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

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23. Under penalties of perjury, the Plan Sponsor declares that (check all that apply): To the best of the Plan Sponsor’s knowledge, the Plan is not currently under examination of either anEmployee Plan Form 5500 series return or other Employee Plan examination. To the best of the Plan Sponsor’s knowledge, the Plan Sponsor is not under an Exempt Organizationsexamination). To the best of the Plan Sponsor’s knowledge, neither the Employer nor any of its representatives havereceived verbal or written notification from the TE/GE Division of an impending examination or of anyimpending referral for such examination. To the best of the Plan Sponsor’s knowledge, the Plan is not currently under investigation by the CriminalInvestigation Division of the Internal Revenue Service. Abusive Tax Avoidance Transaction: Neither the Plan nor the Plan Sponsor has been party to an abusivetax avoidance transaction. Determination Letter Filing: The Plan Sponsor applied for and has currently pending an application for afavorable determination letter with the internal Revenue Service filed on (Insert date) . 403(b) Plan Submissions: The Plan Sponsor has contacted all other entities involved with the Plan and hasbeen assured of cooperation in implementing the applicable correction to the extent necessary. The correction method fully complies with the method set forth in Appendix A or B of section 6.07 of Rev.Proc. 2006-27. I understand that EPCRS is not binding on the US Department of Labor or plan participants. Penalty of Perjury Statement: I have examined this submission, including supporting documents and, to thebest of my knowledge and belief, the facts and information present in support of this submission are true,correct and complete.24. Signature, Name and Title of Plan Sponsor Officer (or Form 2848/Form 8821 Representatively)(Signature)(Title)(Print Name)(Date Signed)ADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (ACT) June 11, 2008 56
EXHIBIT D (CONTINUED)VCP CHECKLISTTAXPAYER’S NAMETAXPAYER’S I.D. NO. PLAN NAME & NO. ATTORNEY/P.O.A.The following items relate to all submissions (for each item insert Yes, No or N/A)If you insert “N/A” for any item enter explanation under the item. 1. Does the submission consist solely of a failure to amend a plan timely for (a) good faithplan amendments for EGTRRA, (b) plan amendments for the final and temporaryregulations under § 401(a)((9) or (c) interim amendments? If yes, please proceed toAppendix F. (See section 11.01 and sections 4.06 and 10.08)2. Have you included an explanation of how and why the failure(s) arose, including adescription of the administrative procedures for the plan in effect at the time the failure(s)occurred? (See sections 11.02(3) and (4))3. Have you included a detailed description of the method for correcting the failure(s)identified in your submission? This description must include, for example, the number ofemployees affected and the expected cost of correction (both of which may beapproximated if the exact number cannot be determined at the time of the request), theyears involved, and calculations or assumptions the Plan Sponsor used to determine theamounts needed for correction. In lieu of providing correction calculations with respect toeach employee affected by a failure, you may submit calculations with respect to arepresentative sample of affected employees. However, the representative samplecalculations must be sufficient to demonstrate each aspect of the correction methodproposed. Note that each step of the correction method must be described in narrativeform. (See section 11.02(5))4. Have you described the earnings or interest methodology (indicating computation periodand basis for determining earnings or interest rates) that will be used to calculateearnings or interest on any corrective contributions or distributions? (As a general rule,the interest rate (or rates) earned by the plan during the applicable period(s) should beused in determining the earnings for corrective contributions or distributions.) (Seesection 11.02(6))5. Have you submitted specific calculations for either affected employees or arepresentative sample of affected employees? (See section 11.02(7))6. Have you described the method that will be used to locate and notify former employeesor, if there are no former employees affected by the failure(s) or the correction(s),provided an affirmative statement to that effect? (See section 11.02(8))7. Have you provided a description of the administrative measures that have been or will beimplemented to ensure that the same failure(s) do not recur? (See section 11.02(9))8. Have you included a statement that, to the best of the Plan Sponsor’s knowledge, theplan is not currently under an Employee Plans examination? (See section 11.02(10))9. Have you included a statement that, to the best of the Plan Sponsor’s knowledge, thePlan Sponsor is not under an Exempt Organizations examination? (See section11.02(10))10. Have you included a statement that neither the plan nor the Plan Sponsor has been aparty to an abusive tax avoidance transaction? Alternatively, have you provided astatement identifying the abusive tax avoidance transaction(s) to which the plan or thePlan Sponsor has been a party? (See section 11.02(11))11. If the submission includes a failure related to Transferred Assets, have you included adescription of the related employer transaction, including the date of the employertransaction and the date the assets were transferred to the plan? (See section 11.02(11))ADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (ACT) June 11, 2008 57
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MEMBER BIOGRAPHIESGOVERNMENT ENTITI
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GENERAL REPORTOF THEADVISORY COMMIT
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Tax Treatment Of Cellular Telephone
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