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

12. Have you included a copy of the portions of the plan document (and adoption agreement,if applicable) relevant to the failure(s) and method(s) of correction? (See section11.03(2))13. Have you included the original signature of the sponsor or the sponsor’s authorizedrepresentative? (See section 11.06)14. Have you included a Power of Attorney (Form 2848) or Tax Information AuthorizationForm (Form 8821)? Note: Authorization to represent a Plan Sponsor before the Serviceusing Form 2848 is limited to attorneys, certified public accountants, enrolled agents, andenrolled actuaries. (See section 11.07)15. Have you included a Penalty of Perjury Statement signed (original signature only) anddated by the Plan Sponsor? (See section 11.08)16. Have you designated your submission for a Qualified Plan, 403(b) Plan, SEP or SIMPLEIRA Plan, or Orphan Plan? In addition, the submission should indicate if the submissionis a Group Submission, an Anonymous Submission or nonamender submission, amutliemployer or multiple employer plan submission. (See section 11.10)17. Have you submitted the Appendix E acknowledgement letter? (See section 11.11)18. If you are requesting a waiver of the excise tax under § 4974 of the Code, have youincluded the request, and, if applicable, an explanation supporting the request for anyaffected owner-employee or 10 percent owner? (See section 6.09(3))19. If you are requesting relief of the excise tax under §§ 4972 or 4979, have you includedthe request and a detailed description of the failure? (See sections 6.09(3) & (4))20. If you are requesting that participant loans being corrected under this revenue procedurenot be treated as distributions pursuant to § 72(p), have you included the request and adetailed description of the failure? Alternatively, if you are requesting that participantloans being corrected under this revenue procedure be recognized as distributions in theyear of correction, instead of the year that the deemed distribution occurred under §72(p), have you include the request and a detailed description of the failure? (Seesections 6.02(6) and 6.07)21. Have you submitted an application for a determination letter and Form 8717 together witha check for the compliance fee made payable to the U.S. Treasury? (See sections 10.06and 11.03(3))22. If the plan is currently being considered in an unrelated determination letter application,have you included a statement to that effect? (See section 11.02(12))ADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (ACT) June 11, 2008 58