Instructions to Correct Participant(s) Social Security Number



|Correct Remittance Money Type |

|Plan Information |

|Plan Name:      |

|Plan Number:      |

|Remittance Information |

|Remittance Event ID:      |Remittance Amount:      |

|Original/Incorrect Money Type: |Revised/Correct Money Type: |

|      |      |

|Vesting Information |

|Does the Vesting Schedule differ between the Original/Incorrect Money Type and the Revised/Correct Money Type? (Circle One) |

| |

|Yes or No |

| |

|If you circle “No”, then the following section regarding overpayment and underpayment does not apply to this correction |

|Overpayment to Participant/Underpayment to Plan |

|An overpayment to a plan participant usually results in a shortage to the Plans Forfeiture account. The Plan Administrator should |

|consider the impact of the shortage to the Plan Forfeiture account because it may affect future benefits to the remaining plan |

|participants. The Plan may need to consider restoring the shortage in the Plan Forfeiture account. |

| |

|Underpayment to Participant/Overpayment to Plan |

|If a Participant’s full withdrawal was underpaid, the underpayment amount will be removed from the Plan Forfeiture account to the |

|extent possible and returned to the Participant in the same manner as the original full withdrawal. |

|Instructions and Authorization |

|I have reviewed and understand the Instructions and Information section attached to this form and I am authorized to request this |

|correction. |

|Authorized Signer’s Name: |Authorized Signer’s Title: |

|      |      |

|Authorized Signer’s Signature: |Date: |

|      |      |

|Instruction and Information Attachment |

|Correct Remittance Money Type |

|When to Use this Form |

|If you believe a correction is required because of a recordkeeping error made by the Service Provider, please contact your Plan |

|Representative for assistance. Otherwise, please complete the appropriate correction form. |

| |

|Payroll Contribution(s) were remitted to an incorrect Money Type. Following are examples: |

|“Employer” Contribution was erroneously remitted as “Employee” Contribution |

|“Safe Harbor Match” was erroneously remitted as “Elective Employer Match” |

| |

|Correction Highlights |

|When correcting Remittance Money Types, there is the potential that each Money Type has a different vesting schedule. If that is |

|the case, Participants who received a distribution may have been overpaid or underpaid due to the difference in the vesting |

|schedules. |

|Overpayment to the Plan Participant/Underpayment to Plan Forfeiture: |

|An overpayment to a plan participant usually results in a shortage to the Plan’s forfeiture account. The plan may need to consider|

|restoring the shortage in the plan forfeiture account because it may affect future benefits to the remaining plan participants |

|depending on the terms of the plan. |

| |

|Underpayment to the Plan Participant/Overpayment to the Plan Forfeiture: |

|The original amount underpaid will be removed from the Plan Forfeiture account (if available) and returned to the Participant. If |

|the Plan would like lost earnings on the underpaid amount to be restored to the Participant pursuant to IRS’s Employee Plans |

|Compliance Resolution System (EPCRS) procedures, the Plan is responsible for providing specific instructions to the Service |

|Provider. |

| |

|Before submitting this form, you may want to discuss with your ERISA Consultant. |

|Gains, Losses, and Fees |

|Due to market fluctuation, gains and losses may occur as a result of this correction. |

| |

|Losses or calculation fees generated as a result of this correction will be deducted from the Plan. |

| |

|Gains generated as a result of this correction will be allocated to the Plan’s Unallocated Plan Asset account. |

| |

|A fee may apply to this request in accordance with the Contract/Administrative Agreement. |

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