Form 14568-E - Model Vcp Compliance Statement Schedule 5 Plan Loan Failures (Qualified Plans And 403(B) Plans)

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Department of the Treasury - Internal Revenue Service
14568-E
Form
OMB Number
Model VCP Compliance Statement - Schedule 5: Plan
1545-1673
(September 2017)
Loan Failures (Qualified Plans and 403(b) Plans)
Include the plan name, Applicant’s EIN and plan number on each page of the compliance statement, including attachments
Plan name
EIN
Plan number
Section I - Identification of Failure
The plan identified above did not comply with the requirements of Section 72(p)(2) of the Internal Revenue Code (IRC).
(Note: The conditions of IRC Section 72(p)(2) must be satisfied for a participant loan to be exempt from being treated as a distribution
to the participant under IRC Section 72(p)(1).) The failure occurred for the following reason(s) (check applicable boxes and provide the
information requested)
A. The loan(s) exceeded the limit under IRC Section 72(p)(2)(A)
Plan Year
Number of Participants Affected
Total Number of Loans Issued That Violated IRC Section 72(p)(2)(A)
B. Loan terms did not satisfy the limits on the duration of the loan under IRC Section 72(p)(2)(B)
Plan Year
Number of Participants Affected
Total Number of Loans Issued That Violated IRC Section 72(p)(2)(B)
C. Loan terms did not satisfy IRC Section 72(p)(2)(C) relating to the frequency and amortization of payments
Plan Year
Number of Participants Affected
Total Number of Loans Issued That Violated IRC Section 72(p)(2)(C)
14568-E
Catalog Number 66149Q
Form
(Rev. 9-2017)
For Paperwork Reduction Act information see current EPCRS Revenue Procedure.

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