Form 5307 - Application For Determination For Adopters Of Modified Volume Submitter Plans Page 2
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Form 5307 (Rev. 6-2014)
Page
3 a Determination requested for (enter applicable number in box)
1 - Initial Qualification — New Plan
2 - Initial Qualification — Existing Plan
3 - Request after Initial Qualification
b
If 3a is "1" or "2," enter the date the plan was initially adopted.
Yes
No
c
Does the VS practitioner have the authority to amend on behalf of the adopting employer?
Does the plan have a determination letter (DL) or did the plan rely on the opinion or advisory letter for the
d
plan's remedial amendment cycle (RAC) immediately preceding the RAC in which the application is filed?
If the plan relied on a DL, complete (i) and (ii).
If the plan relied on an opinion or advisory letter, go to line 3e.
If the plan did not have a DL or did not rely on the opinion or advisory letter, go to line 3f.
(i) Date the letter was issued
(ii) Year of the Cumulative List considered in the letter
e If the plan relied on a favorable opinion or advisory letter as an "identical adopter" of a pre-approved plan for the plan's RAC
immediately preceding the cycle in which the application is submitted, complete the following:
(i)
Name of sponsor or practitioner
(ii)
Date of opinion/advisory letter
(iii) Serial # of opinion/advisory letter
f
Do any amendments not considered in a prior DL have any discretionary provisions?
If "Yes," and the amendment contains only discretionary provisions, mark an "X," in subcolumn (a) of
column (iv) in the table.
If "Yes," and the amendment contains both interim and discretionary provisions, mark an "X" in subcolumns (a)
and (b) of column (iv) in the table.
g Complete the following table. If additional space is needed, attach a separate sheet of paper the same size, label it "Attachment to 3g"
using the same format as below.
(iv)
(v)
(vi)
(vii)
Type of Amendment
(viii)
(ix)
Power to Amend
(ii)
(iii)
Due Date of
Specific Section
Specific Section
Is Required
on Behalf of
(i)
Effective
Adoption
Tax Return
of Plan, Adoption
of Amendment
Practitioner
Amendment ID
Date
Date
(a)
(including
Agreement or
(b)
Creating the
Statement
(MM/DD/YYYY)
(MM/DD/YYYY)
extensions)
Trust Changed
Interim
Discr.
Change in (vii)
Attached
(a)
(b)
(MM/DD/YYYY)
or Added
.
Yes
No
3g(1)
3g(2)
3g(3)
3g(4)
3g(5)
3g(6)
3g(7)
3g(8)
3g(9)
3g(10)
h Total amendments on line 3g.
i Designate the specific tax return that the employer uses to file its federal income tax return.
5307
Form
(Rev. 6-2014)
*11832Y06201402*
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