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Advisory Committee on Tax Exempt and Government Entities (ACT ...

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EXHIBIT DSubmissi<strong>on</strong> Type:(insert from list of Submissi<strong>on</strong> Type Codes listed in instructi<strong>on</strong>s)Eligible for Expedited Processing for St<strong>and</strong>ard Failure <strong>and</strong> Correcti<strong>on</strong> – Yes NoVOLUNTARY CORRECTION PROGRAM (VCP) APPLICATIONInternal Revenue Service Revenue Procedure 2006-27 (Rev. Proc. 2006-27) 98 establishes the VoluntaryCorrecti<strong>on</strong> Program (the “VCP”), which permits Plan Sp<strong>on</strong>sors to correct a failure or failures to meet therequirements of the Internal Revenue Code for applicable plan years. The following c<strong>on</strong>stitutes asubmissi<strong>on</strong> under the VCP <strong>and</strong> a request for a compliance statement. All secti<strong>on</strong> references are to theSubmissi<strong>on</strong> Requirements in secti<strong>on</strong> 11.02 of the VCP unless otherwise indicated. If John Doe Submissi<strong>on</strong> Check this Box <strong>and</strong> Skip to Questi<strong>on</strong> 5.1. Name <strong>and</strong> Address of Plan Sp<strong>on</strong>sor 2. Employer Identificati<strong>on</strong> Number3. Name of Plan 4. Plan Number5. Name, address <strong>and</strong> teleph<strong>on</strong>e number of c<strong>on</strong>tact pers<strong>on</strong>/authorized representative if more informati<strong>on</strong> needed:6. Type of Plan: 7. Check if the submissi<strong>on</strong> is <strong>on</strong>e of the following: Qualified Plan (401(a)) Group Submissi<strong>on</strong>(Insert Plan Code from list in instructi<strong>on</strong>s) An<strong>on</strong>ymous Submissi<strong>on</strong> 403(b) N<strong>on</strong>amender Submissi<strong>on</strong> SEP or SARSEP (408(k)) Multiemployer or Multiple Employer Plan SIMPLE IRA (408(p)) Submissi<strong>on</strong> Orphan Plan Submissi<strong>on</strong> Terminated Plan Submissi<strong>on</strong>8. Identificati<strong>on</strong> of Qualificati<strong>on</strong> Failure(s)9. Descripti<strong>on</strong> of Qualificati<strong>on</strong> Failure(s):(Check all that apply <strong>and</strong> insert applicable Failure Code fromlist in instructi<strong>on</strong>s) Operati<strong>on</strong>al Failure Plan Document Failure Demographic Failure Employer Eligibility Failure98The Voluntary Correcti<strong>on</strong> Procedures are set forth in Internal Revenue Service Revenue Procedure 2006-27, 2006-22 I.R.B. 945.ADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (<strong>ACT</strong>) June 11, 2008 53

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