Form 5300 - Application For Determination For Employee Benefit Plan Page 10
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Form 5300 (Rev. 4-2011)
Page
Procedural Requirements Checklist
Use this list to ensure that your submitted package is complete. Failure to supply the appropriate information may result in a delay in
the processing of the application.
Is Form 8717, User Fee for Employee Plan Determination, Opinion, and Advisory Letter Request, attached to your
1.
submission?
2.
Is the appropriate user fee for your submission attached to Form 8717?
If appropriate, is Form 2848, Power of Attorney and Declaration of Representative, Form 8821, Tax Information
3.
Authorization, or a privately designed authorization attached? (For more information, see the Disclosure Request by
Taxpayer in the instructions and Rev. Proc. 2011-4, 2011-1 I.R.B. 123.)
Is a copy of your plan’s latest determination letter, if any, attached?
4.
Have you included a copy of the plan, trust, and all amendments since your last determination letter?
5.
Is the EIN of the plan sponsor/employer (NOT the trust’s EIN) entered on line 1h?
6.
Does line 4d provide the plan’s original effective date?
7.
Is the application signed and dated? (Stamped signatures are not acceptable; see Rev. Proc. 2011-4.)
8.
Have interested parties been given the required notification of this application? Make sure line 3n is completed. (See
9.
instructions.)
If you are requesting a determination for an Affiliated Service Group Status, have you included the information requested
10.
in the instructions?
If you answered “Yes” to line(s) 6a and/or 6b, have you included the information requested in the instructions?
11.
For Multiple Employer Plans: Have you included the required information as specified in the instructions under Specific
12.
Plans—Additional Requirements?
For Partial Termination Requests: Have you included the required information as specified in the instructions under
13.
Type of Determination Letter Requested, Partial Termination?
If you answered “Yes” to line 8a, have you included the requested information?
14.
If lines 13 and 14 are “No,” and you are requesting additional determinations, are Schedule Q (Form 5300) and the
15.
applicable demonstrations attached? (See instructions for Schedule Q.)
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5300
Form
(Rev. 4-2011)
11740X04201110
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