Application for Special Financial Assistance

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TEMPLATE 9

v20220701p

Reconciliation and Assumption Change for SFA Amount from Interim Final Rule Application
File name: Template 9 Plan Name, where "Plan Name" is an abbreviated version of the plan name.
Instructions for Addendum C for Supplemented Applications, Sections F, G and H
Provide a reconciliation of the change in the requested amount of SFA under the final rule as shown in Template 4A or Template 4B (whichever is applicable) from the
total amount of SFA approved under the interim final rule as shown in Template 4 of the application approved under the interim final rule.
If the filer is proposing a change to the plan's employer contribution assumption to exclude contribution rate increases agreed to on or after July 9, 2021, as permitted
under § 4262.4(c)(3) of PBGC’s SFA regulation, provide a deterministic projection using the "basic method" of determining the SFA amount described in
§ 4262.4(a)(1) without reflecting the changed assumption, in the same format as sheet 4A-4 SFA Details .4(a)(1) of Template 4A.

Additional instructions for each individual worksheet:
Complete sheet 9-1A, 9-1B, 9-1C, 9-1D, 9-1E, or 9-1F depending on the method used to calculate the requested SFA amount under the final rule, and depending on
whether the filer is proposing a change to the plan's employer contribution assumption. See below for more explanation of which sheet is required.
Sheet
9-1A

Section F, Item (1): Reconciliation - Summary for non-MPRA plans using the "basic method" under § 4262.4(a)(1) with no contribution increases
agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

9-1B

Section F, Item (1): Reconciliation - Summary for non-MPRA plans using the "basic method" under § 4262.4(a)(1) with contribution increases
agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, and include the deterministic projection in Sheet 9-2 Recon Details.
For Item number 3, show the SFA amount determined under the final rule using the "basic method" reflecting the assumption change related to excluded contribution
increases agreed to on or after July 9, 2021, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

9-1C

Section G, Item (2): Reconciliation - Summary for MPRA plans for which the requested amount of SFA is determined under the "increasing assets
method" described in § 4262.4(a)(2)(i) with no contribution increases agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.
For Item number 3, show the SFA amount determined under the final rule using the "increasing assets method" with no assumption changes other than using the nonSFA and SFA interest rates, as shown in Sheet '4A-5 SFA Details .4(a)(2)(i)' of Template 4A.

9-1D

Section G, Item (2): Reconciliation - Summary for MPRA plans for which the requested amount of SFA is determined under the "increasing assets
method" described in § 4262.4(a)(2)(i) with contribution increases agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, and include the deterministic projection in Sheet 9-2 Recon Details.
For Item number 3, show the SFA amount determined under the final rule using the "basic method" reflecting the assumption change related to excluded contribution
increases agreed to on or after July 9, 2021, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.
For Item number 4, show the SFA amount determined under the final rule using the "increasing assets method" reflecting the assumption change related to excluded
contribution increases agreed to on or after July 9, 2021, as shown in Sheet '4A-5 SFA Details .4(a)(2)(i)' of Template 4A.

9-1E

Section H, Item (2): Reconciliation - Summary for MPRA plans for which the requested amount of SFA is determined under the "present value
method" described in § 4262.4(a)(2)(ii) with no contribution increases agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.
For Item number 3, show the SFA amount determined under the final rule using the "alternative present value method" with no assumption changes other than using
the non-SFA and SFA interest rates, as shown in Template 4B.

9-1F

Section H, Item (2): Reconciliation - Summary for MPRA plans for which the requested amount of SFA is determined under the "present value
method" described in § 4262.4(a)(2)(ii) with contribution increases agreed to on or after July 9, 2021

For Item number 1, show the SFA amount determined under the interim final rule, as shown in Template 4 of the application that was approved under the interim final
rule.
For Item number 2, show the SFA amount determined under the final rule using the "basic method" with no assumption changes other than using the non-SFA and
SFA interest rates, and include the deterministic projection in Sheet 9-2 Recon Details.
For Item number 3, show the SFA amount determined under the final rule using the "basic method" reflecting the assumption change related to excluded contribution
increases agreed to on or after July 9, 2021, as shown in Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.
For Item number 4, show the SFA amount determined under the final rule using the "alternative present value method" reflecting the assumption change related to
excluded contribution increases agreed to on or after July 9, 2021, as shown in Template 4B.

9-2

Section F, Item (1): Reconciliation - Details for SFA amount under the Final Rule using the "basic method" with no assumption changes other than
using the non-SFA and SFA interest rates

Sheet 9-2 is not required if all the assumptions used in determining the requested SFA amount under the final rule are the same as those used in the application that
was approved under the interim final rule (except for the non-SFA and SFA interest rates).
See Template 4A instructions for Sheet 4A-4, except provide the projection used to determine the intermediate Item number 2 SFA amount from Sheets 9-1B, 9-1D, or
9-1F (whichever applies), under the "basic method" described in § 4262.4(a)(1) and before any assumption change related to excluded contribution increases agreed to
on or after July 9, 2021. Unlike Sheet 4A-4, it is not necessary to explicitly identify the projected SFA exhaustion year in Sheet 9-2.

Version Updates (newest version at top)
Version

Date updated

v20220701p

7/1/2022

TEMPLATE 9 - Sheet 9-1A

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Reconciliation - Summary for non-MPRA plans using the "basic method" under § 4262.4(a)(1) with no contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1A.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: No Recon Details sheets are required for any of the Item numbers.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

TEMPLATE 9 - Sheet 9-1B

v20220701p

Reconciliation - Summary for non-MPRA plans using the "basic method" under § 4262.4(a)(1) with contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1B.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: A sheet with Recon Details is only required for Item number 2.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

Show details supporting the SFA amount on Sheet 9-2.

3

SFA amount under the Final Rule using the "basic
method" reflecting the assumption change related
to excluded contribution increases agreed to on or
after July 9, 2021

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

TEMPLATE 9 - Sheet 9-1C

v20220701p

Reconciliation - Summary for MPRA plans using the "increasing assets method" under § 4262.4(a)(2)(i) with no contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1C.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: No Recon Details sheets are required for any of the Item numbers.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

3

SFA amount under the Final Rule using the
"increasing assets method" with no assumption
changes other than using the non-SFA and SFA
interest rates

$0

From Sheet '4A-5 SFA Details .4(a)(2)(i)' of Template 4A.

TEMPLATE 9 - Sheet 9-1D

v20220701p

Reconciliation - Summary for MPRA plans using the "increasing assets method" under § 4262.4(a)(2)(i) with contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1D.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: A sheet with Recon Details is only required for Item 2.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

Show details supporting the SFA amount on Sheet 9-2.

3

SFA amount under the Final Rule using the "basic
method" reflecting the assumption change related
to excluded contribution increases agreed to on or
after July 9, 2021

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

4

SFA amount under the Final Rule using the
"increasing assets method" reflecting the
assumption change related to excluded
contribution increases agreed to on or after July 9,
2021

$0

From Sheet '4A-5 SFA Details .4(a)(2)(i)' of Template 4A.

TEMPLATE 9 - Sheet 9-1E

v20220701p

Reconciliation - Summary for MPRA plans using the "alternative present value method" under § 4262.4(a)(2)(ii) with no contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1E.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: No Recon Details sheets are required for any of the Item numbers.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

3

SFA amount under the Final Rule using the
"alternative present value method" with no
assumption changes other than using the non-SFA
and SFA interest rates

$0

From Template 4B.

TEMPLATE 9 - Sheet 9-1F

v20220701p

Reconciliation - Summary for MPRA plans using the "alternative present value method" under § 4262.4(a)(2)(ii) with contribution increases agreed to on or after July 9, 2021
See Template 9 Instructions for Additional Instructions for Sheet 9-1F.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?

Item number

Basis for Assumptions/Methods. For each Item,
briefly describe the incremental change reflected Change in SFA Amount (from prior Item number)
in the SFA amount.

SFA Amount

NOTE: A sheet with Recon Details is only required for Item 2.

1

SFA amount under the Interim Final Rule

N/A

From Template 4 of the application that was approved under the Interim
Final Rule provisions.

2

SFA amount under the Final Rule using the "basic
method" with no assumption changes other than
using the non-SFA and SFA interest rates

$0

Show details supporting the SFA amount on Sheet 9-2.

3

SFA amount under the Final Rule using the "basic
method" reflecting the assumption change related
to excluded contribution increases agreed to on or
after July 9, 2021

$0

From Sheet '4A-4 SFA Details .4(a)(1)' of Template 4A.

4

SFA amount under the Final Rule using the
"alternative present value method" reflecting the
assumption change related to excluded
contribution increases agreed to on or after July 9,
2021

$0

From Template 4B.

TEMPLATE 9 - Sheet 9-2

v20220701p

Reconciliation - Details for SFA amount under the Final Rule using the "basic method" with no assumption changes other than using the non-SFA and SFA interest rates
See Template 4A instructions for Sheet 4A-4, except provide the projection used to determine the intermediate SFA amount.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?
SFA Measurement Date:
Fair Market Value of
Assets as of the SFA
Measurement Date:
SFA Amount as of the
SFA Measurement Date
under the method
calculated in this Sheet:
Non-SFA Interest Rate:
SFA Interest Rate:
On this Sheet, show payments INTO the plan as positive amounts, and payments OUT of the plan as negative amounts.
(1)

SFA Measurement Date /
Plan Year Start Date

Plan Year End Date

Contributions

(2)

Withdrawal Liability
Payments

(3)

Other Payments to Plan
(excluding financial
assistance and SFA)

(4)

(5)

Benefit Payments

Make-up Payments
Attributable to
Reinstatement of
Benefits Suspended
through the SFA
Measurement Date

(6)

(7)

(8)

(9)

(10)

(11)

Benefit Payments (from
Benefit Payments (from
Administrative Expenses
(4) and (5)) and
Projected SFA Assets at
(4) and (5)) and
(excluding amount owed Administrative Expenses SFA Investment Income
End of Plan Year
Administrative Expenses Non-SFA Investment
PBGC under 4261 of
(from (6)) Paid from
Based on SFA Interest
(prior year assets +
(from (6)) Paid from
Income Based on NonERISA)
SFA Assets
Rate
(7) + (8))
Non-SFA Assets
SFA Interest Rate

(12)
Projected Non-SFA
Assets at End of Plan
Year
(prior year assets +
(1) + (2) + (3) +
(10) + (11))