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

10.Plan Years in WhichFailure Occurred(including Closed Years)Number of ParticipantsAffected by Failure inPlan Year11. Compliance fee: $Number of Participants Used for Fee Determination(leave blank if N/A)Number of Affected Participants Used for FeeDetermination (leave blank if N/A)Flat Fee Yes No12. Description of Administrative Procedures in Effect at the Time of the Failure(s)13. Explanation of How and Why the Failure(s) Occurred:14. Expected Cost of Correction and Calculations/Assumptions Used to Determine the Amounts Needed andDescription of the Method for Correcting the Failures that the Plan Sponsor has implemented or Proposes toImplement. Plan Amendment Method from Appendix A (insert Sec. No. App. A of Rev.Proc. 2006-27) Other Method Explain15. Description of the Methodology Used to Calculate Earnings or Actuarial Assumptions on Any CorrectiveContributions or Distributions (including Computation Periods and the Basis for Determining Earnings orActuarial Adjustments) DOL Calculator Method from Appendix B (insert Sec. No. App. B of Rev.Proc. 2006-27) Other – Explain16. Specific Calculations – Attach calculations and check one of the applicable boxes below: Each Affected Employee or A Representative Sample of Affected Employees17. Method Used to Locate and Notify Former Employees and Beneficiaries or put N/A if there are no formeremployees or beneficiaries affected by the failure or will receive a correction.ADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (ACT) June 11, 2008 54