Attachment 1-A

Attachment I-A for Form 4461-A, Application for Approval of Master or Prototype or Volume Submitter Defined Benefit Plan
Note: This application is designed to be used in conjunction with Rev. Proc. 2011-49. A list of required modifications is also recommended
for use and may be obtained from the IRS website at www.irs.gov/ep.
In items 10 through 12 indicate the article or section and page number of the
plan or trust where the following provisions are contained. All questions must
be answered. If not applicable, check “N/A” column; otherwise complete the
“Article or Section and Page Number” column.
10 Provisions applicable to all plans:
a Definitions:

N/A

Article or Section and
Page Number

Change

For IRS Use
Only

Where does the plan define the following terms(1) Year of Service?
(1)
(2)

Break in Service?

(3)

(4)

Hour of service under Department of Labor Regulations,
including service with all employers aggregated under sections
414(b), (c), (m), or (o), and service of any individual considered
an employee for purposes of this plan under section 414(n) or
(o)?
Elapsed time?

(5)

Plan year?

(6)

Compensation as defined in section 414(s) as limited by section
401(a)(17)?

(7)

Average annual compensation?

(8)

Earned income as defined in section 401(c)(2)?

(9)

Employee as described in sections 414(b), (c), (m), (n), or (o)?

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)
(10) Leased employee as described in section 414(n) or (o)?
(10)
(11) Highly compensated employee as defined in section 414(q)?
(11)
(12) Owner-Employee?
(12)
(13) Self-employed individual?
(13)
(14) Normal retirement age?
(14)
(15) Straight life annuity?
(15)

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N/A

b Minimum participation standards:
(1) Are the requirements for participation under the plan determined
without regard to maximum age?
(2) Will a new employee, otherwise eligible, participate on the earlier
of the first day of the first plan year after meeting the minimum
age and service requirements of section 410(a)(1) or 6 months
after satisfying such requirements?
(3) Does the initial eligibility computation period begin with the date
on which the employee first performs an hour of service, and do
subsequent eligibility computation periods: (1) begin with the
anniversary of such date, or (2) shift to the plan year in
accordance with section 2530.202-2(b) of the Department of
Labor regulations?
(4) Is the computation period for determining a break in service the
same as is used to compute a year of service for eligibility after
the initial computation period?
(5) If all years of service are not counted for participation purposes,
is the service not counted excludable under section 410(a)(5)(B),
(C), or (D)?
(6) Will an employee otherwise eligible, who is in an ineligible class
of employees, immediately participate on becoming a member of
an eligible class?
c Accrual of benefits:
(1) Does the benefit formula provide for wear-away and fresh-start
rules?
(2) Does the plan provide for the determination of a participant’s
frozen accrued benefit?

Article or Section
and Page Number

Change

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(16)

(17)

(18)

(19)

(20), (21)

(22)

(23)

(24)
(3) Does the plan provide for adjustments to frozen accrued benefits?
(25)
(4) Does the current benefit formula provide for no permitted disparity
and does it use the fractional accrual rule?
(26)
(5) Does the current benefit formula provide for permitted disparity?
(27)
(6) Does the plan define covered compensation, final average
compensation, and taxable wage base?
(27A)
(7) Does the plan provide adjustments for benefits beginning at a
time other than normal retirement age?
(27B)
(8) If the plan provides for permitted disparity, must mandatory
employee contributions be allocated to a separate account?
(27C)
(9) If fully insured, does the plan provide for permitted disparity with
respect to employer-provided benefits?
(27D)
(10) If the plan is integrated, is the employer-provided benefit limited in
accordance with section 401(a)(5)(D)?
(27E)
d Benefits Increases:
For a fully insured plan, or a plan that provides an insured death
benefit, is there a provision for purchasing additional contracts due to
increases in compensation?

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(28)

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N/A

Article or Section
and Page Number

Change

For IRS Use
Only

e (1) Does the plan define an accrual computation period?
(29)
(2) Does the plan define a year of credited service?
(30)
(3) Does the rate of accrual under each benefit formula satisfy one of
the following tests at all times:
(a) 3 percent rule-section 411(b)(1)(A)?
(b) 133-1/3 percent rule-section 411(b)(1)(B)?

(31)

(31)
(c) Fractional rule-section 411(b)(1)(C)?
(31)
(d) Fully insured plan rule-section 411(b)(1)(F)?
(32)
(4) Does the plan provide for pre-ERISA accruals?
(33)
(5) For purposes of determining accrued benefits, is the normal
retirement benefit equal to the greater of the early retirement
benefit under the plan or the benefit beginning at normal
retirement age?
(6) Do plan participants continue to accrue benefits without reduction
in the rate of accruals solely on account of the attainment of any
specified age?
f Employee contributions:

(34)

(35)

(1) Does the plan preclude employee contributions for years
beginning after the date the plan was restated for EGTRRA?
(36)
(2) Does the plan provide a separate account for the portion of each
employee’s accrued benefit derived from voluntary employee
contributions?
(3) Are employee contributions (adjusted for investment experience)
nonforfeitable at all times?

(37)

(38)
(4) Does the plan require that deductible voluntary employee
contributions will be maintained in a separate account?
(39)
g Section 415 limitations:
(40)

Are annual benefits limited as required by section 415?
h Distribution provisions:
(1) Does the plan state the normal form in which benefits will be paid
(life annuity, 10 years certain and life thereafter, etc.)?

(41)
(2) Does the plan specify the actuarial assumptions to be used in
determining actuarial equivalence which comply with Regulations
section 1.417(e)-1?
(3) Are the optional forms of benefits stated in the plan?

(42)

(43)
(4) If the plan disregards service attributable to a distribution in
computing the employer-derived accrued benefit, does the plan
contain provisions that satisfy Regulations section 1.411(a)7(d)(4)?

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(44)

10 (continued)

N/A

(5) If the present value of the accrued benefit is greater than $5,000,
is consent of the participant and spouse (if applicable) required
when benefits are immediately distributable within the meaning of
Regulations section 1.417(e)-1?
(6) (a) Does a married participant automatically receive a qualified
joint and survivor annuity (QJSA), and an unmarried
participant the normal form of life annuity?
(b) Is the participant given an opportunity to make a qualified
election to waive the automatic form of payment in a manner
which satisfies section 417(a)(2) during the election period
described in section 417(a)(6)(A)?
(c) Is a married participant who waives the QJSA given an
opportunity to elect to receive a qualified optional survivor
annuity in accordance with section 417(a)(1)(A)(ii)?
(7) (a) Does the plan provide that the spouse of a deceased
participant will receive a qualified preretirement survivor
annuity (QPSA) that requires payments not less than the
amount specified in section 417(c)(1) in the event of death
before the annuity starting date?
(b) Is the participant given an opportunity to make a qualified
election to waive the QPSA in a manner which satisfies
section 417(a)(2) during the election period described in
section 417(a)(6)(B)?
(8) Does the plan designate or enable the employer to elect the
percentage (not less than 50% nor more than 100%) of the
survivor annuity provided under the QJSA?
(9) (a) Does the plan provide for a written explanation of the
automatic form of payment in a manner which satisfies
section 417(a)(3)(A)?
(b) Does the plan provide for a written explanation of the QPSA
in a manner which satisfies section 417(a)(3)(B)?

Article or Section
and Page Number

Change

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(45)

(46)

(46)

(46)

(46)

(46)

(46)

(46)

(46)
(10) Do benefits under the plan begin, unless otherwise elected in
writing, no later than the 60th day after the latest of the close of
the plan year in which: (i) the participant attains the earlier of age
65 or the plan’s normal retirement age, (ii) the 10th anniversary of
the year in which the participant began participation under the
plan occurs, or (iii) the participant terminates his or her service
with the employer?
(11) If the plan contains an early retirement provision which requires or
could require both a minimum age and service for eligibility, does
a participant who meets the service requirement but separates
from service before meeting the age requirement begin to receive
benefits (unless otherwise elected) upon meeting the age
requirement?
(12) Does the plan provide that the terms of any annuity contract
purchased and distributed by the plan to a participant or spouse
shall comply with the requirements of the plan?
(13) Are annuity contracts nontransferable when distributed?

(47)

(48)

(49)

(50)
(14) Does the plan require, in accordance with section 401(a)(9), that:
(a) Distributions be made beginning not later than the required
beginning date?
(51)
(b) Payment of the participant’s interest be made at least as
rapidly as under the method used prior to death, when the
participant dies after distribution has started?

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(51)

10 (continued)

N/A

(c) Payment of the participant’s interest be made within 5 years of
the participant’s death, unless one of the exceptions in section
401(a)(9)(B)(iii) or (iv) applies, when payment of the
participant’s interest has not begun prior to death?
(d) Distributions, if not made in a single sum, will satisfy the
minimum distribution rules of section 401(a)(9) and the
regulations thereunder, including the minimum distribution
incidental benefit requirement of Regulations section
1.401(a)(9)-6, Q&A-2?
(15) Does the plan provide that any preretirement death benefits are
incidental?

Article or Section
and Page Number

Change

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(51)

(51)

(52)
(16) Does the plan permit distributions only at normal retirement age,
plan termination, termination of employment, death, disability or
attainment of age 62?
(17) (a) Does the plan provide for the direct rollover of an eligible
rollover distribution to an eligible retirement plan?
(b) Does the plan provide for the automatic rollover of a
mandatory distribution over $1,000 to an individual retirement
plan, unless the participant elects otherwise?
(c) If provided in the adoption agreement, does the plan specify
the types of plans that it will accept rollovers from?

(53)
(54)

(54)

(54)
(d) If the plan accepts rollovers made on or after January 1, 2013
and converts those rollovers to additional annuity benefits for
the participant, is the amount of the additional annuity
attributable to the rollover determined in accordance with
sections 411(c)(2)(B) and (C) and 411(c)(3) of the Code and
Rev. Rul. 2012-4?
(18) If the plan provides for suspension of benefits upon
reemployment with the employer or continued employment
beyond normal retirement age, does this provision comply with
Department of Labor regulations?
(19) Does the plan contain pre-termination restrictions?

(54)

(55)

(57)
(20) Does the plan limit the accrual and payment of benefits as
required by section 436?
(57A)
i. Vesting provisions:
(1) Is a computation period for vesting purposes specified in the
plan?
(58)
(2) Is the computation period for determining a break in service the
same as is used to compute a year of service for vesting?
(59)
(3) Does the plan provide that an employee will be fully vested on
reaching normal retirement age?
(60)
(4) Are vesting options limited so that at all times they will provide a
percentage of nonforfeitable rights which is not less than the
percentage that would be provided under one of the options
under section 411(a)(2)?
(5) If all years of service are not counted for vesting purposes, is the
service not counted excludable under section 411(a)(4)?

(61)

(62)
(6) Does the plan contain the vesting break in service one year
holdout provision?
(63)

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N/A

Article or Section
and Page Number

Change

For IRS Use
Only

(7) Does the plan contain the vesting break in service rule of parity?
(64)
(8) Does the participant who has at least 3 years of service have a
reasonable period of time after the adoption of an amendment
which directly or indirectly affects the calculation of his or her
nonforfeitable percentage (including a change to or from a topheavy vesting schedule) to elect to have his or her nonforfeitable
percentage computed without regard to the amendment?
(9) Does the plan provide protection against cutback of vested rights
or rights to accrued benefits under sections 411(a)(10)(A) and
411(d)(6)?
(10) If participants may withdraw their contributions or earnings on
them, may the withdrawal be made without forfeiting vested
benefits based on employer contributions?
(11) If benefits under the plan are forfeited when a participant or
beneficiary cannot be located, does the plan provide for a
reinstatement of the benefit if a claim is made?
j Top-heavy:

(65)

(66)

(67)

(68)

(1) If this plan does not fulfill the basic top-heavy plan requirements
at all times, does the plan define the following terms(69)
(a) Key employee?
(69)
(b) Top-heavy plan?
(69)
(c) Top-heavy ratio (as defined in section 416(g))?
(69)
(d) Permissive aggregation group?
(69)
(e) Required aggregation group?
(69)
(f) Determination date?
(69)
(g) Valuation date?
(69)
(h) Present value?
(69)
(2) Does the adoption agreement provide a section for the employer
to specify the interest rate and mortality table used in determining
the top-heavy ratio because of the required aggregation of
multiple plans?
(3) Does the plan provide that for the purpose of determining the topheavy ratio, the accrual rate used will be that used to accrue
benefits under all defined benefit plans of the employer, or where
there is no such uniform rate, the lowest accrual rate permitted
under section 411(b)(1)(C)?

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(69)

(69)

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N/A

Article or Section
and Page Number

Change

For IRS Use
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(4) Does the plan provide an accrued benefit (determined without
regard to social security) which is at all times not less than 2% of
the highest 5 consecutive years’ average compensation for each
year of service (service may be limited to service while the plan is
top-heavy and to a maximum of 10 years of service) for each
nonkey employee participant who has completed 1,000 hours of
service including a nonkey employee who:
(a) fails to make mandatory contributions to the plan?
(70)
(b) is excluded from the plan because compensation is less than
a stated amount?
(70)
(c) is not employed on the last day of the accrual computation
period?
(70)
(d) has his or her accrued benefit reduced in any way because of
permitted disparity?
(70)
(5) If the minimum accrued benefit in (4) is in a form other than a life
annuity at normal retirement age, is such minimum accrued
benefit at least equal to the actuarial equivalent of the required
minimum accrued benefit?
(6) Are forfeitures of the minimum accrued benefit prohibited in the
event a participant:
(a) works beyond the normal retirement age?
(b) withdraws mandatory employee contributions?

(71)

(72)

(72)
(7) Does the plan provide for vesting not less favorable than the
vesting described in section 416(b)?
(73)
k Amendment and termination:
(1) For an M&P plan, is there a provision for the sponsor to amend
the plan and does the provision describe the circumstances under
which the sponsor will no longer be authorized to amend the plan
on behalf of adopting employers?
(2) For an M&P plan, is there a provision for the employer to amend
the plan to satisfy sections 415 and 416 because of the required
aggregation of multiple plans?
(3) For an M&P plan, does the plan prohibit adopting employers from
amending other than elective provisions (except to the extent
necessary to satisfy section 415 or 416 because of the required
aggregation of multiple plans, or as permitted by section 5.06,
5.09 and 19.03 of Rev. Proc. 2011-49) unless the employer wants
to cease participation in the plan?
(4) Is there a provision for the employer to amend the plan to add
certain model, sample, or other required interim amendments
that specifically provide that their adoption will not cause the plan
to be treated as individually designed?
(5) Are the rights of all affected employees to benefits accrued to the
date of termination or partial termination, to the extent funded as
of such date, nonforfeitable?
(6) Does the plan provide that after merger or consolidation with, or
transfer of assets or liabilities to any other plan, benefits on a
termination basis will be no less than before the merger,
consolidation, or transfer?

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(74)

(75)

(75)

(75)

(76)

(77)

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N/A

(7) If a VS plan allows the practitioner to amend the plan on behalf of
adopting employers, does the plan provide that:
(a) the practitioner will amend the plan on behalf of all adopting
employers?
(b) the practitioner will no longer have the authority to amend on
behalf of any adopting employer as of the date the employer
adopts an amendment to the plan to incorporate a type of plan
not allowable in the VS program or as of the date the plan is
otherwise considered an individually designed plan due to the
nature and extent of the amendments?
(8) Does the adoption agreement of the VS plan, if applicable,
contain, in close proximity to the employer’s signature line, the
circumstances under which the employer may not rely on the
advisory letter?
l Miscellaneous plan provisions:
(1) Does the plan prohibit the assignment or alienation of benefits
except as provided by section 401(a)(13) and 414(p)?
(2) Do loans to plan participants satisfy the requirements of section
4975(d)(1) and the joint and survivor annuity requirements, if
any?
(3) Does the plan provide that corpus or income may not be diverted
for purposes other than the exclusive benefit of employees or
their beneficiaries?
(4) Does the plan provide that if it does not attain or retain
qualification, the employer can no longer participate under the
plan?
(5) If this is a master plan:
(a) Is only a single funding medium available for use by all
adopting employers?
(b) Does the plan provide that funds held in the master trust on
behalf of an adopting employer will be removed as soon as
administratively feasible if the employer’s plan does not attain
or retain qualified status?
(6) Does the plan provide that if the employer maintains a plan of a
predecessor employer, service with the predecessor employer is
counted as service with the employer?
(7) Does the plan provide that in the event of any conflict between
provisions of the plan and the terms of any policy or contract
issued under the plan, the provisions of the plan will control?
(8) If the plan provides for investment in insurance contracts, does it
provide for the disposition of dividends and other credits?

Article or Section
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(78)

(79)

(80)

(81)

(82)

(83)

(84)

(86)

(87)
(9) Does the adoption agreement contain the sponsor or
representative’s name, address, and telephone number for the
purpose of answering employer’s inquiries?
(10) Does the adoption agreement contain a cautionary statement
describing the limitations on employer reliance on an opinion or
advisory letter without a determination letter and that the failure to
properly fill out the adoption agreement may result in
disqualification of the plan?
(11) Does the adoption agreement contain a statement which provides
that the sponsor will inform the adopting employer of any
amendments made to the plan or of the discontinuance or
abandonment of the plan?
(12) Does the plan contain provisions that satisfy section 401(a)(37)
and incorporate the requirements of section 414(u) of the Code
(USERRA)?
(13) Does the plan contain any sub-trusts for life insurance?

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(88)

(88)

(88)

(89)

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Article or Section
and Page Number

Change

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(14) If the plan may be adopted as a multiple employer plan within the
meaning of section 413(c), does the plan:
(i) include, as an addendum to the adoption agreement, a participation
agreement, to be signed by any employer that adopts the plan (other than the
“lead” employer that signs the adoption agreement), which provides that the
participating employer agrees to be bound by the terms of the plan and trust
as adopted by the lead employer, including any amendments thereto and any
elections made by the lead employer, except to the extent the participation
agreement allows for, and the participating employer makes, separate
elections with respect to its employees; and
(ii) provide that for purposes of participation and vesting the adopting
employer and all participating employers are considered a single employer,
and an employee’s service includes all service with the adopting employer or
any participating employer?
(89A)

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(M&P only) Complete if you are filing for a Standardized Plan

N/A

Article or Section
and page number

Change

11 With respect to this standardized plan:
a. Does the plan cover all employees (including individuals required
to be considered employees according to section 414(n) or (o)
and employees of other members of groups aggregated under
section 414(b), (c), (m), or (o)) other than employees who may
be excluded under section 410(a)(1) or (b)(3)?
b.

c.

(90)

Are the eligibility requirements not more favorable for highly
compensated employees, as defined in section 414(q), than for
other employees?
Does the adoption agreement contain, in close proximity to the
employer’s signature line, the circumstances under which the
adopting employer may not rely on the opinion letter (as set forth
in section 19 of Rev. Proc. 2011-49), including a statement that
the employer, in order to obtain or retain reliance, must obtain a
determination letter if the employer ever has maintained any
other plan (including a welfare benefit plan)?

(M&P only) Complete if you are filing for a Nonstandardized Plan

For IRS
Use Only

(91)

(92)
N/A

Article or Section
and page number

Change

For IRS
Use Only

12 With respect to this nonstandardized plan:
a.
b.

c.

Does the plan preclude mandatory contributions in plan years
beginning after the date the plan was restated for EGTRRA?

(102)

If the plan previously provided for mandatory contributions, does
the plan define the accrued benefit derived from employer
contributions as the total accrued benefit, less the accrued
benefit derived from mandatory employee contributions as
provided in Regulations section 1.411(c)-1?

(103)

Is the accrued benefit attributable to mandatory employee
contributions nonforfeitable at all times?
(104)

d.

Does the plan meet the minimum age and service requirements
of section 410(a)(1)?
(105)

e.

f.

Does the plan exclude categories of employees from
participation in addition to those who may be excluded under
section 410(a)(1) or section 410(b)(3)?

(105)

Does the plan give the employer the option to satisfy one of the
nondiscrimination design-based safe harbors?
(106)

g.

h.

Does the adoption agreement contain, in close proximity to the
employer’s signature line, the circumstances under which
adopting employers may not rely on an opinion letter issued by
EP Rulings and Agreements, with respect to the qualification of
this plan unless they apply to EP Determinations for a
Determination Letter?

(107)

Does the plan give the employer the option to select total
compensation?
(108)

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