Attachment I for Application for Approval of Pre-approved Defined
Contribution Plans (Revised 12/2017)
Indicate the article or section and page number of the plan where the following N/A Article or Section Change For IRS Use
provisions are contained. All questions must be answered. If not applicable, check and Page Number Only
“N/A” column; otherwise complete the “Article or Section and Page Number”
column. Governmental and Non-electing church plans may not be subject to many
of the qualification requirements identified on this attachment. If not applicable,
check “N/A” column.
Part I. Provisions applicable to all plans
a. Definitions:
Where does the plan define the following terms-
(1) Year of Service?
(1)
(2) Break
in Service? (2)
(3) Hour of service under Department of Labor Regulations, including
service with all employers aggregated under sections 414(b), (c), (m), or (o), and
service of any individual considered an employee for purposes of this plan under
section 414(n) or (o)? (3)
(4) Elapsed time?
(4)
(5) Plan year?
(5)
(6) Compensation as defined in section 414(s) as
401(a)(17)? limited by section (6)
(7) Earned income as defined
in section 401(c)(2)? (7)
(8) Disability?
(8)
(9) Employee as described in
sections 414(b), (c), (m), (n), or (o)? (9)
(10) Leased employee as described in section 414(n) or (o)?
(10)
(11) Highly compensated
employee as defined in section 414(q)? (11)
(12) Owner-Employee?
(12)
(13) Self-employed
individual? (13)
(14) Normal retirement age?
(14)
(15) Benefiting?
(15)
(16) Straight life annuity?
(16)
b. Minimum participation
(1) Are the requirements standardsfor participation (17)
under the plan determined without
regard to maximum age?
(2) Will a
first day newof employee,the first planotherwiseyear aftereligible,meetingparticipatethe on the earlier of the (18)
minimum age and
service requirements of section 410(a)(1) or 6 months after satisfying
such requirements?
(3) Does the initial
which the eligibility computation period begin with the date on (19)
employee first performs an hour of service, and do
subsequent eligibility computation periods: (1) begin with the
anniversary of such date, or (2) shift to the plan year in accordance with
section 2530.202-2(b) of the Department of Labor regulations?
(4) Is the
as is computationused period for determining a break in service the same (20)
to compute a year of service for eligibility after the initial
computation period?
(5) If all
service yearsnotofcountedservice areexcludablenot countedunderforsectionparticipation purposes, is the (21)
410(a)(5)(B), (C), or (D)?
(6) Does this plan include the
one-year hold-out rule? (22)
(7) Will an employee otherwise eligible, who is in an
employees, immediately participate on ineligible class of (23)
becoming a member of an
eligible class?