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termination began along with the

following plan year, and for the 2 prior

Partial Termination Worksheet

Year

Year of partial termination

Year

plan years, to the extent information is

Participants employed:

available.

a Number at beginning of plan year

2. If the plan has more than one

b Number added during the plan year

benefit computation formula, provide a

schedule of information in the same

c Total, add lines a and b

format as lines 1a through 1f of the

d Number dropped during the plan year

worksheet for each benefit computation

formula.

e Number at end of plan year, subtract d

from c

3. Include an explanation of how the

plan meets the requirements of section

f Total number of participants in this plan

separated from service without full

411(d)(3).

vesting

Special ruling requests. See Rev.

Present value (as of month

day)

Proc. 2016-37 and successors to Rev.

during the year of

Proc. 2016-6 for other types of issues

a Plan assets

for which a Form 5300 may be filed.

b Accrued benefits

Line 4b. If line 4a is “1,” enter the date

the plan was originally adopted. If the

c Vested benefits

initial plan is a proposed plan document,

Submit a description of the actions that may have resulted (or might result) in a partial

enter “09/09/9999.”

termination. Include an explanation of how the plan meets the requirements of section 411(d)

(3).

Line 5. A “pension equity plan” (PEP) is

a DB plan which, rather than or in

addition to expressing the accrued

under Regulations section 1.410(b)-6(d)

1.401(a)(4)-3(b)(3) unit credit DB

benefit as a life annuity commencing at

(2).

plan.

normal retirement age, defines benefits

1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit

for each employee as an amount equal

Line 9. Check “Yes” if the plan is an

DB fractional rule plan.

to an accumulated percentage of final

insurance contract plan under section

1.401(a)(4)-3(b)(4)(i)(C)(2) flat

pay. Benefits are generally described as

412(e)(3).

benefit DB plan.

a percentage of final average pay, with

Line 10. Check “Yes” if the plan is a

1.401(a)(4)-3(b)(5) insurance

the percentage determined as the

multiemployer collectively bargained

contract plan.

accumulation of percentage points or

plan under section 414(f).

lump-sum credits received for each year

Line 14. Check “Yes” if the plan utilizes

of service. Generally, the accumulated

Line 11. Check “Yes” if the plan is a

the permitted disparity rules of 401(l).

percentage points or lump-sum credits

multiple employer plan under section

Line 15. If “Yes,” attach a statement

are multiplied by final average or career

413(c).

providing the plan name, EIN of the plan

average compensation to determine the

Line 12. Section 3001 of the Employee

sponsor/employer, plan type of the

lump-sum amount.

Retirement Income Security Act of 1974

other plan, and a copy of pertinent

A “cash balance” plan is a DB plan

requires that applicants subject to

provisions from the other plan regarding

which, rather than or in addition to

section 410 provide evidence that each

the offset.

expressing the accrued benefit as a life

employee who qualifies as an interested

Line 16. If this is a request for an

annuity commencing at normal

party has been notified of the filing of

individually designed plan that consists

retirement age, defines benefits for

the application. If “Yes” is marked, it

of a DB plan and a qualified cash or

each employee in terms more common

means that each employee has been

deferred arrangement, submit two

to a DC plan, that is, as a single-sum

notified as required by Regulations

Forms 5300 and two applicable user

amount equal to the employee’s

section 1.7476-1. If this is a one-person

fees and provide an attachment with the

hypothetical account balance. Benefits

plan or if this plan isn’t subject to section

plan sponsor/employer EIN and plan

consist of accumulated hypothetical

410, a copy of the notice isn’t required

number of the other plan.

allocation credits in an account plus

to be attached to this application. If “No”

accumulated hypothetical interest

is marked or this line is blank, the

Line 17. Attach a statement that

credits for the account.

application will be returned. Rules

provides the following.

defining “interested parties” and the

Note. If this is only a request for a

1. Name of plans involved.

form of notification are in Regulations

partial termination, DO NOT complete

2. Type of plan.

section 1.7476-1. See Part II of Rev.

the rest of the application.

3. Date of merger, consolidation,

Proc. 2016-6.

Line 6. Check “Yes” if the plan is a

spinoff, or transfer of plan assets or

Line 13. If “Yes,” attach a statement

governmental plan under section

liabilities.

identifying the plan sections that satisfy

414(d).

4. Verification that each plan

the safe harbor (including, if applicable,

Line 7. Check “Yes” if the plan is a

involved was qualified at the time of the

permitted disparity requirements) and

church plan under section 414(e) that

merger, consolidation, spinoff, or

specify which of the following

hasn’t made a section 410(d) election.

transfer of plan assets or liabilities.

regulations is intended to be satisfied.

1.401(a)(4)-2(b)(2) DC plan with

Line 8. Check “Yes” if the plan benefits

If the plan previously obtained a DL,

uniform allocation formula.

any collectively bargained employees

only provide information on a

-4-

Instructions for Form 5300

Instructions For Form 5300 - Application For Determination For Employee Benefit Plan Page 4

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