Termination of Single Employer Plans

This package contains:
Schedule MP
Attachment A
Attachment B
Payment Voucher
Instructions

MISSING PARTICIPANTS
FILING INSTRUCTIONS

These Filing Instructions are for Plans that Terminate before 1/1/2018

The Instructions In This Booklet Apply to Standard And Distress Terminations with Missing Participants.
You Will Also Need the Standard or Distress Termination Package, as Applicable.

Paperwork Reduction Act Notice
PBGC needs the information required by Schedule MP (and applicable attachments) to administer the Missing Participants
Program. Section 4050 of the Employee Retirement Income Security Act of 1974 provides for the Missing Participants
Program to assist plan administrators in closing out plans and to help participants and beneficiaries, who could not be located
when plan benefits were being distributed, to obtain their benefits. PBGC will use the information to direct Missing
Participants for whom annuity contracts were purchased to the appropriate insurance company; to locate and pay Missing
Participants for whom benefits were paid to PBGC; and to monitor and audit compliance. You are required to provide this
information pursuant to section 4050 of ERISA and 29 CFR Part 4050. The information provided to PBGC may be subject to
disclosure under the Freedom of Information Act or protected from disclosure by the Privacy Act, as applicable.
This collection of information has been approved by the Office of Management and Budget (OMB) under control number
1212-0036. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.
PBGC estimates that it will take an average of 21 hours of the plan administrator’s time and cost the plan administrator
$4,100 per plan to comply with standard termination paperwork requirements, including requirements for Missing
Participants. (See PBGC’s Distress Termination Package for burden estimates for distress terminations.) These are estimates
and the actual time will vary depending on the circumstances of a given plan.
If you have comments concerning the accuracy of these estimates or suggestions for making the forms simpler, please send
your comments to the Office of General Counsel, Pension Benefit Guaranty Corporation, 1200 K Street, NW, Washington,
DC 20005-4026.
Table of Contents
I.
II.

OVERVIEW
GENERAL INSTRUCTIONS FOR
MISSING PARTICIPANT FORMS
A. Who Must File
B. What to File and Pay
C. When to File and Pay
1. In General
2. Due Dates for Later Filings
3. Filing Methods and Filing Date
4. Requests for Deadline Extensions
D. Where to File and Pay
1. Where to File

Page

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E.
F.

2. Where to Pay
3. Penalties and Interest
Forms and Instructions; Contacting Us
Recordkeeping Requirements

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III.

SPECIFIC INSTRUCTIONS FOR
MISSING PARTICIPANT FORMS
A. Schedule MP
1. Plan Identification Information
2. Missing Participant Information
3. Amounts Due to PBGC
B. Attachment A
(Annuity Purchase Information)
C. Attachment B (Individual Information)
1. Plan Identification Information
2. Identification of Missing Participant
3. Amounts Due to PBGC
4. Missing Participant Who Is a Participant and
Whose Benefit Was Not in Pay Status
5. Missing Participant Who Is a Beneficiary
and Whose Benefit Was Not in Pay Status
6. Missing Participant Who Was in Pay Status
7. Employee Contribution
8. Residual Assets
Table of Plan Benefit Forms
Appendix A: Examples of Designated Benefit Determinations

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Overview

I. OVERVIEW
PBGC has established a Missing Participants Program for single-employer defined benefit pension plans subject to Title IV
of ERISA. This program helps terminating plans distribute Missing Participants’ benefits and helps Missing Participants
receive their benefits. A Missing Participant is a participant or beneficiary (including a participant’s spouse or alternate
payee) entitled to a distribution under a terminating plan whom, after a diligent search, the plan administrator has not located
as of the date the plan administrator pays the individual’s designated benefit to the PBGC (or distributes the individual’s
benefit by purchasing an irrevocable commitment from an insurer). In the absence of proof of death, individuals not located
are presumed living.
NOTE: You may use the PBGC’s Missing Participants Program for a participant or beneficiary only if you are unable to
locate the person after a diligent search (see Step 1, below). The mere fact that a person fails to return an election form or
cash a check does not mean the person is a “Missing Participant.” Unless a person is a “Missing Participant,” you must, in
accordance with all applicable requirements under the Code and ERISA, distribute plan assets in satisfaction of all plan
benefits by purchase of an irrevocable commitment from an insurer or by distributing benefits to the person in another
permitted form.
In the following, the terms “you” and “plan administrator” are used interchangeably.
You must follow specific steps in distributing the benefits of Missing Participants on plan termination. These steps are
briefly summarized below. Sections II and III below provide detailed instructions.
Step 1: Diligent Search


Conduct a diligent search for all participants and beneficiaries whom you could not locate. “Diligent search” is defined
in 29 CFR § 4050.4. A diligent search must —

•

Begin not more than 6 months before notices of intent to terminate are issued;

•

Be carried on in such a manner that if the individual is found, distribution can reasonably be expected to be
made on or before the deemed distribution date (see Appendix A of Standard Termination or Distress
Termination Instructions (Glossary of Terms), for definition);

•

Include inquiry of any plan beneficiaries (including alternate payees) of the Missing Participant whose
names and addresses are known to the plan administrator; and

•

Include use of a commercial locator service to search for the Missing Participant (without charge to the Missing
Participant or reduction of the Missing Participant’s plan benefit).

Step 2: Method(s) of Distribution


Determine for each Missing Participant whether you will distribute the benefits of that Missing Participant by
purchasing an irrevocable commitment from insurance company or by paying the value of the Missing Participant’s
benefit to PBGC.

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Step 3: Deemed Distribution Date


Select a deemed distribution date and calculate the value of the Missing Participants’ benefits as of that date using
the rules in PBGC’s Missing Participants regulation (see 29 CFR §§ 4050.5 and 4050.12). The deemed
distribution date must be no later than the distribution deadline, including extensions, under 29 CFR § 4041.28(a),
and no earlier than the date when distributions have been completed for all other participants and beneficiaries
(including Missing Participants for whom you provide annuities). (See section III.A. Part II.3.c. below.)
Note: If, late in the distribution period, you locate a participant or beneficiary or learn that a participant or
beneficiary cannot be located, you may request an extension of the distribution deadline, if necessary. To request
a deadline extension, see instructions in Section II.J of the Standard Termination Package or Section C of
Appendix C of the Distress Termination Package.
However, there is only one deemed distribution date for any plan filing. If an extension is granted, and with it
the deemed distribution date is changed, then the extension date is the deemed distribution date for the plan
filing. If an amended standard termination is filed for the plan, the same deemed distribution date will apply to
the amended filing.

Step 4: Forms and Payments


Complete Schedule MP and the applicable attachment(s) and send them to PBGC with the Post-Distribution
Certification. These forms must contain information required by PBGC to identify and locate Missing Participants
to whom it will pay benefits, to compute and pay those benefits, and to direct individuals for whom the plan
purchased annuities to the appropriate insurance company.
If you are sending payment to PBGC for one or more Missing Participants, you may submit a check with
your Missing Participant Payment Voucher or arrange for a wire transfer and indicate on your Missing Participant
Payment Voucher the amount that has been transferred. See section II.D.2 for payment information. The filing
deadline for Schedule MP, for the Post-Distribution Certification, and for payment of designated benefits to
PBGC is 30 days after the deemed distribution date.
If you purchased annuities for all Missing Participants and are not paying designated benefits to PBGC, the deadline
for filing Schedule MP and the Post-Distribution Certification is 30 days after the last distribution of assets in
satisfaction of plan benefits (through priority category 6 under section 4044 of ERISA and 29 CFR Part 4044).
Note: PBGC may assess a penalty for late filing of Schedule MP. However, PBGC will do so only to the extent
the information is filed more than 90 days after the distribution deadline (including extensions) (see section II.H.1
of the Standard Termination Package or section C of Appendix C of the Distress Termination Package.) Also,
PBGC will as- sess interest for late payment of amounts for Missing Participants only to the extent the payment is
made more than 90 days after that distribution deadline (including extensions).

This package contains (1) Missing Participant filing instructions, and (2) Schedule MP, including Attachment A
(Annuity Purchase Information), Attachment B (Individual Information for Missing Participants for whom amounts
are paid to PBGC), and a Missing Participant Payment Voucher to submit with payment to PBGC.
The specific rules for distributing benefits for Missing Participants are set forth in section 4050 of ERISA and in
PBGC’s regulation on Missing Participants (29 CFR Part 4050), which are available on PBGC’s website,
www.pbgc.gov, along with Missing Participant forms and instructions.
Note: If, after paying a designated benefit to PBGC for a Missing Participant, you are contacted by that Missing
Participant, please refer the individual to PBGC’s Customer Contact Center ((800) 400-7242) for payment of
the individual’s benefit.

II. GENERAL INSTRUCTIONS FOR MISSING PARTICIPANT FORMS
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PBGC may assess penalties for incomplete filings. Therefore, you should ensure that an appropriate response is
provided for each item, as follows:

1.

If an item requests a numeric response, a number must be entered.

2.

If an item provides a box or boxes to be checked, a check should be entered (written responses are not
acceptable).

3.

No additions or deletions may be made to the certifications required to be signed by the plan
administrator or enrolled actuary.

4.

All information requested by an item must be provided, e.g., Missing Participants’ full names; complete
addresses where requested.

5.

If requested information is not available, write “N/A” in the space provided or next to the question.

A. Who Must File
If your plan is terminating in a standard termination (or in a distress termination in which the plan is sufficient for at
least guaranteed benefits and closes out in the private sector), you must file Schedule MP with PBGC if you have one
or more Missing Participants. PBGC will apply this filing requirement to participants or beneficiaries who are eligible
for a distribution of residual assets, voluntary employee contributions, or are entitled to a distribution after a PBGC
plan audit but cannot be located, after a diligent search, at the time the distribution is to be made. See section II.C.2.
With regard to distributions of residual assets, voluntary employee contributions, or after an audit, a diligent search is
not required if an earlier diligent search was done and the individual was not found, i.e., the individual was determined
to be a Missing Participant.

B. What to File and Pay
You must file Schedule MP, including Attachment A (Annuity Purchase Information), Attachment B (Individual
Information), or both, as applicable. File Attachment A if the plan purchased an irrevocable commitment for one or
more Missing Participants. File a separate Attachment B for each Missing Participant for whom amounts are due to
PBGC. You must send payment of the total of the amounts on the Attachment B(s) to PBGC, together with a Payment
Voucher.

C. When to File and Pay
1.

In General. The filing due date for the Schedule MP (including attachments) and payment of designated
benefits (including Payment Voucher) is the same as for the Post-Distribution Certification.

2.

Due Dates for Later Filings. In some cases, after you have already filed the Post-Distribution Certification,
you may be required to file a Schedule MP (including applicable attachment(s), payment, and Payment Voucher),
or an amended Schedule MP if a Schedule MP was previously filed. Where there are one or more persons whom
you cannot locate, after a diligent search, at the time benefits must be distributed in the following situations, the
following due dates apply:
(a) Residual Assets. If residual assets remaining after the satisfaction of all plan benefits through priority
category 6 (under section 4044 of ERISA and 29 CFR Part 4044) are owed to one or more persons whom you
cannot locate after a diligent search (unless one was done earlier), you must submit a Schedule MP (including
Attachments A and B, as applicable), any amounts that will be paid to PBGC, and a Payment Voucher no earlier
than the date when the Post-Distribution Certification is filed with PBGC, and no later than the 30th day after the
date on which all residual assets have been distributed to all participants and beneficiaries other than Missing
Participants.

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Note: If you previously filed the Post-Distribution Certification and are using the Missing Participants
Program to provide residual assets with respect to a person who cannot be located after a diligent search at
the time residual assets are distributed, file only Schedule MP (with applicable attachment(s)) and, if
appropriate, a Payment Voucher. Do not file a new Post-Distribution Certification (Form 501 or Form
602).
(b) PBGC Audit of Plan Termination. If, pursuant to an audit of the plan termination, amounts are owed to one or
more persons whom you cannot locate after a diligent search (unless one was done earlier), you must submit
a Schedule MP (with applicable attachments) and any amounts that will be paid to PBGC, along with a
Payment Voucher, by the date specified by PBGC in connection with the audit, unless PBGC grants an
extension.
3.

Filing Methods and Filing Date.
You must file the Schedule MP with the Post-Distribution Certification, Form 501 (in a Standard Termination) or
Form 602 (in a Distress Termination). Follow the applicable instructions for Form 501 or Form 602 for filing
methods and due dates.

4. Requests for Deadline Extensions. PBGC may in its discretion extend a deadline for taking a required action
to a later date. PBGC will grant such an extension where it finds compelling reasons why it is not administratively
feasible for you (or other persons acting on your behalf) to take the action until the later date and the delay is
brief. PBGC will consider (1) the length of the delay and (2) whether ordinary business care and prudence in
attempting to meet the deadline was exercised.
Note: PBGC will not extend the following statutory deadlines: (1) that the Notice of Intent to Terminate (NOIT)
be issued not less than 60 days before the proposed termination date, (2) that the Notice of Plan Benefits (NOPB) be
issued by the time the plan administrator files the standard termination notice with PBGC, and (3) that the PostDistribution Certification be filed with PBGC within 30 days after the last distribution date. (Although PBGC may
assess a penalty for late filing of a Post-Distribution Certification, it will do so only to the extent the PostDistribution Certification is filed more than 90 days after the distribution deadline (including extensions)
described in section II.H.1. of the
Standard Termination Package and section C of Appendix C of the Distress Termination Package.)
If you file a request for an extension with PBGC later than the 15th day before the applicable deadline, you must
include a justification for not filing the request earlier.
Requests for extensions must be in writing and —

Addressed to:
Pension Benefit Guaranty Corporation
Standard Termination Compliance Division
Processing and Technical Assistance Branch
1200 K Street, NW
Washington, DC 20005-4026
E-mailed to: [email protected]; or
Faxed to: (202) 326-4001

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D. Where to File and Pay
1.

Where to File. File the Schedule MP (including any required attachments) with the Post-Distribution
Certification.
Send the forms to:
Pension Benefit Guaranty Corporation
Standard Termination Compliance Division
1200 K Street, NW
Washington, DC 20005-4026

2.

Where to Pay.
(a) Checks.
Send payment for designated benefits and/or other amounts with a completed Payment Voucher to the appropriate
lock-box address below. Make the check payable to the Pension Benefit Guaranty Corporation and write the plan’s
EIN/PN and PBGC Case Number on your check. Send one check for the plan, not separate checks for each
participant.
Note: The amount you pay to the PBGC with this filing must equal the amount entered in column (1) of item
4c of Schedule MP (this is the same amount that should be entered in item 3a of the Missing Participant
Payment Voucher). The amount entered in column (1) of item 4c of Schedule MP must equal the sum of all
amounts entered in column (1) of item 3c of the Attachments B (Individual Information) submitted with this
filing.
If you are using the U.S. Postal Service:
Pension Benefit Guaranty Corporation
P.O. Box 979114 St. Louis, MO 63197-9000
If you are using a delivery service other than the U.S. Postal
PBGC Missing Participants Box 979114
U.S. Bank Government Lockbox
1005 Convention Plaza
SL-MO-C2GLSt. Louis, MO 63101
(b) Wire transfers.
Send wire transfers to:
US Bank
Routing: 081000210
Account: 152310875843
Beneficiary: PBGC
Payment ID line: (MP, the plan’s EIN/PN, and the standard termination case number)
Please use the following format: “MP, EIN/PN: XX-XXXXXXX/XXX, CN: XXXXXXXX”

3. Penalties and Interest. If a plan administrator fails to provide any required information within the specified
time limit, PBGC may assess a penalty under ERISA section 4071. However, it will do so only to the extent the
information is filed more than 90 days after the distribution deadline (including extensions) determined under 29 CFR §
4041.28(a) or § 4041.50, whichever applies, for closeout of a plan. Also, PBGC will assess interest for late payment of
amounts for Missing Participants only to the extent the payment is made more than 90 days after the distribution

8

deadline.

E. Forms and Instructions; Contacting Us
You may obtain forms and instructions from PBGC’s website at www.pbgc.gov.
If you have any questions about Missing Participants, standard terminations, or distress terminations, or if you need
copies of this Missing Participant Package, the Standard Termination Package, or the Distress Termination
Package, call the toll-free telephone number at PBGC’s Customer Service Center for Plan Administrators and
Pension Professionals, (1-800-736-2444). (TTY/TDD users may call the Federal relay service toll-free at 1-800877-8339 and ask to be connected to 1-800-736-2444.)
E-mail addresses:
Standard Terminations ([email protected])
Questions about Missing Participants in a standard termination.
Distress Terminations ([email protected])
Questions about Missing Participants in a distress termination.
Fax: (202) 326-4001

F. Recordkeeping Requirements
Each contributing sponsor and the plan administrator of a terminated plan must maintain all records necessary to
demonstrate compliance with section 4041 of ERISA and 29 CFR Part 4041 for six years after the date the PostDistribution Certification is filed with PBGC. For rules on maintaining records electronically, see 29 CFR Part 4000,
Subpart E (also available on PBGC’s website, www.pbgc.gov, at the “Practitioners” page, select “Law & Regulations”
on right menu bar).
Note: If a contributing sponsor or the plan administrator maintains information in accordance with this
requirement, the other party need not maintain that information.
For each Missing Participant, these records must include all evidence of a diligent search, and all underlying data
(including worksheets prepared by or at the direction of the enrolled actuary) used in determining the amount, form, and
value of plan benefits.
Within 30 days after receipt of PBGC’s written request for records or by a later date specified in the request, the
contributing sponsor or plan administrator, as applicable, must make all such records available to PBGC for inspection
and photocopying (or, for electronic records, inspection, electronic copying, and printout) at the location where they are
kept (or another, mutually agreeable, location), or must submit copies of the records to PBGC.

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III. SPECIFIC
Schedule MP
If you previously filed one or more Schedule MPs for this plan, check the box immediately below “PART I.” If
you checked the box, provide the date(s) of any filing(s).
Note: If this filing is an amended Schedule MP, you must file an amended Form 501 (if you filed a standard
termination) or an amended Form 602 (if you filed a distress termination that is sufficient for at least
guaranteed benefits) unless you are using the Missing Participants Program to provide residual assets with
respect to a person who cannot be located at the time residual assets are payable. See Note on p. 6.
Part I. Plan Identification Information
1a

Enter the complete name of the plan as it appears in the plan document.

1b-c Enter the 9-digit employer identification number (EIN) assigned to the contributing sponsor by the Internal
RevenueService for income tax purposes and the 3-digit plan number (PN) assigned by the plan sponsor.
1d

Enter the PBGC case number.

Part II. Missing Participant Information
2a

Enter the name and address (mailing or internet) of the commercial locator service used. If more than one
service was used, attach sheet with this information for each service used..

3a-b Enter the number of Missing Participants for whom irrevocable commitments were purchased, and the number of
Missing Participants for whom amounts are being paid to PBGC. Enter zero in 3a if no annuities were
purchased for Missing Participants, and zero in 3b if no amounts are being paid to PBGC. Entries are required in
both 3a and 3b.
Entries are required in both columns (1) and (2) as well if this submission is an amended Schedule MP.
(1) If this is your first submission of a Schedule MP, the same numbers should be entered in columns (1)
and (2), and the numbers entered should be consistent with the Missing Participants reported on the
Attachments A and/or B that are attached.
(2) If this submission is an amended Schedule MP, Attachments A and/or B for only those Missing
Participants for whom you are reporting additional or revised information with the amended filing should
be attached.
The numbers entered in column (1) should be a count of only those Missing Participants reported on
Attachments A and/or B that are attached.
The entries in column (2) should be a count of all Missing Participants reported on Attachments A and/or
B that you have submitted to PBGC, in this filing and all earlier filings.
3c

The deemed distribution date is (1) the distribution deadline (including extensions) or (2) if the plan administrator
selects an earlier date that is no earlier than the date when all distributions have been made under the plan except
for distributions to Missing Participants whose designated benefits are paid to PBGC, such earlier date. The
distribution deadline (including extensions) is described in section II.H.1 of the Standard Termination Package
and section C of Appendix C of the Distress Termination Package.
Note: If the only amounts you are distributing (or have distributed) to Missing Participants are residual assets
or voluntary employee contributions, i.e., you have never paid designated benefits to PBGC or purchased

10

annuities for any Missing Participant in the plan, enter “00/00/0000” for the deemed distribution date.
Part III. Amounts Due to PBGC
4a-c The same instructions that applied to items 3a and 3b above apply to items 4a-4c (if the amount in any item is
zero, enter zero; do not leave blank). As was done for items 3a and 3b above, entries are required in both
columns (1) and (2), and what is entered in each column depends on whether this is your first submission of a
Schedule MP, or an amended submission.
For items –
4a (Total amount of designated benefits),
4b (Total of other amounts due for Missing Participants) and
4c (Total amount due to PBGC for Missing Participants),
the numbers entered in column (1) should equal the sum of the amounts in items 3a, 3b, and 3c, respectively, of
all Attachments B (Missing Participant Individual Information) submitted with this filing.
If this filing is your first submission of a Schedule MP, the same numbers should be entered in columns (1) and (2).
If this is an amended submission, the numbers entered in column (2) for items 4a, 4b, and 4c, should equal the
sum of the amounts in items 3a, 3b, and 3c, respectively, of all Attachments B that you have submitted to PBGC,
in this filing and all earlier filings.
4d-e Enter in 4d the date designated benefits in 4a were sent to PBGC.
For 4e, compare the date in 4d with that entered in 3c. Is the date in 4d more than 90 days after the date in 3c?
If “Yes,” interest will be assessed by PBGC from the 91st day after the date in 3c until the date when the
payment was received by PBGC. PBGC will issue a bill to you for the amount of the assessed interest and you
will have 30 days from the date of PBGC’s bill to pay without incurring further interest.
Part IV. Plan Administrator Certification
Part IV should be completed and signed by the plan’s administrator.
Part V. Enrolled Actuary Certification
If only an Attachment A is attached to the Schedule MP, i.e., all distributions to Missing Participants in this filing were
by the purchase of irrevocable commitments, Part V does not need to be completed. If any benefits were paid to
PBGC for Missing Participants in this filing, Part V should be completed and signed by an Enrolled Actuary.

B. Attachment A (Annuity Purchase Information)
File Attachment A (Annuity Purchase Information) with the Schedule MP if the plan purchased irrevocable
commitments for one or more Missing Participants. See II.C.3 above if you have 100 or more Missing Participants,
NOTE: If irrevocable commitments were purchased from more than one insurer, complete a separate Attachment
A for each insurer.
If you previously filed one or more Attachments A for this plan, check the box immediately below “PART I.”
Part I. Plan Identification Information
The information entered in Part I should be the same as that entered in Part I of the Schedule MP.
Part II. Insurance Company Information

11

2a-d Enter the name and address of insurer, and the name, telephone number, and email of your contact at the
insurer. Please verify that the information provided is the most current information available.
2e Enter the policy number with the insurer.
Part III. Annuitized Missing Participant Information
For each Missing Participant listed in Part III, enter the full name, Social Security Number, and date of birth of the
Missing Participant and, if applicable, of the Missing Participant’s spouse or beneficiary. Also enter the certificate
number for the Missing Participant’s annuity.
For the Missing Participant’s Monthly Benefit, enter the monthly benefit payable in the plan’s normal form at the Missing
Participant’s normal retirement age. The normal form is the form in which the benefit is typically paid under plan
provisions (generally a single-life or joint-life annuity). If the Missing Participant is an alternate payee or other
beneficiary, enter the monthly benefit amount payable at the earliest date the alternate payee or other beneficiary may
begin receiving benefits. If the Missing Participant was in pay status, enter the monthly benefit amount that was in pay
status.

C. Attachment B (Missing Participant Individual Information)
File an Attachment B (Missing Participant Individual Information) with the Schedule MP for each Missing Participant
for whom an amount is due to PBGC. On each Attachment B, enter the sequence number of the attachment in terms of
the total number of Attachments B that are submitted with this filing. See II.C.3 above if you have 100 or more
Missing Participants,
Part I. Plan Identification Information
The information entered in Part I should be the same as that entered in Part I of the Schedule MP.
Part II. Identification of Missing Participant
If you previously filed one or more Attachments B for this individual, check the box immediately below “PART
II.”
2a-g Enter the requested identification information for the Missing Participant.
Part III. Amounts Due to PBGC
Note: Where amounts are requested for items 3a-3c, if the amount in any item is zero, enter zero; do not leave
blank. As was done for items 4a-4c on the Schedule MP, entries are required in both columns (1) and (2). What is
entered in each column depends on whether this is your first submission of an Attachment B for this individual, or
if you previously filed an Attachment B for this individual.
If this is your first submission of an Attachment B for this individual, the same amounts should be
entered in columns (1) and (2) for items 3a-3c.
If you previously filed an Attachment B for this individual, the responses entered in column (1) for items 3a-3c
should reflect only the revised or additional information that you are reporting for this individual in this filing.
The entries in column (2) should reflect the responses of all Attachments B that you have submitted to PBGC, in
this filing and all earlier filings.
3

A. Category of designated benefit (see 29 CFR § 4050.5)
Determine the category of the Missing Participant’s designated benefit from the following list and check one of the
boxes under item 3a:
(1) Mandatory lump sum. The terms of the plan require automatic cash out of this Missing Participant. The

12

mandatory lump sum amount must be no greater than the plan’s cash out limit for de minimis benefit amounts,
which may not exceed the dollar limit under § 411(a)(11) of the Code (currently $5,000). This category must
not be checked if the amount is greater than the plan’s cash out limit.
(2) De minimis lump sum. The terms of the plan do not require an automatic cash out of this Missing Participant,
the amount is $5,000 or less when calculated under B.(2) below, and the benefit was not in pay status as of the
deemed distribution date. This category must not be checked if the amount exceeds $5,000.
(3) No lump sum. The terms of the plan require that only an annuity may be paid for this Missing Participant.
(4) Elective lump sum. The benefit of this Missing Participant is not described in the first three categories.

13

NOTE: If the designated benefit category includes any amount attributable to mandatory employee contributions,
check the designated benefit category applicable to the whole accrued benefit - do not check category 4 (Elective lump
sum) merely because the participant may choose to withdraw mandatory employee contributions in contributions in a
lump sum.
B. Amount
Amount of designated benefit (see 29 CFR §§ 4050.5 and 4050.12(c))
After determining the category of designated benefit for the Missing Participant under A., above, and checking the pertinent
box in item 3a, calculate the amount of the designated benefit using the applicable calculation instructions below for that
category.
(1) Mandatory lump sum. The designated benefit amount is the amount that the plan would have distributed to this
Missing Participant as of the deemed distribution date. The amount must be no greater than the plan’s cash out
limit, which must not exceed the dollar limit under § 411(a)(11) of the Code (currently $5,000) but can be less.
(2) De minimis lum lump sum. The designated benefit amount is the lump sum amount calculated as of the deemed
distribution date using PBGC “Missing participant lump sum assumptions” and the “most valuable benefit” for a
Missing Participant who is not in pay status. “Missing participant lump sum assumptions” and “most valuable
benefit”are defined in C., below. As with (1), the amount entered must not be more than $5,000.
(3) No lump sum. The designated benefit amount is the actuarial present value of the Missing Participant’s
benefit as of the deemed distribution date calculated using PBGC “Missing participant annuity assumptions” and
the “most valuable benefit.” “Missing participant annuity assumptions” and “most valuable benefit” are defined
in C., below.

(4) Elective lump sum. The designated benefit amount is the greater of the amounts determined under B.(1),
Mandatory lump sum, or B(3), No lump sum.
C. Definitions for calculation of designated benefit (see 29 CFR §§ 4050.2 and 4050.5(b)(1))
(1) Missing participant annuity assumptions. “Missing participant annuity assumptions” means the interest rate
assumptions and actuarial methods for valuing benefits under 29 CFR § 4044.52 applied –
(a) as if the deemed distribution date were the termination date;
(b) using mortality rates that are a fixed blend of 50 percent of the healthy male mortality rates in
29 CFR § 4044.53(c)(1) and 50 percent of the healthy female mortality rates in
§ 4044.53(c)(2);
(c) without using the expected retirement age assumptions in 29 CFR §§ 4044.55 through
4044.57;
(d) without making the adjustment for expenses provided for in 29 CFR § 4044.52(d);

and

(e) by adding $300, as an adjustment (loading) for expenses, if the missing participant’s designated benefit
without this adjustment is greater than $5,000.
(2)

Missing participant lump sum assumptions. “Missing participant lump sum assumptions” means the interest
rate and mortality assumptions and actuarial methods for determining the lump sum value of a benefit under
29 CFR § 4022.7(d), applied –
(a) as if the deemed distribution date were the termination date; and

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(b) without using the expected retirement age assumptions in 29 CFR §§ 4044.55 through 4044.57.
(3)

Most valuable benefit.
(a) Benefit in pay status - For a missing participant whose benefit is in pay status as of the deemed
distribution date, the most valuable benefit is the pay status benefit.
(b) Benefit not in pay status - For a missing participant whose benefit is not in pay status as of the
deemed distribution date, the most valuable benefit is the benefit payable at the age on or after
the deemed distribution date (beginning with the participant’s earliest early retirement age and
ending with the participant’s normal retirement age) for which the present value as of the
deemed distribution date is the greatest. The present value as of the deemed distribution date
with respect to any age is determined by multiplying:
(i)

the monthly (or other periodic) benefit payable under the plan; by

(ii)

the present value (determined as of the deemed distribution date using the missing
participant annuity assumptions) of a $1 monthly (or other periodic) annuity
beginning at the applicable age.

Note: See Appendix A for examples of the designated benefit categories and calculations of the designated benefit amount.

Pages 2 and 3 of Attachment B: Enter the Missing Participant’s Social Security Number at the top of
each page in the space provided.
3b (continued)
Mandatory employee contributions: Is any part of the Missing Participant’s designated benefit amount
attributable to mandatory employee contributions? If “Yes,” complete (1) - (3) below:
(1) Mandatory employee contributions that fund a portion of the Missing Participant’s accrued benefit under the
plan.
(2) Interest credited on those contributions to the deemed distribution date (see 29 CFR § 4050.12(c)(1).
(3) The total of (1) and (2).
NOTE: The designated benefit amount reported in item 3b must include, and be no less than, the amount of mandatory
employee contributions plus interest to the deemed distribution date. The amount entered in item 3b on page 1 (i.e., the
total designated benefit) must not be lessthan the amount in 3b(3) (i.e., the accumulated value of mandatory employee
contirbutions).
Missed benefit payments: In determining the amount of designated benefits, for any Missing Participant who was in
pay status at the deemed distribution date (see item 6 below), the designated benefit amount must include payments that
were due before the deemed distribution date but that were not made, with interest through the deemed distribution date.
That is, the amount entered in 3b must include the amount entered in the last line of item 6a below.
3c “Other amounts due” are (1) voluntary employee contributions (and earnings thereon) as defined in 29 CFR
§ 4050.12(c)(2)(i) and (ii); and (2) residual assets, as determined under 29 CFR § 4050.12(d). If no voluntary
employee contributions or residual assets are due, enter zero; do not leave blank.
(1) Voluntary employee contributions and earnings

(a) Voluntary employee contributions held in a separate account.
(b) Earnings credited on contributions in (a) to the date sent to PBGC.

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(c) Total of (a) and (b).
(d) If the amount entered in (c) is not zero, enter the date voluntary contributions sent to PBGC (see 29 CFR
§ 4050.12(c)(2)(i) and (ii)).
(2) Residual assets and earnings
(a) The amount, if any, of residual assets due to PBGC based on a Missing Participant’s share of residual assets
(in accordance with section 4044(d) of ERISA).
(b) Earnings on residual assets to the date you pay PBGC (see 29 CFR §4050.12(d)).
(c) Total of (a) and (b).
(c) Enter the sum of (a) and (b)
(d) If the amount entered in (c) is not zero, enter the date residual assets sent to PBGC.
(3) Total other amounts, if any, due to PBGC (line (1)(c) + line (2)(c))

3d Total amount due to PBGC (line 3b + line 3c(3))

Note: You must pay the total amount due for the Missing Participant to PBGC, without any reduction for the 20% tax
withholding, even if 20% tax withholding has already been paid to the Internal Revenue Service for the benefit.

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Note: Complete item 4, item 5 or item 6 below (complete only one):
For a Missing Participant who is a participant and whose benefit was not in pay status as of the deemed distribution date →
Complete item 4
For a Missing Participant who is a beneficiary (including a spouse or alternate payee) and whose benefit was not in pay
status as of the deemed distribution date → Complete item 5
For a Missing Participant whose benefit was in pay status as of the deemed distribution date → Complete item 6
Note: A Missing Participant’s benefit is in pay status as of the deemed distribution date if, as of that date, the plan

administrator has made or (except for administrative delay or a waiting period) would have made one or more benefit
payments. In addition, the benefit of a Missing Participant who is a beneficiary is considered to be in pay status if,
(1) the participant from whom the beneficiary’s benefit was derived went into pay status on or before the deemed
distribution date or (2) payments to the beneficiary have commenced or would have commenced automatically
without an election on or before that date.
In addition, if the Missing Participant is an alternate payee under a QDRO that required benefits to commence
concurrent with the participant’s benefits, the benefit is in pay status if the participant was in pay status as of the
deemed distribution date. If the Missing Participant is an alternate payee who is entitled to commence benefits upon
his or her own election, the benefit is in pay status if, as of the deemed distribution date, the plan administrator has
made or (except for administrative delay or a waiting period) would have made one or more benefit payments.

4

Missing Participant Who Is a Participant and Whose Benefit Was Not in Pay Status
Complete this item only if the Missing Participant is a participant whose benefit was not in pay status as of the deemed
distribution date.

4a Enter the participant’s earliest retirement date (or the deemed distribution date, if later).
4b If applicable, enter the participant’s last-known spouse’s name and Social Security Number; otherwise enter “N/A.”
If you checked category 1 (Mandatory Lump Sum) in item 3.A (Category of Designated Benefit) above, do not
complete 4c-4e; go to item 7.
4c

If applicable, check whether the participant’s last-known spouse consented to the participant’s waiver of the plan’s QPSA. If
“Yes” is checked, attach a copy of the waiver.

4d

If applicable, enter the participant’s last-known spouse’s earliest possible QPSA annuity starting date under the plan (or the
deemed distribution date, if later). Enter the deemed distribution date if the QPSA is payable immediately upon the
participant’s death.

4e

Enter Codes from the Table of Plan Benefit Forms on page 11 which describes the automatic annuity format that would be
payable with respect to the participant. Regardless of the participant’s last-known marital status, provide a Code for the
automatic annuity form for a married participant, 4e(1), and for an unmarried participant, 4e(2).
If you entered Codes 2 – 6, or 10, provide the information requested for that Code (if Code 10 entered, describe the form).

5

Missing Participant Who Is a Beneficiary (including a participant’s spouse or alternate payee) and Whose Benefit Was
Not in Pay Status
Complete this item only if the Missing Participant is a beneficiary, and the beneficiary’s benefit was not in pay status as of the
deemed distribution date.

17

5a Enter a code from the Table of Plan Benefit Forms on page 11 that describes the form of benefit to which the beneficiary is
entitled.
If you entered Code 2 -- 6, or 10, provide the Information requested for that Code (if Code 10 entered, describe the form).
5b

Enter the earliest date the beneficiary could commence receiving benefits (or the deemed distribution date, if later).

6

Missing Participant Who Was in Pay Status
Complete this item only if the Missing Participant was in pay status as of the deemed distribution date.

6a

Enter a Code from the Table of Plan Benefit Forms on page 11 that describes the form of benefit that was in pay status. If you
entered Code 2 – 8, or 10, provide the information requested for that Code (if Code 10 entered, describe the form). In
addition, provide, as applicable, the following information:
•
•
•
•

the date of the first missed payment;
the amount of the first missed payment;
the plan interest rate for missed payments; and
payments that were due before the deemed distribution date but that were not made, with interest through the deemed
distribution date.

6b

If available, the full name(s) of the Missing Participant’s beneficiaries.
available.

7

Enter check marks for all documents which are attached.

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Attach a copy of the beneficiary designation form, if

Table of Plan Benefit Forms
Benefit
Form Code

Benefit Form Applicable to Missing Participant

1

Life annuity

2

Annuity certain

3

Annuity certain and continuous

4

Temporary life annuity

5

Joint and survivor annuity (contingent basis) thereafter

6

Annuity certain and joint and survivor (contingent basis) thereafter

7

Single life cash refund annuity

8

Installment refund annuity

9

Single sum

10

Other benefit form - Use the space provided on Attachment B to describe the benefit form that is
payable with respect to the Missing Participant.
Include, as applicable:
•
•
•
•

the percentage of the Missing Participant’s monthly benefit amount that is payable to each
beneficiary upon the Missing Participant’s death,
the period during which the Missing Participant’s benefit is payable,
the period during which each beneficiary’s benefit is payable, and
any other provisions that distinguish the benefit form. For example, in the case of a
step-down benefit, state when and by how much the benefit is reduced.

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APPENDIX A - Examples of Designated Benefit Determinations
Examples of Designated Benefit Determinations for Missing Participants under § 4050.5 in plans with deemed
distribution dates on and after February 27, 2007. The calculation of the designated benefit is illustrated by the
following examples:
Example 1.a. $5,000 cash out limit. Plan A provides that any participant whose benefit has a value at
distribution of $5,000 or less will be paid a lump sum, and that no other lump sums will be paid. P, Q, and
R are missing participants.
(1)

As of the deemed distribution date, the value of P’s benefit is $4,000 under Plan A’s assumptions.
Under §4050.5(a)(1), the plan administrator pays PBGC $4,000 as P’s designated benefit.

(2)

As of the deemed distribution date, the value of Q’s benefit is $5,200 under Plan A’s assumptions
and $4,700 based on PBGC’s missing participant lump sum assumptions and the most valuable
benefit. Under §4050.5(a)(2), the plan administrator pays PBGC $4,700 as Q’s designated benefit.

(3)

As of the deemed distribution date, the value of R’s benefit is $5,500 under Plan A’s assumptions,
$5,100 based on PBGC’s missing participant lump sum assumptions and the most valuable benefit,
and $5,400 based on PBGC’s missing participant annuity assumptions (which includes the $300
loading) and the most valuable benefit. Under §4050.5(a)(3), the plan administrator pays PBGC
$5,400 as R’s designated benefit.

Example 1.b. - $3,500 cash out limit. Plan A provides that any participant whose benefit has a value at
distribution of $3,500 or less will be paid a lump sum, and that no other lump sums will be paid. P, Q, and
R are missing participants.
(1)

As of the deemed distribution date, the value of P’s benefit is $3,000 under Plan A’s assumptions.
Under § 4050.5(a)(1), the plan administrator pays PBGC $3,000 as P’s designated benefit.

(2)

As of the deemed distribution date, the value of Q’s benefit is $3,600 under Plan A’s assumptions
and $4,700 based on PBGC’s missing participant lump sum assumptions and the most valuable
benefit. Under §4050.5(a)(2), the plan administrator pays PBGC $4,700 as Q’s designated benefit.

(3)

As of the deemed distribution date, the value of R’s benefit is $3,600 under Plan A’s assumptions,
$5,100 based on PBGC’s missing participant lump sum assumptions and the most valuable benefit,
and $4,950 based on PBGC’s missing participant annuity assumptions (which does not include the
$300 loading) and the most valuable benefit. Under §4050.5(a)(3), the plan administrator pays
PBGC $4,950 as R’s designated benefit.

Example 2 Annuity assumptions. Plan B provides for a normal retirement age of 65 and permits early
commencement of benefits at any age between 60 and 65, with benefits reduced by 5 percent for each year before
age 65 that the benefit begins. The qualified joint and 50 percent survivor annuity payable under the terms of the
plan requires in all cases a 16 percent reduction in the benefit otherwise payable. The plan does not provide for
elective lump sums.
(1)

M is a missing participant who separated from service under Plan B with a deferred vested benefit.
M is age 50 at the deemed distribution date, which is in May 2007, and has a normal retirement
benefit of $1,000 per month payable at age 65 in the form of a single life annuity. M’s benefit as
20

of the deemed distribution date has a value greater than $5,000 using either plan assumptions or
PBGC’s missing participant lump sum assumptions. Accordingly, M’s designated benefit is to be
determined under §4050.5(a)(3).
(2)

For purposes of determining M’s designated benefit, M is assumed to be married to a spouse who is
also age 50 on the deemed distribution date. M’s monthly benefit in the form of the qualified joint
and survivor annuity under the plan varies from $840 at age 65 (the normal retirement age) ($1,000 x
(1-0.16)) to $630 at age 60 (the earliest retirement age) ($1,000 x (1-(5 x 0.05)) x (1-0.16)).

(3)

Under §4050.5(a)(3), M’s benefit is to be valued using PBGC’s missing participant annuity
assumptions. The select and ultimate interest rate on the plan’s deemed distribution date are 5.20
percent for the first 20 years and 4.87 percent thereafter. Using these rates and the blended
mortality table described in paragraph (2) of the definition of “missing participant annuity
assumptions” in §4050.2, the plan administrator determines that the benefit commencing at age 60 is
the most valuable benefit (i.e., the benefit at age 60 is more valuable than the benefit at ages 61, 62,
63, 64 or 65). The present value as of the deemed distribution date of each dollar of annual benefit
(payable monthly as a joint and 50 percent survivor annuity) is $8.4632 if the benefit begins at age
60. (Because a new spouse may succeed to the survivor benefit, the mortality of the spouse during
the deferral period is ignored.) Thus, without adjustment (loading) for expenses, the value of the
benefit beginning at age 60 is $63,982 (12 x $630 x 8.4632). The designated benefit is equal to this
value plus an expense adjustment of $300, or a total of $64,282.

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