Form 14568 - Model Vcp Compliance Statement Page 4

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Page 4
Applicant's EIN (do not use SSN)
Plan number
Plan name
If the requested relief is not applied consistently to all loans. For loans where relief from issuing Form 1099-R is
applicable, all repayments made pursuant to the correction of the loans will not result in an affected participant
having additional basis in the plan for the purpose of determining the tax treatment of subsequent distributions
from the plan to the participants. For all other loans (or situations where affected participants do not choose to or
may not qualify for Form 1099-R relief), the IRS will require deemed distributions under IRC Section 72(p) to be
reported on Form 1099-R with respect to the participants affected by the failures. However, the plan will be
permitted to report the deemed distributions on Form 1099-R in the year of correction, instead of the year of the
failure.
Approved:
Manager, Employee Plans Voluntary Compliance
Tax Exempt and Government Entities Division
Date
14568
Catalog Number 66138J
Form
(Rev. 9-2017)

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