Form 8950 - Application For Voluntary Correction Program (Vcp) Page 2

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2
Form 8950 (1-2013)
Page
3 Type of VCP submission (see instructions)
Check one:
VCP regular submission
VCP anonymous submission
VCP group submission
Non-VCP 457(b) submission (as permitted by Revenue Procedure (Rev. Proc.) 2013-12, section 4.09)
4a Name of plan (plan name may not exceed 132 characters, including spaces):
4b Enter 3-digit plan number
4d Enter the dollar value of the
(see instructions)
plan's assets (see instructions)
4c Enter month plan year ends
4e Enter number of participants
(MM) (see instructions)
(see instructions)
5
Indicate type of plan by entering the corresponding number from the list below:
(Enter only one plan type)
01-Profit sharing (not 401(k))
11-SEP
12-SARSEP
02-401(k)
14-Stock bonus
13-SIMPLE IRA
16-Group submission defined contribution
03-Money purchase
17-Group submission defined benefit
06-Target benefit
04-Defined benefit (not cash balance or
99-Other (see instructions)
other statutory hybrid)
09-Cash balance or other statutory hybrid
05-ESOP
15-KSOP
07-403(b)
08-457(b)
10-Governmental 414(d) defined benefit
20-Governmental 414(d) defined contribution
8950
Form
(1-2013)
*37769K01201302*

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