Editor's Note: This revenue procedure has been modified by Rev. Proc. 2002-35 (click) with respect to GUST non-amenders who file by September 3, 2002.

Revenue Procedure 2001-17

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Other parts of this Revenue Procedure:
Table of Contents 1 2 3 4 5 6 7 a b c

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APPENDIX C

VCP CHECKLIST

IS YOUR SUBMISSION COMPLETE?

INSTRUCTIONS

The Service will be able to respond more quickly to your VCP request if it is carefully prepared and complete. To ensure that your request is in order, use this checklist. Answer each question in the checklist by inserting yes, no, or N/A, as appropriate, in the blank next to the item. Sign and date the checklist (as taxpayer or authorized representative) and place it on top of your request.

You must submit a completed copy of this checklist with your request. If a completed checklist is not submitted with your request, substantive consideration of your submission will be deferred until a completed checklist is received.

TAXPAYER'S NAME ________________________________

TAXPAYER'S I.D. NO. ____________________________

PLAN NAME & NO. ________________________________

ATTORNEY/P.O.A.

The following items relate to all submissions:

______   1. Have you included a complete description of the
            failure(s) and the years in which the failure(s)
            occurred (including the years for which the statutory
            period has expired)? (See section 11.02(1) of Rev.
            Proc. 2001-17.) (Hereafter, all section references
            are to Rev. Proc. 2001-17.)

______   2. Have you included an explanation of how and why
            the failure(s) arose, including a description of the
            administrative procedures for the plan in effect at
            the time the failure(s) occurred? (See section
            11.02(2) and (3).)

______   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 of employees affected and the
            expected cost of correction (both of which may be
            approximated if the exact number cannot be determined
            at the time of the request), the years involved, and
            calculations or assumptions the Plan Sponsor used to
            determine the amounts needed for correction. In lieu
            of providing correction calculations with respect to
            each employee affected by a failure, you may submit
            calculations with respect to a representative sample
            of affected employees. However, the representative
            sample calculations must be sufficient to demonstrate
            each aspect of the correction method proposed. Note
            that each step of the correction method must be
            described in narrative form. (See section 11.02(4).)

______   4. Have you described the earnings or interest
            methodology (indicating computation period and basis
            for determining earnings or interest rates) that will
            be used to calculate earnings 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 be
            used in determining the earnings for corrective
            contributions or distributions.) (See section
            11.02(5).)

If you inserted N/A for item 4, enter explanation:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

______   5. Have you submitted specific calculations for each
            affected employee or a representative sample of
            affected employees? (See section 11.02(6).)

______   6. Have you described the method that will be used to
            locate and notify former employees or, 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(7).)

______   7. Have you provided a description of the
            administrative measures that have been or will be
            implemented to ensure that the same failure(s) do not
            recur? (See section 11.02(8).)

______   8. Have you included a statement that, to the best of
            the Plan Sponsor's knowledge, the plan is not
            currently under an Employee Plans examination? (See
            section 11.02(9).)

______   9. Have you included a statement that, to the best of
            the Plan Sponsor's knowledge, the Plan Sponsor is not
            under an Exempt Organizations examination? (See
            section 11.02(9).)

______  10. 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 section 11.04(2).)

______  11. Have you included a copy of the plan's most
            recent Favorable Letter and/or the required applicable
            document(s)? (See section 11.04(4).)

______  12. Have you included the appropriate voluntary
            compliance fee due with the submission? (See section
            11.06.)

______  13. Have you included the original signature of the
            sponsor or the sponsor's authorized representative?
            (See section 11.07.)

_____   14. Have you included a Power of Attorney (Form
            2848)? Note: representation under VCP is limited to
            attorneys, certified public accountants, enrolled
            agents, and enrolled actuaries; unenrolled return
            preparers are not eligible to act as representatives
            under VCP. (See section 11.08.)

______  15. Have you included a Penalty of Perjury Statement
            signed (original signature only) and dated by the Plan
            Sponsor? (See section 11.09.)

______  16. Have you designated your submission as a VCP,
            VCO, VCS, VCT, VCSEP, VCGroup, or Anonymous Submission
            Procedure, as appropriate? (See section 11.11.)

The following items relate only to submissions under VCO (including
VCS):

______  17. If the plan is currently being considered in a
            determination letter application on a Form 5310, have
            you included a statement to that effect? (See section
            11.03(10).)

______  18. Have you included a copy of the first page, the
            page containing employee census information (currently
            line 7f of the 1998 Form 5500), and the information
            relating to plan assets (currently line 31f of the
            1998 Form 5500) of the most recently filed Form 5500
            series return? Note: If a Form 5500 is not
            applicable, insert N/A and furnish the name of the
            plan, and the census information required of Form 5500
            series filers. (See section 11.04(1)(b).)

______  19. Have you proposed a time period of correction
            that is limited to 150 days (240 days for VCGroup)
            from the date the compliance statement is issued?
            (See sections 10.06(8) and 10.14(3)(b).)

The following items relate only to submissions under VCS:

______  20. Are each of the failures you have identified
            eligible for correction under VCS? (See Appendix A
            and Appendix B.)

______  21. Have you identified no more than two VCS
            failures? (If more than two failures were identified,
            VCS is not available, but you may make a submission
            under VCO.) (See section 10.11(3).)

______  22. Have you proposed to correct the failure(s)
            identified in your request using the permitted
            correction method(s) set forth in Appendix A or
            Appendix B? (See Appendix A and Appendix B.)

The following item relates only to submissions under the general
procedures of VCP:

______  24. Have you included a copy of the most recently
            filed Form 5500? (See section 11.04(1)(b).)

______  25. Have you submitted an application for a
            determination letter? (See section 11.05.)

__________________________________________   ____________________
Signature                                    Date

_________________________________________________________________
Title or Authority

_________________________________________________________________
Typed or printed name of person signing checklist

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Other parts of this Revenue Procedure:
Table of Contents 1 2 3 4 5 6 7 a b c