8951
User Fee for Application for Voluntary
OMB No. 1545-1673
Form
Correction Program (VCP)
For IRS Use Only
Under the Employee Plans Compliance Resolution System (EPCRS)
(Rev. September 2016)
Information about Form 8951 and its instructions is at
Amount paid
▶
Department of the Treasury
$
Attach to Form 8950.
Internal Revenue Service
▶
1 Name of plan sponsor (employer if single-employer plan)
2 Plan sponsor’s employer identification number
3 Plan number
4 Plan name
5 Number of plan participants. See instructions to determine this number.
6 If you are submitting a check for an additional VCP user fee that has been requested by an IRS employee in Voluntary
Compliance, check this box
and provide the check amount $
and the VCP case number
.
7 For qualified retirement plans under sections 401(a) and 403(b) that do not qualify for a reduced or alternative user fee, as
described below on line 8. Enter the general user fee amount
based on the number of plan participants.
$
Do not complete line 7 if you qualify for a reduced or alternative fee as described below on line 8.
Check box, if applicable and
8 Reduced and alternative user fees for VCP submissions
enter enclosed fee.
(a) Plan is a section 401(a) or 403(b) plan that qualifies for a reduced fee associated with
specific failures and under certain conditions. See instructions.
Enter fee amount $
(b) VCP submission relates to a request for a minor modification of a previously issued
compliance statement. See instructions.
Enter fee amount $
(c) Plan is a SEP, SARSEP, or SIMPLE IRA. See instructions.
Enter fee amount $
(d) Group submission from an eligible organization. See instructions.
Enter fee amount $
(e) Terminating orphan plan. A terminating orphan plan may be granted a waiver of the fee
upon request. See instructions.
No fee is due at this time.
No payment is due at the
(f) Plan is a section 457(b) plan. See instructions.
time of filing.
8951
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 9-2016)
Cat. No. 37771W