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Begin with Section I, where you will enter the Applicant’s name, EIN (do not use SSN), plan number, and plan name. Ensure that this information is accurate as it will be referenced throughout the document.
In Section II, provide a detailed description of any failures. If necessary, attach additional pages labeled accordingly. Number each failure for clarity.
Move to Section III to describe your proposed method of correction for each failure listed in Section II. Again, attach additional pages if needed and label them appropriately.
For Section IV, outline your proposed procedures to locate and notify former employees or beneficiaries affected by the failures. Include an affirmative statement if no individuals were impacted.
In Section V, explain how the failures occurred and detail measures taken to prevent future occurrences. Attach any relevant schedules as specified.
Finally, complete Section VI regarding requests related to excise taxes and ensure all supporting rationale is attached.

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