SFA Template 4A

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TEMPLATE 4A

v20221102p

SFA Determination - under the "basic method" for all plans, and under the "increasing assets method" for MPRA plans
File name: Template 4A Plan Name, where "Plan Name" is an abbreviated version of the plan name.
If submitting additional information due to a merger under § 4262.4(f)(1)(ii): Template 4A Plan Name Merged, where "Plan Name Merged" is an abbreviated version
of the plan name for the separate plan involved in the merger.
If submitting additional information due to certain events with limitations under § 4262.4(f)(1)(i): Template 4A Plan Name Add, where "Plan Name" is an abbreviated
version of the plan name.
If submitting a supplemented application under § 4262.4(g)(6): Template 4A Supp Plan Name, where "Plan Name" is an abbreviated version of the plan name.
Instructions for Section C, Item (4) of the Instructions for Filing Requirements for Multiemployer Plans Applying for Special Financial Assistance:
IFR filers submitting a supplemented application should see Addendum C for more information.
MPRA plans using the "increasing assets method" should see Addendum D for more information.
For all plans, provide information used to determine the amount of SFA under the "basic method" described in § 4262.4(a)(1).
For MPRA plans, also provide information used to determine the amount of SFA under the "increasing assets method" described in § 4262.4(a)(2)(i).
The information to be provided is:
NOTE: All items below are provided on Sheet '4A-4 SFA Details .4(a)(1)' unless otherwise indicated.
a. The amount of SFA calculated using the "basic method", determined as a lump sum as of the SFA measurement date.
b. Non-SFA interest rate required under § 4262.4(e)(1) of PBGC’s SFA regulation, including supporting details on how it was determined.
[Sheet: 4A-1 Interest Rates]
c. SFA interest rate required under § 4262.4(e)(2) of PBGC’s SFA regulation, including supporting details on how it was determined.
[Sheet: 4A-1 Interest Rates]
d. Fair market value of assets as of the SFA measurement date. This amount should include any assets at the SFA measurement date attributable to financial
assistance received by the plan under section 4261 of ERISA, but should not reflect a payable for amounts owed to PBGC for all amounts of such financial
assistance received by the plan.

e. For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA
coverage period"):
i. Separately identify the projected amount of contributions, projected withdrawal liability payments reflecting a reasonable allowance for
amounts considered uncollectible, and other payments expected to be made to the plan (excluding the amount of financial assistance under
section 4261 of ERISA and SFA to be received by the plan).
ii. Identify the benefit payments described in § 4262.4(b)(1) (including any benefits that were restored under 26 CFR 1.432(e)(9)-(1)(e)(3) and
excluding the payments in e.iii. below), separately for current retirees and beneficiaries, current terminated vested participants not yet in pay
status, current active participants, and new entrants.
[Sheet: 4A-2 SFA Ben Pmts]
Identify total benefit payments paid and expected to be paid from projected SFA assets separately from total benefit payments paid and
expected to be paid from non-SFA assets after the projected SFA assets are fully exhausted.
iii. Separately identify the make-up payments described in § 4262.4(b)(1) attributable to the reinstatement of benefits under § 4262.15 that were
previously suspended through the SFA measurement date.
[Also see applicable examples in Section C, Item (4)e.iii. of the SFA instructions.]
iv. Separately identify administrative expenses paid and expected to be paid (excluding the amount owed PBGC under section 4261 of ERISA) for
premiums to PBGC and for all other administrative expenses.
[Sheet: 4A-3 SFA Pcount and Admin Exp]
Identify total administrative expenses paid and expected to be paid from projected SFA assets separately from total administrative expenses
paid and expected to be paid from non-SFA assets after the projected SFA assets are fully exhausted.
v. Provide the projected total participant count at the beginning of each year.
[Sheet: 4A-3 SFA Pcount and Admin Exp]
vi. Provide the projected investment income earned by assets not attributable to SFA based on the non-SFA interest rate in b. above and the
projected fair market value of non-SFA assets at the end of each plan year.
vii. Provide the projected investment income earned by assets attributable to SFA based on the SFA interest rate in c. above (excluding investment
returns for the plan year in which the sum of annual projected benefit payments and administrative expenses for the year exceeds the
beginning-of-year projected SFA assets) and the projected fair market value of SFA assets at the end of each plan year.
f. The projected SFA exhaustion year. This is the first day of the plan year in which the sum of annual projected benefit payments and administrative
expenses for the year exceeds the beginning-of-year projected SFA assets. Note this date is only required for the calculation method under which the
requested amount of SFA is determined.

Additional instructions for each individual worksheet:
Sheet
4A-1

SFA Determination - non-SFA Interest Rate and SFA Interest Rate

See instructions on 4A-1 Interest Rates.
4A-2

SFA Determination - Benefit Payments for the "basic method" for all plans, and for the "increasing assets method" for MRPA plans

This sheet is not required for an IFR filer submitting a supplemented application under § 4262.4(g)(6) if the total projected benefit payments are the same as those
used in the application approved under the interim final rule.
On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date), and
--Year-by-year deterministic projection of benefit payments.
For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"),
identify benefit payments described in § 4262.4(b)(1) for current retirees and beneficiaries, current terminated vested participants not yet in pay status, currently
active participants, and new entrants. Projected benefit payments should be entered based on current participant status as of the SFA census date. On this Sheet 4A-2,
show all benefit payments as positive amounts.
If the plan has suspended benefit payments under sections 305(e)(9) or 4245(a) of ERISA, the benefit payments in this Sheet 4A-2 projection should reflect
prospective reinstatement of benefits assuming such reinstatements commence as of the SFA measurement date. If the plan restored or partially restored benefits
under 26 CFR 1.432(e)(9)-1(e)(3) before the SFA measurement date, the benefit payments in this Sheet 4A-2 should reflect fully restored prospective benefits.
Make-up payments to be paid to restore previously suspended benefits should not be included in this Sheet 4A-2, and are separately shown in Sheet 4A-4.
Except for the first row in the projection exhibit, each row must include the full plan year of the indicated information up to the plan year ending in 2051. The first
row in the projection period is for the period beginning on the SFA measurement date and ending on the last day of the plan year containing the SFA measurement
date, so the first row may contain less than a full plan year of information. For all other periods, provide the full plan year of information up to the plan year ending in
2051.

4A-3

SFA Determination - Participant Count and Administrative Expenses for the "basic method" for all plans, and for the "increasing assets
method" for MPRA plans

This sheet is not required for an IFR filer submitting a supplemented application under § 4262.4(g)(6).
On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date), and
--Year-by-year deterministic projection of participant count and administrative expenses.
For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"),
identify the projected total participant count at the beginning of each year, as well as administrative expenses, separately for premiums to PBGC and for all other
administrative expenses. On this Sheet 4A-3, show all administrative expenses as positive amounts. Total expenses should match the amounts shown on 4A-4 and
4A-5.
Any amounts owed to PBGC for financial assistance under section 4261 of ERISA should not be included in this Sheet 4A-3.
Except for the first row in the projection exhibit, each row must include the full plan year of the indicated information up to the plan year ending in 2051. The first
row in the projection period is for the period beginning on the SFA measurement date and ending on the last day of the plan year containing the SFA measurement
date, so the first row may contain less than a full plan year of information. For all other periods, provide the full plan year of information up to the plan year ending in
2051.

4A-4

SFA Determination - Details for the "basic method" under § 4262.4(a)(1) for all plans

On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date, non-SFA interest rate, SFA interest rate),
--MPRA plan status and, if applicable, certain MPRA information,
--Fair Market Value of Assets as of the SFA measurement date,
--SFA Amount as of the SFA measurement date calculated under the "basic method",
--Projected SFA exhaustion year (only if the requested amount of SFA is determined under the "basic method"), and
--Year-by-year deterministic projection.
For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"),
provide each of the items requested in Columns (1) through (12). Show payments INTO the plan as positive amounts and payments OUT of the plan as negative
amounts.
If the plan has suspended benefit payments under sections 305(e)(9) or 4245(a) of ERISA, Column (5) should show the make-up payments to be paid to restore the
previously suspended benefits. These amounts should be determined as if such make-up payments are paid beginning as of the SFA measurement date. If the plan
sponsor elects to pay these amounts as a lump sum, then the lump sum amount is assumed paid as of the SFA measurement date. If the plan sponsor elects to pay
equal installments over 60 months, the first monthly payment is assumed paid on the first regular payment date on or after the SFA measurement date. See the
examples in the SFA Instructions. If the make-up payments are paid over 60 months, each row in the projection should reflect the monthly payments for that period.
The prospective reinstatement of suspended benefits is included in Column (4); Column (5) is only for make-up payments for past benefits that were suspended.
Except for the first row in the projection exhibit, each row must include the full plan year of the indicated information up to the plan year ending in 2051. The first
row in the projection period is for the period beginning on the SFA measurement date and ending on the last day of the plan year containing the SFA measurement
date, so the first row may contain less than a full plan year of information. For all other periods, provide the full plan year of information up to the plan year ending in
2051.

4A-5

SFA Determination - Details for the "increasing assets method" under § 4262.4(a)(2)(i) for MPRA plans

This sheet is to only be used by MPRA plans. For such plans, this sheet should be completed in addition to Sheet 4A-4.
On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date, non-SFA interest rate, SFA interest rate),
--MPRA plan status, and if applicable, certain MPRA information,
--Fair Market Value of Assets as of the SFA measurement date,
--SFA Amount as of the SFA measurement date calculated under the "increasing assets method",
--Projected SFA exhaustion year (only if the requested amount of SFA is determined under the "increasing assets method"), and
--Year-by-year deterministic projection.
This sheet is identical to Sheet 4A-4, and the information in Columns (1) through (6) should be the same as that used in the "basic method" calculation in Sheet 4A-4.
The SFA Amount as of the SFA Measurement Date will differ from that calculated in Sheet 4A-4, as it will be calculated in accordance with § 4262.4(a)(2)(i) as the
lowest whole dollar amount (not less than $0) for which, as of the last day of each plan year during the SFA coverage period, projected SFA assets and projected nonSFA assets are both greater than or equal to zero, and, as of the last day of the SFA coverage period, the sum of projected SFA assets and projected non-SFA assets is
greater than the amount of such sum as of the last day of the immediately preceding plan year.

Version Updates (newest version at top)
Version

Date updated

v20221102p

11/2/2022

Added clarifying instructions for 4A-2 and 4A-3

v20220802p

8/2/2022

Cosmetic changes to increase the size of some rows

v20220701p

7/1/2022

TEMPLATE 4A - Sheet 4A-1

v20221102p

SFA Determination - non-SFA Interest Rate and SFA Interest Rate
Provide the non-SFA interest rate and SFA interest rate used, including supporting details on how they were determined.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
Initial Application Date:

SFA Measurement Date:

For a plan other than a plan described in § 4262.4(g) (i.e., for a plan that has not filed an initial application under PBGC's interim final rule), the last day
of the third calendar month immediately preceding the plan's initial application date.
For a plan described in § 4262.4(g) (i.e., for a plan that filed an initial application prior to publication of the final rule), the last day of the calendar quarter
immediately preceding the plan's initial application date.

Last day of first plan
year ending after the
measurement date:
Non-SFA Interest Rate Used:

Rate used in projection of non-SFA assets.

SFA Interest Rate Used:

Rate used in projection of SFA assets.

Development of non-SFA interest rate and SFA interest rate:
Interest rate used for the funding standard account projections in the plan's
most recently completed certification of plan status before 1/1/2021.

Plan Interest Rate:

Corresponding ERISA Section 303(h)(2)(C)(i), (ii), and (iii) rates
disregarding modifications made under clause (iv) of such section.
(i)
(ii)
(iii)

Month Year
Month in which plan's initial application is filed,
and corresponding segment rates (leave (i), (ii),
and (iii) blank if the IRS Notice for this month has
not yet been issued):

24-month average segment rates without regard to
interest rate stabilization rules. These rates are
issued by IRS each month. For example, the
applicable segment rates for August 2021 are
1.13%, 2.70%, and 3.38%. Those rates were
issued in IRS Notice 21-50 on August 16, 2021
(see page 2 of notice under the heading "24-Month
Average Segment Rates Without 25-Year Average
Adjustment").

1 month preceding month in which plan's initial
application is filed, and corresponding segment
rates:
2 months preceding month in which plan's initial
application is filed, and corresponding segment
rates:

They are also available on IRS’ Funding Yield
Curve Segment Rate Tables web page (See
Funding Table 3 under the heading "24-Month
Average Segment Rates Not Adjusted").

3 months preceding month in which plan's initial
application is filed, and corresponding segment
rates:

Non-SFA Interest Rate Limit (lowest 3rd segment rate plus 200 basis points):
Non-SFA Interest Rate Calculation (lesser of Plan
Interest Rate and Non-SFA Interest Rate Limit):
Non-SFA Interest Rate Match Check:

2.00%

Not a match

2.00%

This amount is calculated based on the other
information entered above.

This amount is calculated based on the other information entered above.

If the non-SFA Interest Rate Calculation is not equal to the non-SFA Interest Rate Used, provide explanation below.

SFA Interest Rate Limit (lowest average of the 3 segment rates plus 67 basis points):

#DIV/0!

This amount is calculated based on the other
information entered.

SFA Interest Rate Calculation (lesser of Plan
Interest Rate and SFA Interest Rate Limit):

#DIV/0!

This amount is calculated based on the other information entered above.

SFA Interest Rate Match Check:

#DIV/0!

If the SFA Interest Rate Calculation is not equal to the SFA Interest Rate Used, provide explanation below.

TEMPLATE 4A - Sheet 4A-2

v20221102p

SFA Determination - Benefit Payments for the "basic method" for all plans, and for the "increasing assets method" for MRPA plans
See Template 4A Instructions for Additional Instructions for Sheet 4A-2.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
On this Sheet, show all benefit payment amounts as positive amounts.
PROJECTED BENEFIT PAYMENTS for:
SFA Measurement
Date / Plan Year Start
Date

Plan Year End Date

Current Retirees and
Beneficiaries in Pay
Status

Current Terminated
Vested Participants

Current Active
Participants

New Entrants

Total

TEMPLATE 4A - Sheet 4A-3

v20221102p

SFA Determination - Participant Count and Administrative Expenses for the "basic method" for all plans, and for the "increasing assets method" for MPRA plans
See Template 4A Instructions for Additional Instructions for Sheet 4A-3.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
On this Sheet, show all administrative expense amounts as positive amounts.
PROJECTED ADMINISTRATIVE EXPENSES for:
SFA Measurement
Date / Plan Year Start
Date

Plan Year End Date

Total Participant Count
at Beginning of Plan
Year
N/A

PBGC Premiums

Other

Total

TEMPLATE 4A - Sheet 4A-4

v20221102p

SFA Determination - Details for the "basic method" under § 4262.4(a)(1) for all plans
See Template 4A Instructions for Additional Instructions for Sheet 4A-4.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
MPRA Plan?

Meets the definition of a MPRA plan described in § 4262.4(a)(3)?

If a MPRA Plan, which
method yields the
greatest amount of SFA?

MPRA increasing assets method described in § 4262.4(a)(2)(i).
MPRA present value method described in § 4262.4(a)(2)(ii).

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:

Per § 4262.4(a)(1), the lowest whole dollar amount (not less than $0) for which, as of the last day of
each plan year during the SFA coverage period, projected SFA assets and projected non-SFA assets
are both greater than or equal to zero.

Projected SFA
exhaustion year:

Only required on this sheet if the requested amount of SFA is based on the "basic method".
Plan Year Start Date of the plan year in which the sum of annual projected benefit payments and administrative expenses for the
year exceeds the beginning-of-year projected SFA assets.

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)

(4)

Other Payments to Plan
Benefit Payments
(excluding financial (should match total from
assistance and SFA)
Sheet 4A-2)

(5)
Make-up Payments
Attributable to
Reinstatement of
Benefits Suspended
through the SFA
Measurement Date

(6)

(7)

(8)

(9)

(10)

(11)

Administrative Expenses Benefit Payments (from
Benefit Payments (from
(excluding amount owed
(4) and (5)) and
Projected SFA Assets at
(4) and (5)) and
PBGC under 4261 of Administrative Expenses SFA Investment Income
End of Plan Year
Administrative Expenses Non-SFA Investment
ERISA; should match
(from (6)) Paid from
Based on SFA Interest
(prior year assets +
(from (6)) Paid from
Income Based on Nontotal from Sheet 4A-3)
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))

TEMPLATE 4A - Sheet 4A-5

v20221102p

SFA Determination - Details for the "increasing assets method" under § 4262.4(a)(2)(i) for MPRA plans
See Template 4A Instructions for Additional Instructions for Sheet 4A-5.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
MPRA Plan?

Meets the definition of a MPRA plan described in § 4262.4(a)(3)?

If a MPRA Plan, which
method yields the
greatest amount of SFA?

MPRA increasing assets method described in § 4262.4(a)(2)(i).
MPRA present value method described in § 4262.4(a)(2)(ii).

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:

Per § 4262.4(a)(2)(i), the lowest whole dollar amount (not less than $0) for which, as of the last day of each plan year during the
SFA coverage period, projected SFA assets and projected non-SFA assets are both greater than or equal to zero, and, as of the
last day of the SFA coverage period, the sum of projected SFA assets and projected non-SFA assets is greater than the amount of
such sum as of the last day of the immediately preceding plan year.

Projected SFA
exhaustion year:

Only required on this sheet if the requested amount of SFA is based on the "increasing assets method".
Plan Year Start Date of the plan year in which the sum of annual projected benefit payments and administrative expenses for the
year exceeds the beginning-of-year projected SFA assets.

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)

(4)

Other Payments to Plan
Benefit Payments
(excluding financial (should match total from
assistance and SFA)
Sheet 4A-2)

(5)
Make-up Payments
Attributable to
Reinstatement of
Benefits Suspended
through the SFA
Measurement Date

(6)

(7)

(8)

(9)

(10)

(11)

Administrative Expenses Benefit Payments (from
Benefit Payments (from
(excluding amount owed
(4) and (5)) and
Projected SFA Assets at
(4) and (5)) and
PBGC under 4261 of Administrative Expenses SFA Investment Income
End of Plan Year
Administrative Expenses Non-SFA Investment
ERISA; should match
(from (6)) Paid from
Based on SFA Interest
(prior year assets +
(from (6)) Paid from
Income Based on Nontotal from Sheet 4A-3)
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))