
employer for the members (or possible
members) of the ASG, or received by
the employer from any other members
(or possible members) of the group
(including data as to whether such
management functions are performed
on a regular and continuous basis) and
whether or not it is unusual for such
management functions to be performed
by employees of organizations in the
employer's business field in the United
States.
a. If management functions are
performed by the employer for the
members (or possible members) of the
ASG, describe what part of the
employer's business constitutes the
performance of management functions
for the members (or possible members)
of the group (including the percentage
of gross receipts derived from
management activities as compared to
the gross receipts from other activities).
8. A brief description of any other
plan maintained by the members (or
possible members) of the ASG, if such
other plan is designated as a unit for
qualification purposes with the plan for
which a DL has been requested.
9. A copy of any ruling issued by the
Washington, DC, office on whether the
employer is an ASG; a copy of any prior
DL that considered the effect of section
414(m) on the qualified status of the
employer's plan; and, if known, a copy

of any such ruling or DL issued to any
other member (or possible member) of
the same ASG, accompanied by a
statement as to whether the facts upon
which the ruling or DL was based have
changed.
Enter 5 if requesting a letter
concerning the effect of section 414(n),
attach the following information.
1. A description of the nature of the
business of the recipient organization.
2. A copy of the relevant leasing
agreement(s).
3. A description of the function of all
leased employees in the trade or
business of the recipient organization
(including data as to whether all leased
employees are performing services on a
substantially full-time basis).
4. A description of facts and
circumstances relevant to a
determination of whether such leased
employees' services are performed
under primary direction or control of the
recipient organization (including
whether the leased employees are
required to comply with instructions of
the recipient about when, where, and
how to perform the services, whether
the services must be performed by
particular persons, whether the leased
employees are subject to the
supervision of the recipient, and
whether the leased employees must
perform services in the order or
sequence set by the recipient).
5. If the recipient organization is
relying on any qualified plan(s)
maintained by the employee leasing
organization for purposes of
qualification of the recipient
organization's plan, a description of the
plan(s) (including a description of the
contributions or benefits provided for all
leased employees that are for services
performed for the recipient organization,
plan eligibility, and vesting).

Partial Termination Worksheet
1

Year

Year

Year of partial termination

Year

Participants employed:
a Number at beginning of plan year
b Number added during the plan year
c Total, add lines a and b
d Number dropped during the plan year
e Number at end of plan year, subtract d
from c
f Total number of participants in this plan
separated from service without full
vesting

2

Present value (as of month
during the year of

/

day)

a Plan assets
b Accrued benefits
c Vested benefits
3

Submit a description of the actions that may have resulted (or might result) in a partial
termination. Include an explanation of how the plan meets the requirements of section 411(d)
(3).

affect this or any other plan of the
employer,
4. A statement indicating whether a
partial termination may have occurred or
may occur as a result of proposed
actions and include a statement
describing the applicable actions,
5. A schedule of information for the
plan year in which the partial (or
potential partial) termination began,
using the format in the Partial
Termination Worksheet. Also include on
the schedule data for the subsequent
plan year, as well as for the 2 prior plan
years,
6. If the plan has more than one
benefit computation formula, complete a
Partial Termination Worksheet for each
benefit formula, and
7. Include an explanation of how the
plan meets the requirements of section
411(d)(3).
Enter 7 if this is a termination of a
multiemployer or a multiple employer
plan covered by Pension Benefit
Guaranty Corporation insurance. Insert
date of termination.

Enter 6 if this is a request for the
effect a potential partial termination will
have on the plan’s qualification. The
“effective date” means the date the
partial termination occurred. Enter this
date on line 3c.

Line 3b. If the initial plan is a proposed
plan document, enter “09/09/9999.”

Partial termination. For a partial termination submit:
1. A copy of the restated plan and
trust plus all amendments made to the
date the plan is adopted,
2. A copy of the latest DL, including
caveats,
3. A statement explaining how any
amendments made since the last DL

Lines 3g(1) and (2). See special
instructions under What To File, for
rules that apply to pre-approved plans
asking for rulings under lines 3(a)(2),
3(g) and 6(i). In other circumstances
where a pre-approved plan is asking for
a determination under Form 5300, these
special rules (reviewing on the basis of
the underlying CL) do not apply. Attach
an explanation explaining why the Form
-4-

5300 is being filed and see What To
File.
Mark “Yes” in the applicable box if
this is a multiple employer plan. For
multiple employer plans that do not
involve collective bargaining, submit
either:
1. An application for the plan in the
name of the controlling member, or
2. An application for the plan in the
name of the controlling member and an
application for each employer
maintaining the plan who desires an
individual DL. Each Form 5300 must be
signed by the respective employers.
Mark “Yes” in the applicable box if
this is a DL request required pursuant to
published guidance by the Service,
such as a minimum funding waiver. If
this is a minimum funding waiver
request, see section 15 of Rev. Proc.
2013-6.
Mark “Yes” in the applicable box if
this is an M&P plan where the adopting
employer has added language to satisfy
the requirements of sections 415 and
416 because of the required
aggregation of plans.
Mark “Yes” in the applicable box if the
VS or M&P plan is a pension plan with a
normal retirement age earlier than age
62. In this case the employer must
submit a signed statement that this is a
good faith determination of the typical
retirement age for the industry in which
the covered workforce is employed. See
Regulations section 1.401(a)-1.
Line 3h. An individually designed plan
is eligible for the 6-year RAC if the
employer that sponsors the plan and the

sponsor of a pre-approved M&P or VS
plan document jointly executed Form
8905 before the end of the plan’s 5-year
RAC which ends within the current
6-year RAC. An individually designed
plan is also eligible for the 6-year cycle
under certain other circumstances set
forth in section 17 of Rev. Proc.
2007-44.
Line 3i. A VS plan may, but is not
required to, contain a provision that
authorizes the VS practitioner to amend
the plan on behalf of employers who
have previously adopted the plan. For
purposes of reliance on the advisory
letter, the practitioner will no longer
have the authority to amend the plan on
behalf of the employer as of the date of
the adoption of an employer
amendment to the plan to incorporate a
type of plan not allowable in the VS
program or as of the date the Service
notifies the practitioner that the plan is
an individually designed plan. See
section 15.03 of Rev. Proc. 2011-49.
Line 3j. The plan sponsor is an
“identical adopter” of a pre-approved
M&P or VS plan and has made no
changes to the pre-approved plan
document other than to select among
options provided under the plan or
certain changes described in section
19.03 of Rev. Proc. 2011-49.
Line 3m. Use the table to list all the
amendments to the plan that have been
adopted during the RAC of the plan in
which the application is submitted (the
“current cycle”), other than amendments
described in the following paragraph.
Do not list:
1. Any amendment that was
adopted during the current cycle as a
condition of a DL for the preceding cycle
(but include a copy of the amendment
with the application);
2. Any amendment to a
pre-approved plan that was adopted by
the sponsor on behalf of the employer
and considered by the Service in
issuing an opinion or advisory letter for
the plan;
3. If 4-7 is entered in line 3a(2) or if
1-4 is entered in line 3g, any
amendment to a pre-approved plan that
is effective after the year of the CL that
was considered by the Service in
issuing an opinion or advisory letter for
the plan, regardless of whether the
amendment was adopted by the
sponsor of the pre-approved document
or the employer;
4. Any interim amendment not
included on the CL for which this
determination is being requested.

Note. If the plan does not have a DL for
the preceding RAC and the plan
sponsor is not entitled to rely on an
opinion or advisory letter for that cycle,
the plan sponsor must include with the
application copies of interim
amendments adopted for the preceding
cycle. See What To File. However, do
not list these amendments in the table in
line 3m.
Column (i). Note each amendment
using an identifying number or name
(such as Amendment 1, or PPA
Amendment). An amendment may
consist of modifications made to several
plan provisions that are adopted on the
same date. Two or more amendments
with the same adoption date may be
grouped and listed on a single line of the
table. In this case, enter in column (ii)
the effective date of the amendment
with the earliest effective date of any of
the grouped amendments.
Column (ii). Enter the date the
amendment is actually effective under
the plan. For example, if an amendment
is effective on the first day of the first
plan year beginning on or after January
1, 2013, and the plan year of the plan
ends on June 30, the date to be entered
in column (ii) is 07/01/2013.
Column (iii). If the amendment is in
proposed form enter 09/09/9999.
Column (vi). For each individual
amendment listed, did the pre-approved
plan sponsor have the power to amend
the plan on behalf of the adopting
employer? If “Yes,” enter “X” in this
column.
Column (vii). Note the due date of
the employer's tax return, including
extensions, if applicable, for the year in
which the amendments were adopted. If
the relevant amendment is discretionary
only, this field should be blank.
Line 3n. Enter number of amendments
listed in the table in line 3m.
Line 3o. Designate the specific tax
return that the employer uses to file its
return. For example, Form 1120, 1040
or Form 990 series (in the case of a
tax-exempt employer). For a tax-exempt
employer, the section 990 series is a
substitute for an income tax return. If no
tax return is filed by the entity (such as a
governmental employer) write “N/A” in
the box. See section 5.06(2) of Rev.
Proc. 2007-44 for details.
Line 4a. This field is limited to 70
characters, including spaces. Fill in the
plan name as it should appear on the
DL. Keep in mind that “Employees” and
-5-

“Trust” are not necessary in the plan
name and will be left off if space does
not permit.
Line 4b. Enter the three-digit plan
number, beginning with "001" and
continuing in numerical order for each
plan you adopt (001-499). The
numbering will differentiate your plans.
The number assigned to a plan must not
be changed or used for any other plan.
This should be the same number that is
used when the Form 5500 series annual
returns/report is filed.
Line 4c. Plan month means the month
in which the plan year ends. Enter the
two-digit month (MM).
Line 4e. Enter the total number of
participants. A participant is:
1. Any employee participating in the
plan, including employees under a
section 401(k) qualified cash or deferred
arrangement who are eligible but do not
make elective deferrals,
2. Retirees and other former
employees who have a nonforfeitable
right to benefits under the plan, and
3. The beneficiaries of a deceased
employee who is receiving or will in the
future receive benefits under the plan.
Include one beneficiary for each
deceased employee regardless of the
number of individuals receiving benefits.
Example. Payment of a deceased
employee's benefit to three children is
considered a payment to one
beneficiary.
Lines 4f and 4g. See Notice 2002-1,
2002-2 I.R.B. 283 (as amplified by
Notice 2003-49, 2003-32 I.R.B. 294,
and Notice 2011-86, 2011-45 I.R.B.
698) for further details, including how to
determine compensation.
Line 5a. A Pension Equity Plan (PEP)
is a DB plan which, rather than or in
addition to expressing the accrued
benefit as a life annuity commencing at
normal retirement age, defines benefits
for each employee as an amount equal
to an accumulated percentage of final
pay. Benefits are generally described as
a percentage of final average pay, with
the percentage determined as the
accumulation of percentage points or
lump sum credits received for each year
of service. Generally, the accumulated
percentage points or lump sum credits
are multiplied by final average or career
average compensation to determine the
lump sum amount.
A “cash balance” plan is a DB plan
which, rather than or in addition to
expressing the accrued benefit as a life

annuity commencing at normal
retirement age, defines benefits for
each employee in terms more common
to a DC plan, that is, as a single sum
amount equal to the employee’s
hypothetical account balance. Benefits
consist of an accumulation of
hypothetical allocation credits to an
account plus hypothetical accumulated
interest credits on that account.
Line 5b(2). If the plan’s normal
retirement age is below 62, the
employer (or trustees in the case of
multiemployer plan) must submit a
signed statement that this is a good faith
determination of the typical retirement
age for the industry in which the
covered workforce is employed. See
Regulations section 1.401(a)-(1). If this
is a governmental plan leave blank.
Line 6a(1). If the employer is a
member of a controlled group of
corporations, trades or businesses
under common control, or an ASG, all
employees of the group will be treated
as employed by a single employer for
purposes of certain qualification
requirements. Attach a statement that
provides the following in detail:
1. All members of the group,
2. The relationship of each member
to the plan sponsor,
3. The type(s) of plan(s) maintained
by each employer, and
4. Plans common to all members.
Line 6a(2). Mark "Yes" if the plan
sponsor is a foreign entity or the plan
sponsor is a member of an ASG,
controlled group of corporations, or a
group of trades or businesses under
common control that includes a foreign
entity; a nonresident alien individual;
foreign corporation; foreign partnership;
foreign trust; foreign estate or any other
person that is not a United States
person. See section 1473(5) and
7701(a)(30).
Line 6b. If “Yes,” complete only
applicable sections of this form.
Governmental plans under section
414(d) are exempt from certain
qualification requirements and are
deemed to satisfy certain other
qualification requirements under certain
conditions. For example, the
nondiscrimination, minimum
participation rules, top heavy rules, and
minimum funding standards do not
apply to governmental plans. In
addition, such plans meet the vesting
rules if they meet the pre-ERISA vesting
requirements.

Line 6c. If a church plan has not made
such an election, complete only the
portions of this form that apply.
A church plan (for which no special
election under section 410(d) has been
made) is ordinarily not subject to various
qualification requirements. Section
provisions that do not apply to a
nonelecting church plan include section
410 (relating to minimum participation
standards), section 411 (relating to
minimum vesting standards), section
412 (relating to minimum funding
standards for pension plans), and
section 4975 (relating to prohibited
transactions). In addition, provisions
relating to joint and survivor annuities,
mergers and consolidations,
assignment or alienation of benefits,
time of benefit commencement, certain
social security increases, withdrawals of
employee contributions, and
distributions after plan termination,
respectively, also do not apply.
Line 6g or 6h. Complete if this is a
request with respect to whether the
requirements of section 401(h) are
satisfied in a plan with retiree medical
benefits features and/or on plan
language that permits, pursuant to
section 420, the transfer of assets in a
DB plan to a health benefit account
described in section 401(h). Also submit
a cover letter specifically providing the
location of plan provisions for 401(h),
and section 420, if applicable. See the
Appendix in Rev. Proc. 2013-8, 2013-1
I.R.B. 237 available at www.irs.gov/irb/
2013-01_IRB/ar13.html for additional
instructions.
Line 6i(4). If the employer is submitting
the controlling plan, use the EIN for the
Form 5500. Otherwise use the EIN of
the controlling plan.
Line 7. Section 3001 of the Employee
Retirement Income Security Act of 1974
requires that applicants subject to
section 410 provide evidence that each
employee who qualifies as an interested
party has been notified of the filing of
the application. If “Yes” is marked, it
means that each employee has been
notified as required by Regulations
section 1.7476-1. If this is a one-person
plan or if this plan is not subject to
section 410, a copy of the notice is not
required to be attached to this
application. If “No” is marked or this line
is blank, the application will be returned.
Rules defining “interested parties” and
the form of notification are in
Regulations section 1.7476-1.
Line 12. If “Yes,” attach a separate
statement providing the name, EIN and
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plan type of the other plan and a copy of
pertinent plan provisions from the
related plan regarding the offset.
Line 13. If this is a request for an
individually designed plan that consists
of a DB plan and a qualified cash or
deferred arrangement, submit two
Forms 5300 and two applicable user
fees.
Line 14. Attach a statement that
provides the following:
1. Name of plans involved,
2. Type of plan,
3. Date of merger, consolidation,
spinoff, or a transfer of plan assets or
liabilities, and
4. Verification that each plan
involved was qualified at the time of the
merger, consolidation, spinoff, or a
transfer of plan assets or liabilities.
Note. Verification includes a copy of a
prior DL, if any, interim and
discretionary amendments, and the
appropriate opinion or advisory letter
and/or adoption agreement and plan
document.
If applicable, file Form 5310-A,
Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or
Liabilities; Notice of Qualified Separate
Lines of Business, 30 days prior to the
merger, consolidation, or transfer of
assets or liabilities.
Line 15a. If the plan has been restated
to change the type of plan under
Regulation section 1.401-1, answer this
question "Yes" and attach a statement
explaining the change.
Line 16a. Attach a statement for each
plan, that includes the following
information:
1. Name of plan,
2. Type of plan,
3. Form of plan (standardized,
nonstandardized, VS, or individually
designed),
4. Plan number,
5. Vesting schedule, and
6. Whether the plan has received a
DL or an application for a letter is
pending with IRS.
Lines 16b and 16c. See M-8, M-12,
and M-14 of Regulations section
1.416-1.
Line 17. Section 411(d)(6) protected
benefits include:
The accrued benefit of a participant
as of the later of the amendment's
adoption date or effective date; and

Any early retirement benefit,
retirement-type subsidy, or optional
form of benefit for benefits from service
before such amendment.
If the answer is “Yes,” explain on an
attachment how the amendment
satisfies one of the exceptions to the
prohibition on reduction or elimination of
section 411(d)(6) protected benefits.
Line 24. Applicable DC plans are
required to contain the participant
diversification rights under section
401(a)(35). In general, an applicable DC
plan means any DC plan that holds
publicly traded employer securities. DC
plans are required to have plan
language reflecting the section 401(a)
(35) rights, with exceptions including the
following:
1. The terms of the plan do not
permit any investments in employer
securities.
2. The terms of the plan provide that
the plan may invest in employer
securities, but only if these securities
are held indirectly as part of a broader
fund that is:
a. a regulated investment company
described in section 851(a),
b. a common or collective trust fund
or pooled investment fund maintained
by a bank or trust company supervised
by a State or a Federal agency,
c. a pooled investment fund of an
insurance company that is qualified to
do business in a State, or

d. an investment fund managed by
an investment manager within the
meaning of section 3(38) of ERISA for a
multiemployer plan.
3. The terms of the plan state that
the plan is a one-participant retirement
plan as defined in section 401(a)(35)(E)
(iv); or
4. The plan is an ESOP, described
in section 4975(e)(7), that does not hold
any amounts subject to sections 401(k)
or (m) and is separate from any other
plan of the employer.

How To Get Forms,
Publications, and
Assistance
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website 24 hours a day, 7 days a week
at IRS.gov to:
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need to wait on the phone or stand in
line. The ITA is available 24 hours a
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with a variety of tax information related
to general filing topics, deductions,
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the response screen, you can print the
entire interview and the final response
for your records. New subject areas are
added on a regular basis.

Answers not provided through ITA may
be found in Tax Trails, one of the Tax
Topics on IRS.gov which contain
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Map, which includes an international
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For questions regarding this form,
call the Employee Plans Customer
Service, toll-free, at 1-877-829-5500.

Privacy Act and Paperwork Reduction Act Notice. We ask for information on this form to carry out the Internal Revenue
laws of the United States. We use this information to determine whether the plan complies with these laws. You are not
required to request a determination letter; however, if you do so, sections 6001, 6011, 6058(a), and 6109 require you to provide
the information requested. Failure to provide this information in a timely manner, or providing false or fraudulent information,
may subject you to penalties.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long
as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103. However, section 6104(b) makes certain information contained in this
form publicly available. We may also give it to the Department of Labor or the Pension Benefit Guaranty Corporation (PBGC)
for administration of ERISA, the Department of Justice for civil and criminal litigation, and cities, states, the District of Columbia,
and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to
other countries under a treaty, to federal and state agencies to enforce federal non-tax criminal laws, and to federal law
enforcement and intelligence agencies to combat terrorism.
is:

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time

Form 5300

Recordkeeping

Learning about the law or the form

Preparing the form

Copying, assembling, and sending the form

33 hr., 57 min.

10 hr., 7 min.

17 hr., 38 min.

1 hr., 52 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we
would be happy to hear from you. You can send us comments from www.irs.gov/formspubs/. Click on “More Information” and
then on “Comment on Tax Forms and Publications.” Or you can send your comments to Internal Revenue Service, Tax Forms
and Publication Division, 1111 Constitution Ave., NW, IR-6526, Washington, DC 20224.
Do not send any of these forms or schedules to this address. Instead, see Where To File.

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