Form 14568-H - Appendix C Part Ii Schedule 8 - Failure To Pay Required Minimum Distributions Timely Under 401(A)(9)

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Department of the Treasury - Internal Revenue Service
Appendix C Part II Schedule 8
14568-H
Form
OMB Number
1545-1673
Failure to Pay Required Minimum Distributions
(January 2014)
Timely under § 401(a)(9)
Please include the plan name, Applicant’s EIN, and plan number information on each page of the submission
Plan name
EIN
Plan number
Section I - Identification of Failure
Calendar Years
Number of Participants Affected
Total Amount of Missed Required Minimum Distributions
Section II - Description of the Proposed Method of Correction
Defined Contribution plan only - The plan will distribute the required minimum distributions (with Earnings from the date of the
failure to the date of distribution) to affected participants. For each affected participant, the amount to be distributed for each year in
which the failure occurred will be determined by dividing the adjusted account balance on the applicable valuation date by the
applicable distribution period. For this purpose, adjusted account balance means the actual account balance, determined in
accordance with § 1.401(a)(9)-5 Q&A-3 of the Income Tax Regulations, reduced by the amount of the total missed minimum
distributions for prior years.
Defined Benefit plan only - The plan will distribute the required minimum distributions plus an interest payment representing
the loss of use of such amounts. The interest adjustment is determined as follows:
Section III - Request for Relief
A. The Applicant requests relief with regard to excise taxes under § 4974
Yes
No
At least one affected participant is either an owner-employee (see § 401(c)(3)) or, if the Plan Sponsor is a
corporation, a 10 percent owner of such corporation.
If “Yes,” the Applicant submits the following explanation for its request for relief from the § 4974 excise tax:
14568-H
Catalog Number 66153Y
Form
(1-2014)
For Paperwork Reduction Act information see Revenue Procedure 2013-12.

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