Comprehensive Premium Filing 

Instructions for 2017 Plan Years

Revised January 25, 2017 to correct example on page 15.
Contents

Introduction and What’s New ........................................................................................... 1

Who Must File .................................................................................................................. 3

When to File ..................................................................................................................... 5

How to File ...................................................................................................................... 8

How to Count Participants ................................................................................................ 9

How to Determine Unfunded Vested Benefits ................................................................... 12

Spinoffs, Mergers and Consolidations ............................................................................... 20

Data to be Submitted ....................................................................................................... 25

Description of Data Elements ........................................................................................... 29

Late Payment Charges ...................................................................................................... 42

Correcting Errors, Credit Balances and Reconciling Estimates............................................. 45

Recordkeeping Requirements and PBGC Audits ................................................................ 48

Appendices

 Appendix 1 – Definitions..................................................................................................... 49

 Appendix 2 – Contact information...................................................................................... 53

 Appendix 3 – Online Premium Filing with MyPAA............................................................. 55

 Appendix 4 – Paperwork Reduction ActNotice.................................................................. 59
Introduction and What’s New

Page 1

Introduction

Payment of premiums to the Pension Benefit Guaranty Corporation (PBGC) is required by sections 4006 and 

4007 of the Employee Retirement Income Security Act of 1974 (ERISA), and PBGC’s Premium Regulations (29 

CFR Parts 4006 and 4007). You can find these regulations by clicking on the “Laws and Regulations” link on the 

Practitioners’ page of PBGC’s website.

There are two kinds of annual premiums: the Flat-rate Premium, which applies to all plans, and the Variable-rate 

Premium, which applies only to Single-employer Plans.

Every covered plan under ERISA section 4021 must make a premium filing each year. The due dates are 

described in the “When to File” section.

Electronic filing is mandatory for all plans. My Plan Administration Account (My PAA) is a secure Web-based 

application that enables pension plan professionals to electronically submit premium filings to PBGC in 

accordance with PBGC’s regulations. Electronic filings may be prepared using My PAA’s data entry screens or 

with compatible private-sector software. See “How to File” section for more information. For more information 

on e-filing options, see Appendix 3.

This document provides information for plans paying premiums for plan years beginning in 2017, including 

instructions for each data element that must be reported. If you are filing for a previous year, you must follow 

the instructions for that year (available from the “Premium Payment Instructions and Addresses” webpage).

If you are amending a filing for a plan year that did not begin in 2017, the rules in this document do not apply. 

You must follow the instructions and regulations applicable for that plan year. However, because contact 

information and information about electronic funds transfers change periodically, the most recent information 

should be used instead of the information included in an instructions booklet for a prior plan year. This 

information can be accessed from the “Premium Payment Instructions and Addresses” link on the Practitioners’

page of PBGC’s website.

Defined terms

Appendix 1 provides definitions for terminology used throughout this document. In general, the defined terms 

are capitalized to signal the reader to refer to Appendix 1 for more information. However, the convention of 

capitalizing the defined terms is not followed for a few defined terms such as “participant,” “we,” “you,” and 

“your.”
Introduction and What’s New

Page 2

What’s New

The filing requirements for 2017 are almost identical to the filing requirements for 2016. The key changes to 

note for 2017 relate to changes in premium rates:

 Flat-rate Premiums —The per-participant flat-rate premium rate for single-employer plans is $69 up from

$64. For multiemployer plans the rate is $28 up from $27.

 Variable-rate Premium — The rate per $1,000 of unfunded vested benefits is $34, up from $30.

 Cap on Variable-rate Premium — The MAP-21 Cap on the Variable-Rate Premium cap is $517 times the 

number of participants, up from $500 times the number ofparticipants.

In addition, a new section has been added providing additional guidance about determining premiums in a year 

when a plan is involved with a Spinoff, Merger or Consolidation. We added this section because we’ve 

encountered several situations where premiums for these plans were not determined properly. To avoid the 

possibility of late payment charges, we encourage you to read this new section in its entirety if your plan is 

involved in any of these transactions.

Reminder about changes to payment instructions

Instructions about where and how to send premium payments (both electronically and by

U.S. mail) were recently changed (the most recent change took place in 2015). Examples of 

things that changed include:

 The mailing addresses for paper checks (both for U.S. Mail for other delivery services);

 The wire transfer instructions for electronic payments initiated with your financial 

institution (ACH or Fedwire); and

 The PBGC Company ID that must be provided to your financial institution if your 

account has an ACH Debit Block. This affects both payments made within My PAA and 

payments made via the pay.gov website.

Because the payment instructions are always subject to change, we encourage you to 

review our “Premium Payment Instructions and Addresses” webpage each year before 

sending payment. Payments not received timely because they sent were sent to outdated 

addresses or because of a debit block may be subject to late payment charges.
Page 3

Who Must File

2

0F

All Covered Plans Must File

The Plan Administrator of each pension plan covered under ERISA section 4021 is required annually to file the 

prescribed premium information and pay the premium due in accordance with PBGC’s Premium Regulations and 

instructions.

Most private-sector defined benefit plans that meet tax qualification requirements are covered. If you are 

uncertain whether your plan is covered, you should promptly request a coverage determination. Note that a 

request for a coverage determination does not extend the due date for any premium that is finally determined 

to be due.

If your plan is covered, you must make a premium filing even if no premium is owed.

Short Plan Years

Premium filings are required for short plan years regardless of the reason why the plan year covers fewer than 

12 full months. Unless the plan qualifies for premium pro-ration (see below), a full year’s premium is owed for a 

short plan year.

Premium proration

In some cases, plans qualify to pay a prorated premium for a short plan year. For example, if a short plan year 

covers nine months (i.e., 75% of a full year) and the plan is eligible for premium proration, the calculated 

premium would be reduced by 25%.

Premiums are not pro-rated for short plan years created as the result of a mid-year Merger or Consolidation. In 

other words, if a plan ceases to exist during the plan year because all if its assets and liabilities are transferred to 

another PBGC-insured plan, a full year’s premium is owed for the final plan year of the plan ceasing to exist.

Premiums are pro-rated for short plan years if that short plan year:

 Is the first year of a New Plan;

 Is created by:

- an amendment that changes the plan year1

;

- distribution of plan assets pursuant to plan termination; or

- the appointment of a trustee for a Single-employer Plan under ERISA section4042.

 Includes a portion of time in which the plan was not covered by PBGC, unless such period of non-coverage 

began after the first day of the plan year1F .

Note that the short year need not have ended by the time you pay a prorated premium, but if the plan year 

turns out to be longer than you anticipated, you will have to make up any premium underpayment, which will be 

subject to interest and penalties.

1 An amendment is not considered to change the plan year if the plan merges into or consolidates with another plan or otherwise ceases 

its independent existence either during the short plan year or at the beginning of the full plan year following the short plan year. 2 A Newly Covered Plan with a coverage date after the first day of the Premium Payment Year qualifies to pay a prorated premium. A 

plan that ceases to be a covered plan before the end of the plan year does not qualify for proration.
Page 4

Who Must File

One Plan or More Than One?

If several unrelated employers participate in a program of benefits wherein the funds attributable to each 

employer are available to pay benefits to all participants, then there is a single Multiemployer or Multipleemployer Plan and the Plan Administrator must file and pay premiums for the plan as a whole. Separate filings 

and premiums cannot be submitted for each individual employer.

If several employers participate in a program of benefits wherein the funds attributable to each employer are 

available only to pay benefits to that employer’s employees, then there are several plans (one for each 

employer) and the Plan Administrator must file and pay premiums separately for the plan of each individual 

employer.

If separate plans are maintained for different groups of employees, regardless of whether each is maintained by 

the same employer or by employers that are part of the same controlled group, then the Plan Administrator(s) 

must file and pay premiums separately for each plan.

When Filing Obligation Ceases

You must continue to make premium filings and pay premiums through and including the plan year in which any 

of the following occurs:

 Plan assets are distributed in satisfaction of all Benefit Liabilities pursuant to the plan’s termination.

 A trustee is appointed for the plan under ERISA section 4042.

 The plan disappears by transferring all its assets and liabilities to one or more other plans in a Merger or 

Consolidation.

 The plan ceases to be a covered plan under ERISA section 4021. 

The following examples illustrate when the filing obligationceases:

Example 1 – A calendar-year plan terminates in a standard termination with a termination date of September 

29, 2016. On April 6, 2017, assets are distributed in satisfaction of all Benefit Liabilities. The Plan Administrator 

must file and make the premium payments for the 2016 and 2017 plan years. There is also an obligation to file a 

post-distribution certification (Form 501) as part the standard termination process. See § 4041.29 for additional 

information.

Example 2 – A plan with a plan year beginning July 1 and ending June 30 terminates in a distress termination 

with a termination date of April 27, 2017. On July 6, 2017, a trustee is appointed to administer the plan under 

ERISA section 4042. Premium filings and payments must be made for this plan for both the 2016 and 2017 plan 

years, because a trustee was not appointed until after the beginning of the 2017 plan year.
Page 5

When to File

2F

4 5

Introduction

This section describes when premium filings are due. A filing includes both the submission of required data and 

the payment of any required premium. In general, if a filing is not made by the due date, late payment charges 

will apply. Late payment charges include both interest charges and penalty charges. See “Late Payment Charges” 

section for more information on the ramifications of missing a deadline.

Normal Premium Due Date

The Normal Premium Due Date applies unless:

 The plan is a New or Newly Covered Plan (including plans created as the result of a mid-year spinoff from 

another plan),

 The plan year changed since last year, or

 All assets are distributed during the Premium Payment Year pursuant to a standardtermination.

The Normal Premium Due Date is the 15th day of the 10th full calendar month in the plan year (e.g., generally 

October 15th for calendar-year plans).3 If the Normal Premium Due Date falls on a Saturday, Sunday or Federal 

Holiday3F , the due date is automatically extended to the next business day4F .

The following table shows the Normal Premium Due Dates for plan years beginning in 2017:

2017 Normal Premium Due Dates

Premium Payment 

Year Begins Premium Due Date Premium Payment Year Begins Premium Due Date

1/1/2017 10/16/2017*

01/02 - 02/01/2017 11/15/2017 07/02 - 08/01/2017 05/15/2018

06/15/2018

07/16/2018*

08/15/2018

09/17/2018*

10/15/2018

02/02 - 03/01/2017 12/15/2017 08/02 - 09/01/2017

03/02 - 04/01/2017 01/16/2018* 09/02 - 10/01/2017

04/02 - 05/01/2017 02/15/2018 10/02 - 11/01/2017

05/02 - 06/01/2017 03/15/2018 11/02 - 12/01/2017

06/02 - 07/01/2017 04/16/2018* 12/02 - 12/31/2017

* The actual due date falls on a Saturday, Sunday or Federal Holiday, so the date shown above is the 

first business day following the actual due date.

3 The due date is the 15th day of the 10th full calendar month that begins on or after the first day of the Premium Payment Year. In 

situations involving a short plan year, this due date may not be “in the plan year.” 4 This extension does not apply to state or local holidays such as Patriots Day in Massachusetts or Emancipation day in the District of 

Columbia.

5 See “Late Payment Charges” section for information on how late charges are determined if payment is made after an automatically 

extended due date.
Page 6

When to File

Due Date for Special Situations

In the situations noted below, premiums may be due on a date other than the Normal Premium Due Date:

 The plan is a New or Newly Covered Plan,

 The plan year changed since last year, or

 All assets are distributed during the Premium Payment Year pursuant to a standardtermination.

The due dates for these situations are described below. For all of these situations, if the adjusted due date falls 

on a Saturday, Sunday or Federal Holiday, the due date is automatically extended to the next business day.

New and Newly Covered Plans

In some cases, these first time filers cannot have their filings ready by the Normal Due Date. For example, 

consider a calendar year plan that is adopted November 1stwith an effective date retroactive to January 1. 

Because the plan was adopted after the Normal Premium Due Date (October 15th), a later due date is warranted. 

This rule applies even if the New Plan was created as the result of a mid-year spinoff from another plan.

To accommodate such plans, the due date for New and Newly Covered Plans is the latest of:

 The Normal Due Date,

 90 days after the date of the plan’s adoption,

 90 days after the date on which the plan became covered by Title IV of ERISA,or

 In the case of a Small Plan that is also a Continuation Plan, 90 days after the UVB Valuation Date. 

These rules are illustrated in the following examples:

Example 1 – Plan B, a calendar-year plan was adopted August 1, 2017 with a retroactive effective date of 

January 1, 2017. Plan B is not a Continuation Plan or a Small Plan. The due date for Plan B’s first premium filing 

is October 30, 2017 (90 days after August 1, 2017) because that date is later than the Normal Premium Due Date 

(October 16, 2017).

Example 2 – The situation for Plan C is identical to Plan B (see Example 2) except that the plan was adopted one 

month earlier, July 1, 2017. The due date for Plan C’s first premium filing is October 16, 2017, the Normal 

Premium Due Date because that date is later than 90 days after the adoption date.

Example 3 – A professional service employer maintains Plan D, a calendar plan year plan. From plan inception 

through September 30, 2017, Plan D never had more than 25 active participants, and was not a covered plan 

under ERISA section 4021. On October 1, 2017, a few employees were hired and became covered by the plan 

resulting in a total active participant count of 26 and therefore, the plan became a covered plan on that date. 

Plan D will continue to be a covered plan regardless of how many active participants the plan has in the future. 

Note that the Premium Payment Year begins on January 1, 2017, even though the plan did not become covered 

until after that date. The due date for the plan’s first premium filing is January 2, 2018 (90 days after October 1, 

2017 is a Saturday; January 2 is the first business day) because the date is later than the Normal Premium Due 

Date (October 16, 2017).

See “Spinoffs, Mergers, and Consolidations” section for additional examples of how these types of transactions 

affect due dates.
Page 7

When to File

5F

Plans Changing Plan Years

For a plan that changes its plan year, the filing due dates for the short year are unaffected by the change in plan 

year. However, for the first plan year under the new cycle, the due date is whichever is later:

 The Normal Premium Due Date, or

 30 days following the date on which a plan amendment changing the plan year was adopted. 

The following examples show the due dates for plans changing planyears:

Example 1 – By plan amendment adopted on December 1, 2017, a plan changes from a plan year beginning 

January 1 to a plan year beginning June 1. This results in a short plan year beginning January 1, 2017, and ending 

May 31, 2017. Premiums for the short plan year are due October 16, 2017, the Normal Premium Due Date.

For the plan year beginning June 1, 2017, the premiums are due by the Normal Premium Due Date (March 15, 

2018) because that is later than 30 days after the date the plan amendment changing the plan year was adopted 

(December 31, 2017).

Example 2 – By plan amendment adopted on January 6, 2018, and made retroactively effective to April 1, 2017, 

a plan changes from a plan year beginning on March 1 to a plan year beginning on April 1. For the March 1, 2017

- March 31, 2017 short plan year, the premium is due December 15, 2017. For the new plan year beginning April 

1, 2017, the due date is 30 days after the adoption of the plan amendment changing the plan year (February 5, 

2018) because that is later than the Normal Premium Due Date (January 16, 2018).

Assets Distributed Pursuant to a Standard Termination

For the Premium Payment Year in which all plan assets are distributed pursuant to standard termination, it’s 

possible that the employer will be out of business or plan records and personnel will not be available by the 

Normal Premium Due Date. To streamline the final premium payment with the other activities related to a 

standard termination, the due date for a plan in this situation is the earlier of:

 The Normal Premium Due Date (i.e., the date premiums would have been due had the plan not been 

terminated), or

 The date when the post-distribution certification6 is filed with us.

Disaster Relief

From time to time PBGC grants disaster relief by waiving late filing and payment penalties for certain plans that 

are unable to meet the filing deadline as a result of a major disaster (e.g., a hurricane). If such relief is granted, a 

Disaster Relief Announcement explaining what relief has been granted and how to claim the relief is accessible 

via the Practitioners Page on the PBGC’s website.

Additional Information

You can find detailed rules about filing due dates in PBGC’s premium payment regulation (29 CFR Part 4007). 

You can access this regulation on the “Laws and Regulations” page, accessible from the Practitioners Page or the 

“Open Government” section of the Home Page on PBGC’s website.

6 The post-distribution certification (Form 501) is a document required to be submitted to PBGC as part the standard termination process

See § 4041.29 for additional information.
Page 8

How to File

General

To make a complete premium filing, you must report certain required data and submit any required premium 

payment by completing and submitting a comprehensive premium filing.

A list of the data that must be reported is included in the “Data to be Submitted” section. For simplicity, the 

required data elements are shown in a traditional “form” format. The purpose of the “form” is to provide a 

comprehensive list of data that must be submitted electronically. These instructions are written as if they 

related to the illustrative form (see “Description of Data Elements” section). The “form” is for illustrative 

purposes only.

Filing Method

Premium filings are submitted electronically through PBGC’s e-filing application, My Plan Administration 

Account (My PAA).

You may prepare the filing directly using My PAA’s data entry screens. Alternatively, you may use approved 

private-sector software to prepare a filing and then “import” the data into My PAA’s editing screens or “upload” 

the filing via My PAA. Approved private sector-software is able to place your filing in an electronic file in an 

“XML” format that meets PBGC specifications.

Depending on how you choose to prepare electronic filings (My PAA data entry screens or private-sector 

software), the order in which the questions are asked may differ from the order shown on the forms. In

addition, in some cases, the software may perform certain calculations instead of requiring that you manually 

enter each required data element.

Appendix 3 provides an introduction to My PAA. The “Online Premium Filing (My PAA)” section of PBGC’s 

website (accessible from the Practitioners Page) provides detailed, and often more up to date, information 

about My PAA.

Paying Premiums

Although e-filing of premium information through My PAA is mandatory, premium payments may be made 

either within My PAA or outside of My PAA. If you choose to pay within My PAA, you may pay by an electronic 

funds transfer using Automated Clearing House (ACH). If you pay outside of My PAA, you may pay by 

electronic funds transfer (ACH or Fedwire), paper check or on-line via www.pay.gov. Pay.gov is a free, and userfriendly Federal website from which you can make secure electronic payments directly to many Federal 

Agencies, including PBGC. We recommend using Pay.gov to minimize the potential for errors (e.g., incorrect 

account numbers).

Note re: debit blocks - If you are sending payment electronically, be sure to provide the PBGC Company ID to 

your financial institution before you submit your payment so they may authorize PBGC to debit your account. 

Without this authorization, your financial institution may reject the processing of your payment. A debit block is 

the most common reason for failed ACH payments, and the most common reason late premium payment 

penalties are assessed.

Currently, PBGC has two Company ID numbers, one for payments made within My PAA, and one for payments 

made outside of My PAA. Please refer to the payment instructions in My PAA or on PBGC.gov for up to date 

information.

Additional information on payment options is included in Appendix 3.
Page 9

How to Count Participants

General

Plan participants must be counted because Flat-rate Premiums are based on the number of participants, as are 

both caps on the Variable-rate Premium (MAP-21 Cap and Small Employer Cap). In addition, the number of 

participants affects whether variable-rate premiums are based on current or prior (i.e., “lookback”) year 

measurements. The date on which participants are counted is called the “Participant Count Date.”

Participant Count Date

The Participant Count Date is the last day of the plan year preceding the Premium Payment Year except as 

follows:

 If the plan is a New Plan, the Participant Count Date is the first day of the Premium Payment Year (i.e., the 

effective date).

 If the plan is a Newly Covered Plan, the Participant Count Date is the first day of the Premium Payment Year. 

This is the case even if the plan wasn’t covered under ERISA section 4021 on thatdate.

 If the plan is the Transferee Plan in a Merger (i.e., the continuing plan) or the Transferor Plan in a Spinoff 

and the transaction meets the conditions described below, the Participant Count Date is the first day of the 

Premium Payment Year. A plan Merger or Spinoff is covered by this ruleif:

- a Merger is effective on the first day of the Transferee Plan’s premium payment year, or a Spinoff is 

effective on the first day of the Transferor Plan’s premium payment year,and

- the Merger or Spinoff is not de minimis, as defined in the regulations under section 414(l) of the Code 

with respect to Single-employer Plans, or in PBGC’s regulation under ERISA section 4231 (29 CFR Part 

4231) with respect to Multiemployer Plans.

The following examples illustrate the determination of the Participant Count Date.

Example 1 – An ongoing plan changes its plan year from a calendar year to a plan year that begins June 1, 

effective June 1, 2017. The Participant Count Date for the:

 January 1, 2017 – May 31, 2017 plan year is December 31,2016,

 June 1, 2017 – May 31, 2018 plan year is May 31,2017.

Example 2 – A new calendar-year plan is adopted February 18, 2017, retroactively effective as of January 1, 

2017. The Participant Count Date is January 1, 2017.

Example 3 – A new calendar-year plan is adopted January 1, 2017, effective April 1, 2017. The Participant Count 

Date is April 1, 2017.

Example 4 – A calendar-year plan that was not a covered plan under ERISA section 4021 becomes covered on 

May 31, 2017. The first day of the Premium Payment Year is January 1, 2017, and the Participant Count Date is 

January 1, 2017.

See “Spinoffs, Mergers, and Consolidations” section for additional examples of how these types of transactions 

affect the Participant Count Date.
How to Count Participants

Page 10

Participant

For premium purposes, “participant” means an individual (whether active, inactive, retired, or deceased) with 

respect to whom the plan has Benefit Liabilities as of the Participant Count Date. Beneficiaries and alternate 

payees are not counted as participants. However, a deceased participant will continue to be counted as a 

participant if there are one or more beneficiaries or alternate payees who are receiving or have a right to receive 

benefits earned by the participant.

An individual is not counted as a participant after all Benefit Liabilities with respect to the individual are 

distributed through the purchase of irrevocable commitments from an insurer or otherwise. In addition, a nonvested individual is not counted as a participant after:

 A deemed “zero-dollar cashout,”

 A one-year break in service under plan rules, or

 Death.

Cashouts

If the plan has a separate cashout provision for zero benefits, terminated non-vested participants are deemed to 

be cashed out as of the date specified in the deemed cashout provision or, if no date is specified, as of the 

employment termination date. If the plan provides that zero benefit amounts will be deemed to be paid as soon 

as possible, terminated non-vested participants will also be deemed to be cashed out as of the employment 

termination date.

If the plan does not have a separate cashout provision for zero benefits, but does have a mandatory cashout of 

small benefit amounts (e.g., benefits $5,000 or less), terminated non-vested participants are deemed to be 

cashed out in the same manner as terminated vested participants. If the plan is silent as to the timing of actual 

cashouts of terminated vested participants, the plan is deemed to read “as soon as practicable” and the 

terminated non-vested participants are deemed to be cashed out immediately upon termination of 

employment. If the plan specifies a date as of which actual cashouts of terminated vested participants take place 

(e.g., on the first day of the next month), that rule would also apply to deemed cashouts of terminated nonvested participants. These rules do not apply if, despite plan language, the plan has an obvious pattern or 

practice of delaying distributions for long periods.

Example – Suppose a calendar-year plan provides that if a participant terminates employment and the 

participant’s vested benefit has a value of $5,000 or less, the plan will pay the vested benefit to the participant 

in a lump sum as of the first of the month following termination of employment. Suppose further that no plan 

provisions specifically address payment of benefits upon termination of employment by non-vested participants. 

If a participant with a non-vested accrued benefit terminates employment on December 15, 2016, the 

participant will be included in the Participant Count as of December 31, 2016 (because the cashout is deemed to 

occur on January 1, 2017, the first of the month following termination of employment). If, as is typically the case 

for a calendar-year plan, the plan’s Participant Count Date for 2017 is December 31, 2016, a Flat-rate Premium 

must be paid for this participant for 2017.
How to Count Participants

Page 11

Breaks in Service

A non-vested individual ceases to be a participant for premium purposes when the individual incurs a one-year 

break in service under the plan.

If the break in service occurs in a service computation period that coincides with the plan year preceding the 

Premium Payment Year, we treat the individual as not being a participant for purposes of determining the 

premium for the Premium Payment Year.

Example 1 – A calendar-year plan with five-year vesting provides that a participant who performs 500 or fewer 

hours of service in a service computation period incurs a one-year break in service as of the last day of the 

computation period. The plan also provides that the annual service computation period begins on the 

anniversary of a participant’s date of hire. Consider an employee who was hired on December 1, 2011, and 

terminates employment on February 1, 2016. Further assume that this participant does not perform more than 

500 hours of service during the December 1, 2014 – November 30, 2016 computation period. This participant 

incurs a one-year break in service on November 30, 2016. Since the break occurred before December 31, 2016 

(the Participant Count Date for the 2017 premium), the individual would not be included in the Participant 

Count for 2017.

Example 2 – A calendar-year plan provides that a participant who performs 500 or fewer hours of service in a 

service computation period incurs a one-year break in service as of the last day of the computation period. The 

plan also provides that the annual service computation period is the calendar year. Consider a non-vested 

employee who does not perform more than 500 hours of service during the 2016 calendar-year computation 

period. This participant incurs a one-year break in service on December 31, 2016. Although the break occurs on 

the Participant Count Date for the 2017 premium, the individual would not be included in the Participant Count 

for 2017.

Comparison to Form 5500

The Participant Count for the Premium Payment Year and the number of participants reported for item 6 of 

Form 5500 for the plan year preceding the Premium Payment Year (e.g., the 2017 premium filing and the 2016 

Form 5500) are generally determined as of the same date (i.e., the last day of the plan year preceding the 

Premium Payment Year). However, the two counts may differ. For example:

 For premium purposes, individuals who are earning or retaining credited service but with respect to whom a 

plan has no Benefit Liabilities are not counted as participants. But individuals who are earning or retaining 

credited service are considered to be participants for purposes of item 6 of the Form 5500, even if the plan 

has no Benefit Liabilities with respect to them.

 There is a difference in the break-in-service rules that apply when counting participants for premium 

purposes and for purposes of item 6 of Form 5500. For purposes of item 6 of Form 5500, whether a nonvested individual is excluded from the count because of a break in service depends upon the plan language; 

under the provisions of most plans, the instructions for item 6 would require that a separated non-vested 

individual be counted as a participant until the individual has incurred five or more consecutive one-year 

breaks in service. For premium purposes, on the other hand, a non-vested individual is excluded from the 

count because of a break in service when the individual has incurred a one-year break in service under the 

terms of the plan.
Page 12

How to Determine Unfunded Vested Benefits

General

“Unfunded vested benefits” (UVBs) is the term used to describe the underfunding measure on which the 

Variable-rate Premium is based. For Variable-rate Premium purposes, unfunded vested benefits means 

the excess, if any, of the Premium Funding Target, over the fair market value of plan assets. This section 

describes how and when the Premium Funding Target and fair market value of plan assets are 

determined for this calculation.

Which year’s UVBs

In general, Variable-rate Premiums are based on UVBs for the Premium Payment Year. However, Small 

Plans are subject to a Lookback Rule, under which the Variable-rate Premium for the Premium Payment 

Year is based on UVBs for the plan year preceding the Premium Payment Year - for example, under the 

Lookback Rule, the 2017 Variable-rate Premium is based on UVBs for 2016 (the Lookback Year).

The lookback rule first applied for 2014 plan years. At that time Small Plans were given automatic 

approval to permanently opt out of the Lookback Rule (i.e., to use current year UVBs to determine the 

Variable-rate Premium). Most Small Plans chose to do so. Those plans must continue to use current 

year UVBs to determine the Variable-rate Premium unless and until they seek and receive permission 

from PBGC to start using the Lookback Rule in the future (or unless the plan ceases to be a Small Plan). 

Information about how to seek such permission is covered later in this “Which year’s UVBs” section.

New and Newly Covered Small Plans

The Lookback Rule doesn’t apply to New and Newly Covered Small Plans because such plans don’t have 

a covered prior year to look back to. So, special rules apply. If a New or Newly Covered Plan is Small 

and:

 Was created as the result of a non de minimis spinoff7 or consolidation (i.e., “Continuation Plans”), 

the Variable-rate Premium for the Premium Payment Year is based on UVBs for that same year. 

These plans do, however, get more time to complete their filings (see “When to File”section).

 Is not a Continuation Plan, the plan is exempt from the Variable-rate Premium for its first year of 

filing. Note that such a plan could be either a newly established plan or a plan resulting from a 

de minimis spinoff. The exception applies in either case.

These plans will be permitted to opt out of using the Lookback Rule without first seeking PBGC 

permission, the first time the Lookback Rule would otherwise apply.

Opting out of the Lookback Rule Starting with 2017

 Not the first opportunity to opt out - If a Plan had the opportunity to opt out of the Lookback Rule in 

the past but chose not to, PBGC permission is required to opt out for 2017. See next page for 

information on how to seek such permission.

 First opportunity to opt out - If the 2017 plan year is the first year for which a plan has the 

opportunity to opt out of the Lookback Rule, the plan may do so without first seeking permission 

from PBGC. For example, permission to opt out is not requiredif:

– The plan was not a Small Plan for any year after 2013, but because of a decrease in Participant 

Count, is Small Plan for 2017;

7 See the regulations under section 414(l) of the Code with respect to Single-employer Plans.
How to Determine Unfunded Vested Benefits

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8

– The plan was a New or Newly Covered Small Plan that was also a Continuation Plan for 2016 and 

was thus, required to use current year UVBs to determine its 2016 Variable-ratePremium;

– The plan did not have to calculate nor report UVBs for any year after 2013 because it was 

exempt from the VRP or eligible for the Small-employer Cap and chose to pay the cap and not 

report UVBs.

Small Plans reporting UVBs for the first time are cautioned to be careful to ensure the data reported 

in the Variable-rate Premium section of the filing are entered correctly because if the reported UVB 

Valuation Date7F is within the Premium Payment Year, we will expect all future filings to be completed 

using current year UVBs to determine the Variable-ratePremium.

Note for small plans with year-end valuation dates – It is not practical for a small plan with a

year-end valuation date to opt out of the Lookback Rule. For example, consider a small plan with a 

calendar year plan year. Opting out of the Lookback Rule would mean measuring UVBs on 

December31st, two and half months after the October 15th due date.

Requesting permission to use (or not use) the Lookback Rule

As noted above, PBGC permission is required if:

 a small plan that had the opportunity to opt out of the Lookback Rule in the past but chose not to, 

wants to opt out starting with 2017, or

 a small plan that opted out of using the Lookback Rule in the past, wants to start using the Lookback 

Rule starting with 2017.

In either case, to request permission, send an email with “Request re: Lookback Rule” in the subject line 

to premiums@pbgc.gov at least 60 days before the due date. In the email, you must identify the plan 

and explain the reason the plan wants to change its previously established process for determining 

UVBs. PBGC will reply to acknowledge receipt of such requests. If you do not receive an 

acknowledgement within two business days, please call PBGC at 1 (800) 736-2444 to confirm that your 

request was received.

PBGC will review such requests based on the facts and circumstances and will grant such requests only 

for good cause in appropriate circumstances. PBGC will not grant requests made solely to reduce 

premiums.

If you do not receive a determination within 30 days of making the request, please call us at the 800 

number shown above, as you will need the determination to make a timely premium filing.

Measurement date

Unfunded Vested Benefits are measured on the funding valuation date (i.e., the measurement date for 

determining the minimum required contribution) for the applicable plan year (i.e., either the Premium 

Payment Year or the Lookback Year, depending on whether the Lookback Rule applies). Regardless of 

whether the Lookback Rule applies, this date is called the UVB Valuation Date to distinguish it from the 

Participant Count Date (see “How to Count Participants” section).

So, for plans using the Lookback Rule, the UVB Valuation Date is the valuation date used to determine 

the minimum required contribution (i.e., “the funding valuation date”) for the Lookback Year. For all 

other plans, the UVB Valuation Date is the funding valuation date for the Premium Payment Year.

8 See (line (7)(c)(3) of the illustrative form in the “Data to be submitted” section.
How to Determine Unfunded Vested Benefits

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9

Examples

The following examples illustrate these rules:

Example 1 – Plan A, a calendar year plan, is not a Small Plan and therefore, in accordance with ERISA 303 

must have a beginning of year valuation date. Plan A’s Variable-Rate Premium for 2017 is based on 

UVBs for 2017 (i.e., the Premium Payment Year) measured as of 1/1/2017. This result is not dependent 

on whether the plan is a Continuation Plan.

Example 2 – Plan B is a pre-existing Small Plan and is therefore is subject to the Lookback Rule. Plan B 

has a calendar year plan year and a beginning of year valuation date. Plan B did not submit a request a 

PBGC regarding the Lookback Rule. If Plan B did not opt out of the Lookback Rule for 2016, its Variablerate Premium for 2017 is based on UVBs for the plan year beginning in 2016 measured as of 1/1/2016. 

If Plan B opted out of the Lookback Rule for 2016, its Variable-rate Premium for 2017 is based on UVBs 

for the plan year beginning in 2017 measured as of 1/1/2017.

Example 3 – Plan C is a New Small Plan with a calendar year plan year and a beginning of year valuation

date. Plan C was created as the result of a non de minimis spin-off on 1/1/2016 and is therefore 

considered a Continuation Plan for 2016. As a Continuation Plan, Plan C is not subject to the Lookback 

Rule for 2016 (because there is no prior year to look back to). That means UVBs are measured as 

1/1/20168F .

Example 4 – Plan D is a pre-existing Plan which has a calendar year plan year and a beginning of year 

valuation date. Plan D had a participant count of 102 for 2016, but due to attrition, its 2017 participant 

count is 98. Thus, Plan D is now subject to the Lookback Rule. That means Plan D’s Variable-rate 

Premium for 2017 is based on UVBs for the plan year beginning in 2016 (i.e., the “Lookback Year” 

measured as of 1/1/2016), the same UVBs that were used to determine the 2016 VRP. Alternatively, 

Plan D may opt out of the Lookback Rule, in which case, its Variable-rate Premium for 2017 will be based 

on UVBs for the plan year beginning in 2017 measured as of 1/1/2017.

Premium Funding Target

The Premium Funding Target is the liability measure underlying the UVB calculation. It is determined the 

same way the funding target is determined under ERISA section 303 (minimum funding requirements) 

except that only vested benefits are included, and a special premium discount rate structure is used.

With the exception of the discount rate, all other assumptions must be identical to those used to 

determine the minimum required contribution under ERISA section 303. In lieu of using the special 

premium discount rates, you may make an election (irrevocable for five years) to use smoothed 

discount rates, similar to, and in some cases identical to, the rates used to determine the minimum 

required contribution. Different terminology is used to describe the Premium Funding Target depending 

on whether this election is in effect.

 Standard Premium Funding Target – This term describes the Premium Funding Target that applies 

unless the above-noted election is in effect. The discount rates used to determine the Standard 

Premium Funding Target are the ERISA section 4006(a)(3)(E)(iv)) segment ratesfor:

9 Assuming the participant count remains below 100, Plan D will be subject to the Lookback Rule for 2017. That means that Plan 

D’s Variable-rate Premium for 2017 will also be based on UVBs for 2016 measured as of 1/1/2016. But, Plan D can opt out of 

the Lookback Rule starting with 2017.
How to Determine Unfunded Vested Benefits

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9F

- In the case of a Small Plan using the Lookback Rule, the month before the month in which the 

Lookback Year begins.

- In the case of any other plan, the month before the month in which the Premium Payment Year 

begins.

The ERISA section 4006(a)(3)(E)(iv) segment rates are based on the same bond yields as used to 

determine the segment rates for the ERISA section 303 funding target. However, unlike ERISA 303 

segment rates which are averaged over 24 months, the segment rates used to determine the 

Standard Premium Funding Target are not averaged. These “spot” segment rates are published by 

IRS each month and are also posted on the “Interest Rates and Factors” section of the Practitioners 

Page on PBGC’s website.

 Alternative Premium Funding Target – This term describes the Premium Funding Target if the 

election described above is in effect. The Alternative Premium Funding Target is determined using 

the discount rates that would have been used to determine the ERISA section 303 funding target 10 

for the Premium Payment Year (or, for a plan using the Lookback Rule, the Lookback Year) if not for 

the Interest Rate Stabilization Rules. Thus, if an election is madeunder:

- ERISA section 303(h)(2)(D)(ii) to use the full yield curve instead of the three segment rates for 

purposes of determining the minimum required contribution, that same yield curve is used to 

determine the Alternative Premium Funding Target; or

- ERISA section 303(h)(2)(E) to use one of the four months preceding the valuation date as the 

“applicable month,” instead of the month containing the valuation date, for determining which 

month’s rates to use, that same month’s rates, determined without regard to the Interest Rate 

Stabilization Rules, are used to determine the Alternative Premium FundingTarget.

Until an election is officially revoked, it remains in place. An election to use the Alternative Premium 

Funding Target cannot be revoked for five calendar years. Similarly, once an election is revoked, the 

plan cannot make another election to use the Alternative Premium Funding Target for five full years. 

The following example illustrates the rules on making and revoking an election to use the Alternative 

Premium Funding Target.

Example – Plan A first makes an election to use the Alternative Premium Funding Target for a plan year 

that begins on April 1, 2017. In this case, the Alternative Premium Funding Target must be used to 

determine unfunded vested benefits for all plan years beginning before April 1, 2022. The plan may 

revoke the election first effective for any plan year beginning on or after April 1, 2022, but unless the 

election is revoked, it will remain in place.

This is the case even if the plan year subsequently changes. For example, if the plan year is changed to 

the calendar year first effective January 1, 2022, the Alternative Premium Funding Target must be used 

for the short plan year April 1, 2021 – December 31, 2021 and for the January 1, 2022 – December 31, 

2022 plan year. The first plan year for which the Plan Administrator may revoke the election is the 

2023 plan year.

The election (or revocation) must be made by the premium filing due date. An election to use (or 

revoke) the Alternative Premium Funding Target is made as part of the comprehensive premium filing. If

10 Note that this will not be the case if the plan is not yet subject to PPA for funding purposes, or if an election is made under 

PPA 2006 section 402, to use an 8.25% discount rate to determine the funding target for funding purposes. See “Plans Subject

to Special Funding Rules” later in this section.
How to Determine Unfunded Vested Benefits

Page 16

an election (or revocation) is not made as part of the comprehensive filing, it may be made as part of an 

amended filing only if the amended filing is made on or before the due date.

Vested Benefits

Only vested benefits are taken into account when determining the Premium Funding Target. For this 

purpose, a benefit does not fail to be considered vested solely because it is not protected under Code 

section 411(d)(6) and thus may be eliminated or reduced by the adoption of a plan amendment or by 

the occurrence of a condition or event. Such a benefit is vested for premium purposes (if the other 

requirements for vesting have been met) so long as the benefit has not actually been eliminated or 

reduced. In addition, certain benefits payable upon a participant’s death do not fail to be considered 

vested solely because the participant is still living. The benefits to which this rule applies are a qualified 

pre-retirement survivor annuity (QPSA), a post-retirement survivor annuity such as the annuity paid 

after a participant’s death under a joint-and-survivor or certain-and-continuous option, and a benefit 

that returns a participant’s accumulated mandatory employee contributions.

Also, a participant’s pre-retirement lump-sum death benefit (other than a benefit that returns 

accumulated mandatory employee contributions or a QPSA paid as a lump sum) is not vested if the 

participant is living. Similarly, a disability benefit is not vested if the participant is not disabled. The 

following examples illustrate these concepts:

Example 1 – Under Plan A, if a participant retires at or after age 55 but before age 62, the participant 

receives a temporary supplement from retirement until age 62. The supplement is not a qualified social 

security supplement (QSUPP) as defined in Treasury Reg. §1.401(a)(4)-12, and is not protected under 

Code section 411(d)(6). The temporary supplement is considered vested, and its value is included in the 

premium funding target, for each participant who, on the UVB Valuation Date, is at least 55 but less 

than 62, and thus eligible for the supplement. The calculation is unaffected by the fact that the plan 

could be amended to remove the supplement after the UVB Valuation Date.

Example 2 – Plan B provides a QPSA upon the death of a participant who has five years of service, at no 

charge to the participant. The QPSA is considered vested, and its value is included in the premium 

funding target, for each participant who, on the UVB Valuation Date, has five years of service and is thus 

eligible for the QPSA. The calculation is unaffected by the fact that the participant is alive on that date.

Estimated Premium Funding Target

If the Premium Funding Target is not known by the due date, an estimated Variable-rate Premium may 

be paid on the due date. Doing so triggers a requirement to submit an amended filing at a later date to 

reconcile the actual Variable-rate Premium with the estimate. In the event the actual Variable-rate 

Premium is greater than the estimate, penalties for late payment will be waived if the estimate meets 

certain criteria and the reconciliation filing is made by the end of the sixth calendar month that begins 

on or after the premium filing due date (generally April 30th after year end for calendar year plans). For 

additional information, see “Automatic Penalty Waiver for Certain Late Variable-Rate Premiums” in the 

“Late Payment Charges” section.

Fair Market Value of Plan Assets

The asset measure underlying the UVB calculation is determined the same way assets are determined 

under ERISA section 303 except without regard to any averaging method. For premium purposes, the 

market value of assets is measured on the UVB Valuation Date and adjusted to account for contribution 

receipts using the same methodology as is used for funding purposes.
How to Determine Unfunded Vested Benefits

Page 17

Adjustments for prior year contributions

If contributions for the plan year prior to the Premium Payment Year (or, in the case of a plan using the 

Lookback Rule, the plan year preceding the Lookback Year) are made after the UVB Valuation Date, the 

market value is increased to reflect the value of such contributions discounted to the UVB Valuation 

Date. The discount rate for this purpose is the ERISA section 303(h)(2)(A) effective interest rate for the 

plan year for which the contributions were made (as reported in item 5 of Schedule SB). For example, 

consider a calendar year plan with a January 1, 2016 UVB valuation date.

Contributions made in 2017 for the 2016 plan year are included in the January 1, 2017 asset value.

Such contributions are discounted from the date made to January 1, 2017 using the 2016 effective 

interest rate. Such contributions are included only to the extent made by the date of the premium filing.

Adjustments for current year contributions

If contributions for the Premium Payment Year (or, in the case of a plan using the Lookback Rule, the 

Lookback Year), are made before the UVB Valuation Date, the market value is decreased to exclude the 

adjusted value of these current year contributions. For this adjustment, such are increased to the UVB 

Valuation Date using the ERISA section 303(h)(2)(A) effective interest rate for the plan year for which 

they were made. This can happen only if the UVB Valuation Date is after the beginning of the plan year.

Comparison to asset value reported on Schedule SB

In the case of:

 a Small Plan using the Lookback Rule, the asset value reported is generally the same as the market 

value of assets required to be reported in the Schedule SB for the Lookback Year (item2a).

 any other plan, the asset value reported here is generally the same as the market value of assets 

required to be reported in the Schedule SB for the Premium Payment Year (item2a).

The amounts would differ only if a premium filing is made before the premium due date and prior year 

contributions are made after the premium filing is made (and thus not included in assets).
How to Determine Unfunded Vested Benefits

Page 18

10F

Summary

The following table summarizes the various dates and assumptions that are used to determine Variablerate premiums for 2017. Although Participant Count Date is not used to determine the Variable-rate 

premium, it is included in the table so that all of the variables affecting premium calculations are 

contained in one summary. Please review the column that relates to your plan.

Summary 11

If Lookback Rule Applies If Lookback Rule Does Not Apply

Standard Premium 

Funding Target

Alternative Premium Funding 

Target

Standard Premium 

Funding Target

Alternative Premium 

Funding Target

Participant Count 

Date

Last day of 

2016 plan year

Last day of 

2016 plan year

Last day of 

2016 plan year

Last day of 

2016 plan year

UVB Valuation 

Date

Funding valuation 

date for 2016

Funding valuation 

date for 2016

Funding valuation 

date for 2017

Funding valuation 

date for 2017

Benefits reflected 

in Premium 

Funding Target

Vested portion of 

benefits included in 

2016 funding target

Vested portion of 

benefits included in 

2016 funding target

Vested portion of 

benefits included in 

2017 funding target

Vested portion of 

benefits included in 

2017 funding target

Assumptions

• Discount rates Spot segment rates for 

month before 2016 plan 

year begins

Whatever would have been 

used for funding purposes for 

2016 if Interest Rate 

Stabilization Rules had not 

applied 12

11 F

Spot segment rates for 

month before 2017 plan 

year begins

Whatever would be used 

for funding purposes for 

2017 if Interest Rate 

Stabilization Rules did not 

apply11

• All other 

assumptions

Whatever was used 

for funding purposes 

for 2016

Whatever was used 

for funding purposes 

for 2016

Whatever is used 

for funding purposes

for 2017

Whatever is used 

for funding purposes 

for 2017

At-risk status Whatever status was 

in effect for funding 

purposes for 2016

Whatever status was 

in effect for funding 

purposes for 2016

Whatever status is 

in effect for 

funding purposes 

f 2017

Whatever status is 

in effect for funding 

purposes for 2017

At-risk load

• 4% of liability 

portion of load

If the plan was at-risk for 

2016 for funding 

purposes, 4% of what 

the Standard Premium 

Funding Target would be 

if the plan wasn’t at-risk.

Otherwise, N/A.

If the plan was at-risk for 

2016 for funding 

purposes, 4% of what 

the Alternative Premium 

Funding Target would be 

if the plan wasn’t at-risk.

Otherwise, N/A.

If the plan is at-risk for 

2017 for funding 

purposes, 4% of what 

the Standard Premium 

Funding Target would be 

if the plan wasn’t at-risk.

Otherwise, N/A.

If the plan is at-risk for 

2017 for funding 

purposes, 4% of what 

the Alternative Premium 

Funding Target would be 

if the plan wasn’t at-risk.

Otherwise, N/A.

• Per-participant 

portion of load

The same amount 

included in the liability 

for funding purposes 

for 2016

The same amount 

included in the liability 

for funding purposes 

for 2016

The same amount 

included in the liability 

for funding purposes 

for 2017

The same amount 

included in the 

liability for funding 

purposes for 2017

11 Table entries assume plan is not a New or Newly Covered Small Plan. The terms “funding” or “for funding purposes” in this table 

mean amounts determined under ERISA Section 303. References to 2016 or 2017 relate to the plan year beginning in such year. 12 This is not the case for plan that are not subject to PPA for funding purposes or plans made elections under section 402 of PPA 

which the funding target is determined using an 8.25% discount rate. See “Plans Subject to Special Funding Rules” on next page.
How to Determine Unfunded Vested Benefits

Page 19

Plans Subject to Special Funding Rules

Plans covered by any of the special funding rules listed below must determine UVBs in the same manner 

(and using the same discount rate basis) as all other plans.

 Section 104 of the Pension Protection Act of 2006 as amended by the Preservation of Access to Care 

for Medicare Beneficiaries and Pension Relief Act of 2010, Public Law 111-192, dealing with eligible 

charity plans and plans of certain rural cooperatives.

 The Cooperative and Small Employer Charity Pension Flexibility Act, Public Law 113-97, dealing with 

certain defined benefit pension plans maintained by more than oneemployer.

 Section of 402(b) of the Pension Protection Act of 2006, Public Law 109-280, dealing with certain 

frozen plans of commercial passenger airlines and airlinecaterers.

In particular, under Section 402 of PPA 2006, certain plans may elect to use an 8.25% discount rate for 

funding purposes and other plans may elect to use an 8.85% discount rate. These rates may not be used 

to determine UVBs, even if the Alternative Premium Funding Target is elected.
Spinoffs, Mergers and Consolidations

Page 20

General

This section provides additional guidance for plans involved in a Spinoff, Merger, or Consolidation. 

Plans considering any of these transactions are encouraged to read this section carefully before 

finalizing the transaction because decisions that have little impact on funding requirements can

have a significant impact on the amount of premium due and the due date. For example, with respect 

to a non de minimis Spinoff to a New Plan, the aggregate premium due for both plans will generally be 

less if the Spinoff occurs at the beginning of the plan year. Also, when combining two plans, aggregate 

premium amounts will differ depending on, for example, whether Plan A is merged into Plan B, Plan B 

is merged into Plan A, or the two plans are consolidated into a New Plan C.

Note that as the result of one of these transactions, a plan could become a Small Plan for the first 

time or cease to be a Small Plan. Filers are cautioned to review the Lookback Rule provisions in either 

of these situations (See “How to Determine UVBs” section).

Information about Spinoffs, Mergers and Consolidations are reported by all PBGC-covered plans 

involved in the transaction as part of the Comprehensive Premium Filing in items that request 

information about “Transfers from other plans” and “Transfers to other plans”. See “Description of 

Data Elements” section, items 14 and 15.

Spinoffs

A “Spinoff” is a transaction in which a plan (the Transferor Plan) transfers a portion of its assets and/or 

liabilities to another plan (the Transferee Plan). The Transferee Plan may be a New Plan, created by the 

Spinoff, or it may be a pre-existing plan.

If the Spinoff is not de minimis and the Transferee plan is a New Plan, it is, by definition, a Continuation 

Plan. All of the special rules applicable to New Plans and Continuation Plans apply. For example, for 

the plan’s first plan year:

 Depending on when the transaction occurs and the plan’s UVB Valuation Date, the due date might 

be later than the Normal Due Date (see “When to File” section).

 The applicable Participant Count Date for purposes of determining the Flat-rate Premium is the first 

day of the premium payment year (see “How to Count Participants” section).

 The Standard Premium Funding Target is used to determine the Variable-rate Premium unless the 

plan makes a timely election to use the Alternative Premium Funding Target. This is the case even 

if the Transferor Plan had an election to use the Alternative Premium Funding Target in effect or 

revoked such an election fewer than five years prior to theSpinoff.

 If the plan is a Small Plan, the Lookback Rule does not apply because there is no prior plan year to 

look back to. The Lookback Rule will automatically apply for the plan’s second year of existence, 

unless the plan opts out of using that rule (See “How to Determine Unfunded Vested Benefits”).

Mergers

A “Merger” is a transaction in which a plan transfers all of its assets and liabilities to an existing plan 

and, as a result, ceases to exist. In essence, the Transferor Plan becomes part of the Transferee Plan.
Spinoffs, Mergers and Consolidations

Page 21

If, as a the result of Merger, a plan ceases to exist, in addition to reporting information about the 

transaction, note that the fact that the filing is the last filing for the plan must also be reported.13 See 

"Description of Data Elements” section, items 13).

Consolidations

A “Consolidation” is a transaction in which two or more plans transfer all of their assets and liabilities to 

a New Plan and, as a result, cease to exist (because the Transferor Plans become part of the new 

transferee plan). It differs from a Merger because in a Merger, the Transferee Plan existed before the 

transaction. In a Consolidation, the Transferee Plan is a New Plan that is created in the Consolidation.

Thus, the plan that exists after a Consolidation follows the premium filing rules for a New Plan.

If, as the result of a Consolidation, a plan ceases to exist, in addition to reporting information about 

the transaction, note that the fact that the filing is the last filing for the plan must also be reported. 

(See “Description of Data Elements” section, items 13).13

Examples

The following examples illustrate the effect of these transactions on premiums.14

Example 1 (Beginning of Plan Year Spinoff to a New Plan) — Plan B is created on January 1, 2017 as the 

result of a Spinoff from Plan A (a plan with a calendar year plan year). Plan B will also have a calendar 

year plan. Plan A made an election to use the Alternative Premium Funding Target in 2009; such election 

is still in effect. Both plans have beginning of year valuation dates (i.e., UVB measurement dates).

For 2017, premiums for these plans are determined as follows:

 Due date — Premiums for both plans are due October 16, 2017 (October 15th is aSunday).

 Participant Count Date:

- Plan A: Because the Spinoff occurred on the first day of Plan A’s plan year, Plan A’s 2017 flat-rate 

Premium is based on the participant count on the first day of the plan year (January 1, 2017) 

instead of the last day of the prior year (December 31, 2016). See special rule re: beginning of 

year Spinoffs in “How to Count Participants” section.

- Plan B: Because Plan B is a New Plan, its Participant Count Date is also the first day of the plan 

year (January 1, 2017).

 UVB Measurement Date — Both plans measure Unfunded Vested Benefits as of January 1,2017.

 Premium Funding Target:

- Plan A: The Alternative Premium Funding Target is used unless the election is revoked as part of 

the 2017 Comprehensive PremiumFiling.

13 If a plan ceases to exist because of a merger or consolidation and the transaction occurs after the premium filing is 

submitted, please contact PBGC via email at premiums@pbgc.gov, so we can update our records. Absent this notification, 

PBGC will likely contact the plan (that no longer exists) to inquire about why the subsequent year’s filing isn’t submitted.

14 For purposes of these examples, assume all plans have been covered by PBGC since inception, that none of the affected 

plans are Small Plans and that none of the Spinoffs or Mergers are de minimis.
Spinoffs, Mergers and Consolidations

Page 22

- Plan B: As a New Plan, the Variable-Rate Premium must be determined using the Standard 

Premium Funding Target unless the Plan makes a timely election to use the Alternative Premium 

Funding Target (as part of its 2017 filing).

 Proration — Neither plan qualifies to pro-rate its 2017premium.

 Reporting on Comprehensive Premium Filing — Plan A reports the Spinoff in the “Transfers to other 

plans” item and Plan B reports the Spinoff in the “Transfers from other plans” item.

Example 2 (Mid-year Spinoff to a New Plan) — Plan B is created on July 1, 2017 as the result of a Spinoff 

from Plan A. Both plans have calendar year plan years and beginning of year UVB Valuation Dates. Plan 

B’s first plan year will be a short plan year (i.e., July 1, 2017 – December 31, 2017). Plan A made an 

election in 2009 to use the Alternative Premium Funding Target that is still in effect. For 2017, 

premiums are determined as follows:

 The Spinoff has no effect on Plan A’s 2017 premium obligation. Thatmeans:

- Due Date: October 16, 2017 (October 15th is a Sunday).

- Flat-rate Premium: Based on the participant count as of December 31, 2016. There is no 

adjustment for participants who are spun off later in the year.

- Variable-rate Premium: Unfunded Vested Benefitsare:

o Measured as of January 1, 2017. There is no adjustment for the assets and/or liabilities 

that are spun off later in the year.

o Determined using the Alternative Premium Funding Target unless the Plan makes a timely 

election to revoke the prior election (as part of its 2017filing).

 Plan B is subject to special rules because it is a New Plan. Forexample:

- Due date: April 15, 2018 (i.e., the 15th day of the 10th full calendar month after July 1, 2017). 

However, because the 15th is a Sunday, the due date is automatically extended until April16th.

- Flat-rate Premium: Based on the participant count on July 1, 2017. The fact that some of these 

participants may have been included in the participant count for Plan A’s 2017 Flat-rate 

premium has no bearing on Plan B’s Flat-ratePremium.

- Variable-rate Premium: Unfunded Vested Benefitsare:

o Measured on the same date used to determine funding requirements for Plan B’s first 

(short) plan year.

o Determined using the Standard Premium Funding Target unless the Plan makes a timely 

election to use the Alternative Premium Funding Target (as part of its 2017filing).

- Proration: Because the first plan year is a short plan year and the plan was created as the result 

of a Spinoff, the 2017 premium is prorated. There are six months in the short plan year (July 1, 

2017 – December 31, 2017), so the plan owes 50% (i.e., 6/12) of the otherwise determined 

premium. Note that for proration purposes, a partial month is treated as a full month. So, had 

the spinoff had occurred on July 25th instead of July 1st, the result would be thesame.

 Reporting on Comprehensive Premium Filing — Plan A reports the Spinoff in the “Transfers to other 

plans” item. Plan B reports the Spinoff in the “Transfers from other plans”item.
Spinoffs, Mergers and Consolidations

Page 23

Example 3 (Mid-year Spinoff to a pre-existing plan) — Plans A and B are both calendar year plans with 

beginning of year UVB valuation dates. Both plans made an election in 2014 to use the Alternative 

Premium Funding Target that is still in effect. On July 1, 2017, Plan A spun off assets and liabilities for 

participants in Location XYZ to Plan B.

In this scenario, the Spinoff has no effect on the amount of premium owed or the due date for the 2017 

plan year of either plan. Plan A reports the Spinoff in the “Transfers to other plans” item and Plan B 

reports the spinoff in the “Transfers from other plans” item.

Example 4 (Beginning of year Merger) — Plans A and B are both calendar year plans with beginning of 

year UVB Valuation Dates. On January 1, 2017, Plan B merges into Plan A.

The Merger’s impact on 2017 premiums is as follows:

 Plan A’s 2017 flat-rate Premium is based on the participant count on the first day of the plan year 

(January 1, 2017) instead of the last day of the prior year (December 31, 2016) because the Merger 

occurred on the first day of Plan A’s plan year (See special rule re: beginning of year Mergers in 

“How to Count Participants” section).

 Plan B is not required to submit a 2017 Comprehensive Premium Filing because the plan ceased to 

exist on what would have been the first day of Plan B’s 2017 plan year. In other words, the Merger 

is deemed to be effective before the 2017 plan yearbegins.

 Plan A reports the Merger in the “Transfers from other plans” item. Because the Merger did not 

occur until after the due date for Plan B’s 2016 Comprehensive Premium Filing, PBGC expects that 

Plan B would not have reported that 2016 would be its “Final Filing” as part of its 2016 filing. As 

long as Plan A properly reported the Merger in its 2017 filing, it is not necessary to amend Plan B’s 

2016 filing to indicate that it’s the finalfiling.

Example 5 (Mid-year Merger) — Plan A is a calendar year plan. Plan B has a plan year that begins on 

March 1. Both plans have beginning of year UVB Valuation Dates. On February 1, 2017, Plan B merges 

into Plan A.

The Merger’s impact on 2017 premiums is as follows:

 The Merger has no effect on Plan A’s premium obligation. Among other things, that means the Flatrate Premium is based on the participant count as of December 31, 2016 (i.e., the Plan B participants 

that merged into Plan A on February 1, 2017 are notincluded).

 Plan B is not required to submit a Comprehensive Premium Filing because the plan ceased to exist 

before its 2017 plan year would have begun (i.e., before March 1,2017).

 Plan A reports the Merger in the “Transfers from other plans” item.

 Because the Merger did not occur until after the due date for Plan B’s 2016 Comprehensive 

Premium Filing, PBGC expects that Plan B would not have reported that 2016 would be its “Final 

Filing” as part of its 2016 filing. As long as Plan A properly reports the Merger in its 2017 filing, it is 

not necessary to amend Plan B’s 2016 filing to indicate that it’s the finalfiling.
Spinoffs, Mergers and Consolidations

Page 24

Example 6 (Mid-year Merger) — Plan A is a calendar year plan. Plan B has a plan year that begins on 

October 1. Both plans have beginning of year UVB Valuation Dates. Plan B merges into Plan A on 

December 1, 2017. The Merger’s impact on premiums is as follows:

 Plan A: The Merger has no effect on the amount of Plan A’s 2017 premium. Because the Merger 

occurs after the due date for Plan A’s 2017 Comprehensive Premium Filing, Plan A will not report the 

Merger in in the “Transfers from other plans” item until the 2018filing.

 Plan B: Although Plan B’s 2017 plan year is a short plan year (October 1, 2017 – November 30, 

2017), Plan B’s 2017 premium is not pro-rated because the short plan year was created as a the 

result of a mid-year Merger. In its 2017 Comprehensive Premium Filing, Plan B reports the Merger 

in the “Transfers to other plans” item and in the “Final Filing” item.

Example 7 (Consolidation) - On March 1, 2017, three plans (A, B, and C) with beginning of year valuation 

dates were consolidated into a New Plan D and thus ceased to exist. Prior to the Consolidation, Plan A 

had a calendar year plan year. Plan B and C’s plan years began on March 1 and October 1, respectively. 

Neither Plan A, B or C was a Small Plan. Plan D has a calendar year plan year.

2017 premiums are determined as follows:

 Plan A – The Consolidation has no effect on the amount of the 2017 premium owed or the due date. 

Despite the short plan year (January 1, 2017 – February 28, 2017), the plan does not qualify for 

premium pro-ration.

 Plan B – Because the plan ceased to exist on what would have been the first day of Plan B’s 2017 

plan year, Plan B is not required to submit a 2017 Comprehensive Premium Filing. In other words, 

the Consolidation is deemed to be effective before the 2017 plan yearbegins.

 Plan C – Because the Consolidation occurred before Plan C’s 2017 plan year began, Plan C is not 

required to submit a 2017 Comprehensive Premium Filing. Although the Consolidation occurs

during Plan C’s 2016 final short plan year (October 1, 2016 – February 28, 2017), it has no effect on 

the due date or the amount due for 2016 (i.e., the plan does not qualify for premiumpro-ration).

 Plan D – Because Plan D is a New Plan and, because it was created as the result of a consolidation, it 

is also a Continuation Plan. Like all New Plans, Plan D owes premiums for its first (short) plan year of 

coverage March 1, 2017 – December 31, 2017. Because the short plan year was created as the 

result of a consolidation, the premium is prorated.

The Participant Count Date is March 1, 2017. The fact that 2017 Flat-rate Premiums for some, or all, 

of those participants might have been paid by Plan A or Plan B has no impact on Plan D’s Flat-rate 

Premium.

The Variable-rate Premium must be determined using the Standard Premium Funding Target 

unless the Plan makes a timely election to use the Alternative Premium Funding Target (as part of 

its 2017 filing).

 Other reporting

- Plan A reports the Consolidation in item 15 (Transfers to other plans) of its 2017 filing and 

indicates that its 2017 filing will be the last filing in item13.

- Plan B does not report the Consolidation because it occurred after the 2016 filing was due.

- Plan D reports all three transfers in item 14 (Transfers from other plans) of its 2017 filing.
Page 25

Data to be Submitted

Form is for Illustrative Purpose Only

Amended filing 2017 PBGC Comprehensive Premium Filing Disaster Relief (enter code) _ _ - _ _

Part I – General Plan Information

1 Plan sponsor information

a Name

b Six-digit business code _ _ _ _ _ _ _ c First six digits of CUSIP number _ _ _ _ _ _

2 Plan administrator information

a Name

b Address line 1

c Address line 2 

d City e State f Zip g Country (if not U.S.)

h Contact person

(1) Name (for “attention” line ofmailings)

(2) e-mail address (3) Phone number: _ _ _ -_ _ _ - _ _ _ _ ext _ _ _ __

i Alternative phone number for Insured Plans List on pbgc.gov: _ _ _ -_ _ _ - _ _ _ _ ext _ _ _ _ _

3 Additional plan contact (optional)

(1) Name _

(2) e-mail address (3) Phone number: _ _ _ -_ _ _ - _ _ _ _ ext _ _ _ __

4 Plan information

a Plan name

b Premium payment year information:

(1) This filing is for the premium payment year commencing _ _ /_ _ / _ _ _ _ and ending _ _ /_ _ / _ _ _ _.

(2) For the premium payment year, is the plan a “small plan” (see definitions section of instructions)? Yes No

(3) If the plan year commencement date has changed since the most recent PBGC filing as a result of a plan amendment changing the plan year, enter the date 

the plan year change was adopted _ _/_ _/_ _ _ _ .

(4) Check box if plan qualifies to pay a prorated premium for this premium payment year (i.e., if plan has less than a full year of coverage).

c Employer Identification Number and Plan Number information:

(1) EIN and PN: EIN _ _ _ _ _ _ _ _ _ PN _ _ _

(2) If the EIN and PN are not both the same as on the most recent premium filing, enter EIN and PN from most recent premium filing: 

EIN _ _ _ _ _ _ _ _ _ PN _ _ _. Otherwise, skip to item 4c(3).

(3) If the EIN and PN are not both the same as on the 2016 Form 5500, enter EIN and PN from 2016 Form 5500 and provide explanation: Otherwise, skip to 

item 4d. EIN _ _ _ _ _ _ _ _ _ PN _ _ _. Explanation

d Plan effective date _ _ /_ _ / _ _ _ _

e Plan type: Multiemployer Single-employer (including multiple-employerplans)

f Check box if plan is a new or newly covered plan and provide the following information:

(1) Adoption date _ _ /_ _ / _ _ _ _ (2) Date coverage began on _ _ /_ _ / _ _ _ _.

(3) Is the plan a “continuation plan” (see definitions sectionof instructions)? Yes No
Page 26

Data to be Submitted

Part II – Flat-Rate Premium Information

5 Flat-rate premium

a Participant count date: Month _ Day Year

b Flat-rate premium calculation

(1) Applicable rate (Single-employer plans enter $69; Multiemployer plans, enter $28)

(2) Participant count as of participant count date

Active: Terminated vested Retirees and beneficiaries: Total:

(3) Flat-rate premium (item 5b(1) x item 5b(2))

Part III – Variable-rate Premium Information

Multiemployer plans — Skip to PartIV

Complete item 6 only if the plan is electing, or revoking an election, to use the Alternative Premium Funding Target instead of the Standard Premium Funding Target; 

otherwise skip to item 7.

6 Alternative Premium Funding Target Election or Revocation

a Election - Check box to elect to use the Alternative Premium Funding Target instead of the Standard Premium Funding Target. The election will be effective —

and the plan will be required to use the Alternative Premium Funding Target — beginning with this premium payment year and for all subsequent plan years 

unless and until the election is subsequently revoked.

b Revocation - Check box to revoke a prior election to use the Alternative Premium Funding Target. The revocation will be effective — and the plan will be 

required to use the Standard Premium Funding Target — beginning with this premium payment year and for all subsequent plan years unless and until a new 

election is subsequentlymade.

Note — Elections or Revocations must remain in place for at least five years.

7 Variable-rate premium (VRP)

a VRP exemptions – If an exemption applies, check applicable box and skip to item 8.

New or newly covered small plan other than a continuation plan No vested participants

Standard termination with a final distribution during the premiumpayment year 412(e)(3) plan

Standard termination with a proposed termination date in a prior year (proposed termination date: _ _ /_ _ /_ _ _ _)

b VRP small employer cap qualification – Check box if this plan qualifies for the small employer cap applicable to certain plans of small employers (those with

25 or fewer employees). If box is checked, items 7c through 7g may, but need not, be omitted.

c Assumptions and methods used to determine premium funding target

(1) Premium funding target method: Standard Alternative

(2) Discount rate(s): 1stsegment % 2nd segment % 3rd segment % N/A, full yield curve used

(3) UVB valuation date: Month Day Year

d Premium funding target as of UVB valuationdate – Check box if the reported premium funding target information is an estimate.

(1) Attributable to active participants _

(2) Attributable to terminated vested participants _

(3) Attributable to retirees and beneficiaries receiving payment _

(4) Total premium funding target (item 7d(1) + item 7d(2) + item 7d(3)) _

e Market value of assets as of UVB valuation date _

f Unfunded vested benefits (excess, if any, of item 7d(4) over item 7e, rounded up to the next $1,000) _

g Uncapped variable-rate premium (item 7f x 0.034) _

h Maximum VRP

(1) MAP-21 cap ($517 x item 5b(2)) _

(2) Small employer cap, if applicable ($5 x item 5b(2) x item 5b(2)) – Omit this item if plan is not eligible for this cap _

(3) Maximum variable-rate premium — If the plan qualifies for the small employer cap, the lesser of item 7h(1) and 7h(2). Otherwise, 

item 7h(1). _

i Variable-rate premium — If the plan qualifies for the small employer cap and item 7g was omitted, item 7h(3). Otherwise, the lesser 

of item 7g and item 7h(3). _
Page 27

Data to be Submitted

Part IV – Total Premium Information

8 Premium proration (If the plan does not qualify for premium proration, skip to item 9)

a Number of months (complete and partial) in the short plan year

b Total premium before reflecting proration (item 5b(3) + item 7i, if applicable)

9 Total premium — If the plan does not qualify for premium proration, item 5b(3) + item 7i, if applicable. If the plan qualifies for premium 

proration, item 8b x item 8a ÷ 12.

Part V – Payment Information

10 Premium credit

a Payments made previously for this premium payment year

b Outstanding credit from the plan year immediately preceding the premium payment year

c Total (item 10a + item 10b)

11 Amount due (excess, if any, of item 9 over item 10c)

12 Treatment of overpayment

a Excess, if any, of item 10c over item 9

b Treatment of balance (select one): Credit towards next year’s premium Refund by check

Refund by electronic funds transfer (EFT). If you select this option, complete item 12c.

c Information for EFT refund: Type of account Checking Savings Bank routing number

Account number Sub-account number (if any)

Part VI – MiscellaneousInformation

13 Final filing – If this is the last filing for this plan, enter the date of event _ _ /_ _ / _ _ _ _ and check box that best describes why filing obligation is ceasing: 

Merger/Consolidation Trusteeship Distribution pursuant to termination Cessation of covered status

14 Transfers from other plans – If another plan transferred assets or liabilities to this plan since the most recent comprehensive premium filing, provide the following 

information with respect to each plan from which assets or liabilities were transferred (if transfer involved a new or newly covered plan, see instructions).

EIN _ _ _ _ _ _ _ _ _ PN _ _ _ Date of transfer _ _ /_ _ / _ _ _ _ Type of transfer: Merger Consolidation Spinoff Other 

EIN _ _ _ _ _ _ _ _ _ PN _ _ _ Date of transfer _ _ /_ _ / _ _ _ _ Type of transfer: Merger Consolidation Spinoff Other

15 Transfers to other plans – If this plan transferred assets or liabilities to another plan since the most recent comprehensive premium filing, provide the following 

information with respect to each plan to which the assets or liabilities were transferred (if transfer involved a new or newly covered plan, see instructions).

EIN _ _ _ _ _ _ _ _ _ PN _ _ _ Date of transfer _ _ /_ _ / _ _ _ _ Type of transfer: Merger Consolidation Spinoff Other 

EIN _ _ _ _ _ _ _ _ _ PN _ _ _ Date of transfer _ _ /_ _ / _ _ _ _ Type of transfer: Merger Consolidation Spinoff Other

16 Participation freeze – If, as of the beginning of the premium payment year, this plan is closed to new entrants, enter the date the plan became closed to new 

entrants _ _/_ _/_ _ _ _ .

17 Accrual freeze – If, as of the beginning of the premium payment year, benefit accruals under this plan are partially or totally frozen, enter the date the freeze 

became effective_ _/_ _/_ _ _ _ and check box that best describes the nature of the freeze:

For all participants, both pay and service are frozen For all participants, service is frozen, pay isnot

For some participants, both pay and service are frozen For some participants, service is frozen, pay isnot

Other (enter explanation)
Page 28

Data to be Submitted

18. Risk transfer activity – Do not complete this item if this is the last filing for this plan

a Lump Sum Windows: If the plan provided one or more Lump Sum Windows during the time period described in the instructions, report the number of persons 

eligible to elect a lump sum under any such window and the number who elected a lump sum:

(1) Persons eligible to elect lump sum _ (2) Persons who elected lump sum

b Annuity purchases: If, during the time period described in the instructions, the plan purchased annuities for a group of people, report the number of persons 

for whom an annuity was purchased:

(1) Persons not in pay status when annuitywas purchased: (2) Persons in pay status when annuity waspurchased: 

19 Amended filing – Complete this item only if this is an amended filing

a If either the first or last day of the premium payment year reported in this amended filing (item 4b(1)) differs from what was reported in the filing that is being 

amended, provide the dates that were reported in the original filing:

Date premium payment year commenced _ _ /_ _ /_ _ _ _ Date premium payment year ended _ _ /_ _ /_ _ _ _.

b If the EIN and PN reported in this amended filing (item 4c(1)) are not both the same as what was reported in the filing that is being amended, enter the EIN and 

PN from the original filing: EIN _ _ _ _ _ _ _ _ _ PN _ _ _.

c If the reason for amending the filing is other than reconciling an estimated Variable-rate Premium and the total premium reported in this amended filing 

(item 9) is less than the amount reported in the filing that is being amended, provide an explanation of why an amended filing is necessary:

Part VII – Certifications

20 Certification of Plan Administrator – The plan administrator must sign and complete this item.

I certify under penalty of perjury, to the best of my knowledge and belief, that all the information in the filing is true, correct and complete and has been determined 

in accordance with PBGC's premium regulations and instructions, except that if the filing reports an estimated premium funding target, the estimate is reasonable, 

takes into account the most current information available to the enrolled actuary, and has been determined in accordance with generally accepted actuarial 

principles and practices, and that if I received variable-rate premium information certified by an enrolled actuary for this filing, the variable-rate premium 

information in the filing is the same as the variable-rate premium information certified by the enrolled actuary.

Name of person signing: First name Last name

_ _ _ -_ _ _ - _ _ _ _ ext _ _ _ _ _ _

E-mail address Telephone

_ _ /_ _ /_ _ _ _

Signature Date

21 Certification of Enrolled Actuary – An enrolled actuary must sign and complete this item unless the plan is (1) a multiemployer plan, (2) exempt from the variablerate premium, or (3) eligible for the small employer cap, paying the maximum VRP and not reporting the uncapped VRP.

I certify under penalty of perjury, to the best of my knowledge and belief, that the variable-rate premium information in the filing is true, correct and complete and 

has been determined in accordance with PBGC's premium regulations and instructions; except that if the premium funding target is estimated, the estimate is 

reasonable, takes into account the most current information available to me and has been determined in accordance with generally accepted actuarial principles 

and practices.

Name of person signing: First name Last name

_ _ _ -_ _ _ - _ _ _ _ ext _ _ _ _ _ _

Firm Telephone

_ _ -_ _ _ _ _

E-mail address Enrollment number

_ _ /_ _ /_ _ _ _

Signature Date
Page 29

Description of Data Elements

Overview

This section provides a description of each required data element presented in the same order as the “form” 

used to illustrate the data elements (see “Data to be Submitted” section). Item numbers are presented solely to 

facilitate understanding. The My PAA screens do not include item numbers. If you are using private-sector 

software, item numbers may or may not be included. We recommend you review these instructions with a copy 

of the “form” in front of you.

Note for plans with more than one plan year beginning in 2016 or 2017:

References in these instructions to the 2016 plan year (and to filings for the 2016 plan year) should be 

considered to refer to your plan’s most recent complete plan year. For example, a plan that changes its plan 

year could have two plan years beginning in calendar 2017. When such a plan makes its premium filing(s) for its 

second 2017 plan year, the references in these instructions to the 2016 plan year (and to filings for the 2015 

plan year) should be considered to refer to the plan’s first 2017 plan year (and to filings for that plan year), 

because that is the plan’s most recent complete plan year. Similarly, if your plan had two plan years beginning in 

calendar 2016, the references in these instructions to the 2016 plan year (and to filings for the 2016 plan year) 

should be considered to refer to the plan’s second 2016 plan year, which is the plan’s most recent complete plan 

year.

Note about reporting dollar amounts

With the exception of total premium, premium credits, the amount due PBGC, and the amount of any 

overpayment, money amounts reported should be in dollars only (no cents). Unfunded vested benefits are 

rounded up to the next $1,000.

Amended Filing

Check this box only if this filing is an amendment to a previously submitted filing for the 2017 plan year.

Note that a Variable-rate Premium reconciliation filing (in which you provide final Premium Funding Target 

information after having reported an estimated Premium Funding Target) is considered an amended filing. If you 

amend a comprehensive filing for a reason other than reconciling an estimated Variable-rate Premium and the 

amended filing shows a lower premium than the amount that was reported in the filing that is being amended, 

you must provide an explanation of the specific circumstances or events that caused the reduction. See the 

“Correcting Errors, Credit Balances and Reconciling Estimates” section for more information.

Note – If you are amending a filing for a plan year that did not begin in 2017, the rules in this document do not 

apply.

Disaster Relief

From time to time, when major disasters occur, PBGC grants disaster relief by waiving late filing and payment 

penalties for certain plans. Disaster Relief Announcements are available through the Practitioners Page on 

PBGC’s website. If your plan is covered by a PBGC Disaster Relief Announcement for this premium filing, report 

the four-digit code provided in the applicable Disaster Relief Announcement.
Description of Data Elements

Page 30

Instructions for Part I – General Plan Information 

1 Plan sponsor information

a Report the name of the Plan Sponsor.

b Business Code – Report the six-digit code that best describes the nature of the employer’s business. If more 

than one employer is involved, report the business code for the predominant business activity of all 

employers. A list of business codes can be found in the instructions to Form 5500 and in the “Premium

Filings” section of the Practitioners Page on PBGC’s website. Because codes for the Premium Payment Year 

may not be available at the time you submit this filing, you may report the relevant code for either the 

Premium Payment Year or the prior year. http://www.pbgc.gov/documents/Principal-Business-ActivityCodes.pdf

c CUSIP number – If a CUSIP number has been assigned to publicly traded securities of the Plan Sponsor or 

any member of the Plan Sponsor’s controlled group, report the first six digits of the CUSIP number.

Otherwise, leave this item blank.

A CUSIP number is a nine-digit number assigned to the publicly traded securities of a Plan Sponsor (or 

member of the Plan Sponsor’s controlled group) under the securities numbering system of the Committee 

on Uniform Securities Identification Procedures. The first six digits of the CUSIP number identify the 

securities issuer, the next two digits identify the specific securities issue, and the last digit is a check digit.

2 Plan administratorinformation

a-g Report the name and address of the Plan Administrator. Note that this is the address where we send 

official correspondence to the plan (e.g., an invoice for late payment charges).

h Report the name, e-mail address, and phone number of the person we should contact if we have any 

questions concerning this filing. We will send official correspondence to the “attention of” this person at 

the address reported in (b)-(g). In addition, unless a different phone number is provided in item 2i, the 

phone number reported in 2h will be posted on PBGC’s Is My Pension Insured list as the number plan 

participants should call if they have questions about theirplan.

i If you would prefer plan participants with questions about their plan call a phone number other than the 

one reported in item 2h, report the phone number you would like them to use. If this item is left blank, 

the Insured Plans List on PBGC’s website will show the phone number reported in item2h.

To keep our records current and enable us to send correspondence to the correct address, you should inform 

us of address changes as soon as they occur. You may do so by contacting us either in writing or by e-mail.

See Appendix 2 for contact information.

3 Additional plan contact(optional)

Although official correspondence related to premium filings is directed to the Plan Administrator (see item 2), 

some plans choose to provide contact information for another individual as well. In general, the contact 

person identified in this section will be used for questions that aren’t important enough for official 

correspondence. PBGC may also contact this individual if official inquiries to the Plan Administrator go 

unanswered.
Description of Data Elements

Page 31

4 Plan information

a Plan name – Report the complete name of the plan as stated in the plan document. For example, “The ABC 

Company Pension Plan for Salaried Personnel.”

b Premium Payment Year information

(1) Report the date the Premium Payment Year commences and the date it ends. If you are filing for the first 

year of a New Plan, the Premium Payment Year commencement date (“PYC”) should be the plan 

effective date.

(2) Check the appropriate box to indicate whether the plan is a Small Plan for the Premium Payment Year 

(See definition of Small Plan in Appendix 1).

(3) If the plan year commencement date has changed since the most recent PBGC filing as a result of a plan 

amendment changing the plan year, enter the adoption date of the plan yearchange.

(4) Check the box if plan qualifies to pay a prorated premium for this Premium Payment Year (see “Who 

must File” section for rules related to pro-ration.

c Employer Identification Number (EIN) and Plan Number (PN) information

(1) Report the nine-digit EIN of the Plan Sponsor and the three-digit PN of theplan.

(2) If the EIN and PN for this filing do not both match exactly the EIN and PN reported in the most recent 

premium filing, report both the EIN and PN that were reported in the most recent premium filing. If this 

is the first premium filing for this plan, leave this itemblank.

Please note the following exceptions that apply only if this is an amended filing:

 If item 4c(2) was reported incorrectly in the original filing (i.e., the filing that is being amended), 

provide the correct information in the amendedfiling.

 If item 4c(2) was reported correctly in the original filing, provide the same information in the 

amended filing.

(3) If the EIN and PN for this filing do not both match exactly the EIN and PN reported in the 2016 Form 

5500, report both the EIN and PN that were reported in the 2016 Form 5500, and attach an explanation. 

If a 2016 Form 5500 was not required, leave this itemblank.

d Plan effective date – Report the date the plan became effective.

e Plan type – Indicate whether the plan is a Multiemployer Plan or a Single-employer Plan.

f Information for New or Newly Covered Plans – If this is a New or Newly Covered Plan, check the box and

complete the rest of item 4f.

(1) Adoption date – Enter the date the plan was adopted

(2) Coverage date – Enter the date the plan became covered under Title IV. If the plan has had one or more 

periods of coverage, report the earliest date in the Premium Payment Year when the plan was covered 

under Title IV — not the date when the plan became covered in a prior year. If another plan transferred 

assets or liabilities to this New or Newly Covered Plan, be sure to complete the “Transfers from other 

plans” item (see item 14).

(3) Continuation Plan – Check the box to indicate whether this New or Newly Covered Plan meets the 

definition of a Continuation Plan (see definition).
Description of Data Elements

Page 32

Instructions for Part II – Premium Information

5 Flat-rate Premium

a Report the Participant Count Date. See “How to Count Participants” section for special rules relating to New 

Plans, Newly Covered Plans, Mergers and Spinoffs.

b Flat-rate Premium calculation

(1) Applicable rate – Enter the per-participant flat premium rate. For 2017, the rate is $69 for 

Single-employer Plans and $28 for MultiemployerPlans.

(2) Participant count – Report the number of participants covered by the plan on the Participant Count Date 

separately for active participants, terminated vested participants, retirees and beneficiaries receiving 

payment, and in total. See “How to Count Participants” section.

(3) Flat-rate Premium – Report the product of the Participant Count and the applicable premium rate. If the 

plan year is a short plan year, the required Flat-rate Premium may be a prorated portion of this amount; 

however, the amount reported in this item must reflect a full year’spremium.

Note that you must make a premium filing even if the Flat-rate Premium is $0. This may happen, for example, 

if your plan is a New Plan that grants no past service credits, so that there are no Benefit Liabilities on the 

Participant Count Date. A plan with no Benefit Liabilities has no participants for premium purposes.

Instructions for Part III – Alternative Premium Funding Target Election/Revocation

This Part applies only to Single-employer Plans. Multiemployer Plans should skip to Part IV.

6 Alternative Premium Funding Target Election / Revocation

To be valid, an election must be made in accordance with these instructions and must be filed with PBGC on 

or before the deadline.

a Election - Check this box to make an election to use the Alternative Premium Funding Target first effective 

for this Premium Payment Year.

b Revocation - Check this box to revoke a prior election to use the Alternative Premium Funding Target that 

was in effect for the plan year immediately preceding the Premium Payment Year.

You may elect to use the Alternative Premium Funding Target to determine unfunded vested benefits instead 

of the Standard Premium Funding Target. Once an election is made, it remains in effect for all subsequent 

plan years unless and until it is subsequently revoked. You may revoke a prior election only if the Premium 

Payment Year begins at least five years after the beginning of the plan year for which the election was first 

applicable.

Similarly, if you revoke an election, you may not make a new election to use the Alternative Premium Funding 

Target until five years have passed.

If you are not sure if an election is in effect or when an election first took effect, you find it by viewing your 

account history in My PAA.
Description of Data Elements

Page 33

See “How to Determine Unfunded Vested Benefits” section for more information on elections and 

revocations.

7 Variable-rate Premium

This item relates to Variable-rate Premium information and applies only to Single-employer Plans.

In general, the Variable-rate Premium is $34 per $1,000, or fraction thereof, of unfunded vested benefits as of 

the UVB Valuation Date, but no more than $517 times the number of participants (i.e., the MAP-21 Cap). For 

certain plans of small employers, the Variable-rate Premium may be capped at an amount lower than the 

MAP-21 CAP (see item 7b).

Some Single-employer Plans are exempt from the Variable-rate Premium; others may have a Variable-rate 

Premium of $0. In either case, this section must be completed in accordance with the following instructions.

a Exemptions – A Single-employer Plan may claim an exemption from the Variable-rate Premium if it meets 

the requirements for any of the exemptions described below:

 New or Newly Covered Small Plans other than Continuation Plans – Your plan qualifies for this 

exemption if it is a New or Newly Covered Plan and a Small Plan, but not a Continuation Plan. See 

Definitions section for more information about these terms.

 Standard termination — closing out in current year – Your plan qualifies for this exemption if it makes a 

final distribution of assets in a standard termination during the Premium PaymentYear.

You may claim this exception in anticipation of a full distribution by plan year-end even if that hasn’t 

happened by the time you submit the filing. However, if you fail to complete the final distribution by 

the end of the year, the exemption will not apply. In that case, you will need to amend the filing 

accordingly and late payment charges will be assessed on any Variable-rate Premium owed and paid 

after the applicable due date.

 Standard termination — proposed termination date in a prior year — Your plan qualifies for this 

exemption if notices of intent to terminate in a standard termination were issued in accordance with 

ERISA section 4041(a)(2), setting forth a proposed termination date before the beginning of the 

Premium Payment Year.

To qualify for this exemption, it is not necessary that the plan make a final distribution of assets during 

the Premium Payment Year. However, this exemption is conditioned on the plan’s ultimately making a 

final distribution of assets in full satisfaction of its obligations under the standard termination. If that 

doesn’t happen, the premium that would otherwise have been required will be due retroactive to the 

applicable due date.

 Plans with no vested participants – Your plan qualifies for this exemption if the plan has no participants 

with vested benefits as of the UVB ValuationDate.

 Section 412(e)(3) plans (formerly called 412(i) plans) – Your plan qualifies for this exemption if the plan 

is described in section 412(e)(3) of the Code and regulations thereunder on the UVB Valuation Date.

If an exemption applies, check the applicable box to indicate which exemption applies and skip to item 8. If 

more than one exemption applies, check all applicable boxes.

b Small-Employer Cap qualification – If the plan qualifies as a small-employer plan, the Variable-rate Premium 

may be capped at an amount lower than the MAP-21 Cap.

Determining whether a plan qualifies for the Small-Employer Cap – For this purpose:
Description of Data Elements

Page 34

 a plan is a small-employer plan if the aggregate number of employees of all contributing sponsors of the 

plan and all members of the contributing sponsors’ controlled groups, as of the first day of the Premium 

Payment Year, is 25 orfewer,

 the aggregate number of employees is determined in the same manner as under section 410(b)(1) of the 

Code, taking into account the provisions of section 414(m) and (n) of the Code, but without regard to 

section 410(b)(3), (4), and (5) of the Code, and

 employees are counted as of the first day of the Premium Payment Year, not as of the Participant Count 

Date or the UVB Valuation Date.

Note that a plan with 25 or fewer participants does not necessarily qualify for the Small-Employer Cap 

because the eligibility criterion is based on employees, not the Participant Count. For example, if a plan has 

15 participants, but there are more than 25 employees (taking into account all employees of all contributing 

sponsors of the plan and all members of their controlled groups), the plan does not qualify for the cap.

Also note that a plan with more than 25 participants might qualify for the cap. For example, consider a 

contributing sponsor with 20 employees, all of whom are participants in a plan. If the plan also covers 15 

former employees who are either terminated vested or retired, there are 35 participants in total. This plan 

would qualify for the cap (assuming there are no other contributing sponsors and no controlled group 

members).

Reporting requirements – If your plan qualifies for this cap, check the box to report that fact.

If your plan qualifies for this cap, instead of calculating and reporting both the uncapped Variable-rate 

Premium and the maximum Variable-rate Premium and then paying the lesser of the two amounts, you may 

report and pay only the maximum Variable-rate Premium.

If you choose to not report the uncapped Variable-rate Premium, omit all items 7c through 7g and go 

directly to item 7h. Note that if you choose to pay the maximum Variable-rate Premium without 

determining whether it is less than the uncapped Variable-rate Premium, you may pay a larger Variable-rate 

Premium than required.

c Assumptions and methods used to determine Premium Funding Target

(1) Premium Funding Target method – Report whether you are using the Standard Premium Funding Target 

or the Alternative Premium Funding Target to determine unfunded vested benefits by checking the 

applicable box (i.e., “Standard” or “Alternative”). Notethat:

 The standard method must be used unless an election to use the alternative method is ineffect.

 If an election to use the alternative method is in effect, you must use the alternative method. This is 

the case only if a valid election:

– is made as part of a timely filing for the Premium Payment Year by checking the election box in 

item 6 of Part III, or

– that was made in a prior year has not yet been revoked.

 Filers are encouraged to review prior filings or to review the Account History on My PAA to confirm 

whether an election to use the alternative method is ineffect.

 Checking the alternative box in item 7(c)(1) does not constitute an election. See item 6instructions.

For additional information on Premium Funding Target methods, see “How to Determine Unfunded

Vested Benefits” section.
Description of Data Elements

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(2) Discount rates – Report the discount rates used to determine the Premium Funding Target. For 

information on which rates to use, see “How to Determine Unfunded Vested Benefits”section.

(3) UVB Valuation Date – Report the UVB Valuation Date for the Premium Payment Year. In the case of a 

Small Plan using the Lookback Rule, this date must be the valuation date for the Lookback Year. For any 

other plan this date must be the valuation date for the Premium Payment Year. Note for Small Plans -

For information about whether you should be using the Lookback Rule, see “How to Determine 

Unfunded Vested Benefits” section.

d Premium Funding Target as of UVB Valuation Date

Report the Premium Funding Target (dollars only) calculated as described in the Premium Funding Target 

part of the “How to Determine Unfunded Vested Benefits” section. Report the amount separately for (1) 

active participants, (2) terminated vested participants, (3) retirees and beneficiaries receiving payment, and

(4) the total premium funding target((1)+(2)+(3)).

Estimated Premium Funding Targets – If the Premium Funding Target (and thus, the Variable-rate Premium) 

being reported in this filing is an estimate, check the box to report that fact. If you file on an estimated basis, 

you must ultimately make a reconciliation filing using the actual Premium Funding Target (by amending this 

filing). In the reconciliation filing, in addition to reporting the actual Premium Funding Target data, be sure 

to indicate that the reported amount is no longer an estimate by making sure the “estimate” box is no 

longer checked. See “Correcting Errors, Credit Balances and Reconciling Estimates” section for more 

information. See also the “Late Payment Charges” section for information on the automatic late payment 

penalty relief that may be available to plans paying estimated Variable-rate Premiums by the due date and 

later reconciling.

e Market value of assets – Report the fair market value of plan assets (dollars only) as of the UVB Valuation 

Date adjusted to reflect contribution receipts as described in the “How to Determine Unfunded Vested

Benefits” section.

f Unfunded vested benefits – Report the excess (rounded up to the next $1,000), if any, of the Premium 

Funding Target over the fair market value of assets.

g Uncapped Variable-rate Premium – Report the product of 0.034 and the amount of unfunded vested 

benefits.

h Maximum Variable-rate Premium

(1) MAP-21 Cap – Report the product of the Participant Count and$517.

(2) Small Employer Cap – Report the product of $5 and the Participant Count squared. If the plan does not 

qualify for the Small Employer Cap, this item must be leftblank.

(3) Maximum Variable-rate Premium – If the plan qualifies for the Small Employer Cap, report the lesser of 

the Small Employer Cap and the MAP-21 Cap. Otherwise, report the MAP-21Cap.

i Variable-rate Premium – Report the lesser of the maximum Variable-rate Premium and the uncapped 

Variable-rate Premium. If the plan qualifies for the Small Employer Cap and chooses not to report uncapped 

Variable-rate premium data, report the maximum Variable-rate Premium.

If this is a short plan year of coverage, the required Variable-rate Premium may be a prorated portion of this 

amount; however, the full year’s premium amount must be reported in this item.
Description of Data Elements

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Instructions for Part IV – Total Premium Information

8 Premium proration (If the plan does not qualify for premium proration, skip to item9.)

a Number of months in the short plan year – Report the number of months (complete and partial) in the short 

plan year. For this purpose, each plan month (i.e., each month in the plan year) generally begins on the 

same day of each successive calendar month. For example, if the plan year begins on July 1, the first day of 

each successive calendar month is the beginning of a new month; similarly, if the plan year begins on 

January 15, the second plan month begins on February 15, the third plan month on March 15, etc. Thus, if a 

short final year begins on January 1 and ends on June 1, there would be six (full or partial) months in the 

short year. (The last (partial) month, beginning (and ending) on June 1, would count as a full month for 

purposes of prorating the premium.) Similarly, if a short first year begins on July 31 and ends on December 

31, there would also be six (full or partial) months in the shortyear.

There are two special rules when a plan year begins at or near the end of a calendar month:

 If the plan year begins on the last day of a calendar month, successive plan months begin on the last 

day of successive calendar months. For example, if the plan year begins on November 30, successive 

plan months begin on December 31, January 31, the last day of February (the 28th or 29th), March 31, 

etc.

 If the plan year begins on the 29th or 30th of a calendar month other than February, the plan month 

beginning in February begins on the last day of February. For example, if the plan year begins on 

November 29, successive plan months begin on December 29, January 29, the last day of February (the 

28th or 29th), March 29, etc. If the plan year begins on December 30, successive plan months begin on 

January 30, the last day of February (the 28th or 29th), March 30, April 30,etc.

Counting months for New Plans – The short first year of a New Plan is treated as beginning on the 

Participant Count Date (i.e., the plan effective date).

Counting months for Newly Covered Plans – Although the Premium Payment Year for a Newly Covered Plan 

is, most likely, a full year, premiums are due only for the portion of the year the plan is covered by PBGC. 

Therefore, for purposes of prorating the premium for the first year of coverage, a Newly Covered Plan’s first 

year of coverage is treated as beginning on the date when the plan becomes covered under ERISA section 

4021

Counting months for terminating plans – The (short) plan year of a terminating plan’s final year is treated as 

ending on:

 for a Multiemployer Plan that distributed all its assets pursuant to ERISA section 4041A, the date the 

distribution is completed; or

 for a Single-employer Plan, the earlier of:

- the date on which the distribution of the plan’s assets in satisfaction of all Benefit Liabilities was 

completed; or

- the date that a trustee for the terminating plan was appointed under ERISA section4042.

b Total premium before proration – Report the sum of the Flat-rate Premium and, if applicable, the Variablerate Premium.
Description of Data Elements

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9 Total premium

 If the plan does not qualify for premium proration, report the sum of the Flat-rate Premium and, if 

applicable, the Variable-rate Premium.

 If the plan qualifies for premium proration, multiply the total premium before reflecting proration by the 

number of months (complete and partial) in the short plan year and then divide by 12. Round to two 

decimal places after completing the calculation.

If this amount includes cents, report the exact amount (dollars and cents), not a rounded amount.

Instructions for Part V – Payment Information 

10 Premium credit

Report the total amount of premium credits available to offset the premium due. Premium credits include:

 Any payments made for 2017 (including an estimated Variable-rate Premium when amending the filing 

to reconcile the estimate; see “Correcting Errors, Credit Balances and Reconciling Estimates” section), 

and

 Any overpayment of the 2016 premium filing for which a refund was not requested and that has not 

been applied to amounts due. A plan account history is available on My PAA. You should review the 

account history to confirm that a 2016 overpayment is available.

If this amount includes cents, report the exact amount (dollars and cents), not a rounded amount.

11 Amount due

If the total premium due exceeds the total premium credit, subtract the total credit from the total premium 

and report the result as the amount due. This is the amount you owe PBGC. See Appendix 3 for information 

on payment options.

If this amount includes cents, report the exact amount (dollars and cents), not a rounded amount.

12 Treatment of Overpayment

a If the total premium is less than the total premium credit, subtract the total premium from the total credit 

and report the result as an overpayment. If this amount includes cents, report the exact amount (dollars 

and cents), not a rounded amount.

b If you have an overpayment, you must choose whether to have the overpayment credited towards the 

next year’s premium for the plan or refunded (by electronic funds transfer or check). Report your choice 

by checking the appropriate box.

 Credit - If you choose to use the overpayment as a credit towards next year’s premium for the plan, 

you should claim the overpayment amount as a credit on the next year’s premium filing for the plan.

Refund - If you choose to have the overpayment refunded, the quickest way to receive your refund is to select 

the electronic funds transfer option, which we strongly recommend. To facilitate an ACH electronic funds 

transfer, indicate whether the account is a checking account or savings account, and provide the bank routing 

number and account number to which the refund is to be credited.
Description of Data Elements

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Instructions for Part VI – Miscellaneous Information

13 Final premium filing

If this is the last premium filing for this plan, indicate the reason: (1) that the plan merged or consolidated 

with another plan, (2) that the plan was trusteed under ERISA section 4042, (3) that the plan completed a 

distribution pursuant to termination, or (4) that the plan ceased to be a covered plan.

Report the date of the event that led to the cessation of the requirement to file. If the reason this is the last 

premium filing is because:

 the plan merged or consolidated into another plan, report the effective date of the Merger or 

Consolidation;

 the plan terminated in an involuntary or distress termination, report the effective date of the 

trusteeship;

 there was a distribution of assets pursuant to a termination:

- for a Single-employer Plan that completed a standard termination, report the date on which the 

distribution of the plan’s assets in satisfaction of all Benefit Liabilities was completed (the same date 

reported on PBGC Form 501 in item 3a), or

- for a Multiemployer Plan that distributed all its assets pursuant to ERISA section 4041A, report the 

date the distribution is completed; or

 the plan ceased to be covered by Title IV of ERISA, report the date coverage ceased (i.e., the date 

reported in PBGC’s response to a request for a coveragedetermination).

See also “Failure to report a filing as the final premium filing” in the “Correcting Errors, Credit Balances and 

Reconciling Estimates” section.

14 Transfers from other plans

Pre-existing plans – If another plan transferred assets or liabilities to this plan since the date of the most 

recent comprehensive premium filing (or, if this is a filing for a plan year beginning in 2017, since the date of 

the 2016 “final filing”), report the EIN and PN of the plan from which the assets were transferred (i.e., the 

“Transferor Plan”).

New Plans – If this plan is a New Plan and another plan transferred assets or liabilities to this plan in 

conjunction with the creation of this plan, report the EIN and PN of the plan from which the assets were 

transferred.

Newly Covered Plans – If this plan is a Newly Covered Plan and another plan transferred assets or liabilities 

to this plan on or after the date this plan became covered and before the date the premium filing is made, 

report the EIN and PN of the plan from which the assets were transferred.

In all cases, report the date of the transfer and check the box that best describes the type of transfer (see 

definitions of Merger, Spinoff, and Consolidation). For this purpose, the date of transfer is the date the 

transfer went into effect.

The section on “Mergers, Spinoffs, and Consolidations” contains examples of how this item is completed in 

various scenarios.
Description of Data Elements

Page 39

Note that the date of a transfer is determined based on the facts and circumstances of the particular 

situation. (For transfers subject to section 414(l) of the Code, report the date determined under 26 CFR 

1.414(l)-1(b)(11).)

If the transfer is the result of something other than a Merger, Spinoff, or Consolidation, for example, a 

reciprocity arrangement where assets and liabilities are transferred between two plans when an employee 

changes locations or changes status (e.g., from Salaried to Hourly and as a result becomes covered by 

another plan), check the “Other” box. Also check the “Other” box if you have no way of determining 

whether the Transferor Plan ceased to exist in connection with a Merger or Consolidation into your plan.

If more than one Transferor Plan is involved, provide the above information with respect to each Transferor 

Plan.

15 Transfers to other plans

Pre-existing plans – If this plan transferred assets or liabilities to another plan since the date of the most 

recent comprehensive premium filing, report the EIN and PN of the plan to which the assets were 

transferred (i.e., the “Transferee Plan”). In addition, report the date of transfer and check the box that best 

describes the type of transfer.

New Plans – If this plan is a New Plan and this plan transferred assets or liabilities to another plan on or after 

the earlier of the Plan Adoption Date and the effective date, and before the date the premium filing is made, 

report the EIN and PN of the plan to which the assets were transferred and the type of transfer.

Newly Covered Plans – If this plan is a Newly Covered Plan and this plan transferred assets or liabilities to 

another plan on or after the date the plan became covered and before the date the premium filing is made, 

report the EIN and PN of the plan to which the assets were transferred and the type of transfer.

In all cases, if more than one Transferee Plan is involved, provide the above information with respect to each 

transferor plan. See instructions to item 14 for more information on what is to be reported for “date of 

transfer.”

The section on “Mergers, Spinoffs, and Consolidations” contains examples of how this item is completed in 

various scenarios.

16 Participation freeze

If, as of the beginning of the Premium Payment Year, participation is limited to participants who were 

covered by the plan as of a specified date (i.e., the plan is closed to new entrants), enter the date the plan 

became closed to new entrants.

17 Benefit accrual freeze

If, as of the beginning of the Premium Payment Year, the plan is partially or totally frozen for benefit accrual 

purposes, enter the date the freeze became effective and indicate the nature of the freeze by reporting 

whether (1) both pay and service are frozen for all participants, (2) both pay and service are frozen for some 

participants, (3) for all participants, service is frozen, but pay is not, (4) for some participants, service is 

frozen, but pay is not, or (5) some other type of accrual freeze is in effect (in which case you must provide a 

description of the freeze).

If more than one description applies (for example, if pay and service are frozen for employees at location X 

and only service is frozen for employees at location Y), select “Other” and provide a description.
Description of Data Elements

Page 40

If more than one freeze has occurred, report the date and nature of the most recent freeze.

18 Risk transfer activity – Do not complete this item if this is the final filing for the plan.

a Lump Sum Windows – If the plan provided one or more Lump Sum Windows during the premium payment 

year or the prior premium payment year, enter the requested information with respect to individuals 

eligible to elect a lump sum under the window. For this purpose:

 Disregard any Lump Sum Window for which the time period for electing a lump sum ended less than 60 

days before the premium filing is made.

 Disregard any Lump Sum Window for which the requested information was reported in the premium 

filing for the prior premium payment year.

 Disregard lump sums offered:

– In the course of routine plan operations,

– In conjunction with a plan termination,

– Upon a participant’s separation from service, or

– As part of an incentive program to encourage active participants to retire early (commonly called an 

early retirement window).

 Disregard lump sums paid under mandatory cash out provisions.

 A person eligible for a Lump Sum Window whose offer letter is undeliverable may be excluded from the 

“Eligible to elect a lump sum” count.

 If the exact counts are not readily available, reasonable estimates based on readily available plan 

records may be reported.

b Annuity Purchases - If the plan purchased annuities for a specified group of individuals during the premium 

payment year or the prior premium payment year, enter the requested information with respect to that 

group of individuals. For this purpose:

 Disregard annuities purchases made less than 60 days before the premium filing ismade.

 Disregard annuities purchases for which the requested information was reported in the premium filing 

for the prior premium payment year.

 Do not include annuity contracts:

– Purchased in the course of routine plan operations,

– Purchased in conjunction with a plan termination, or

– That remain an asset of the plan (commonly called a “buy-in”).

 If the exact counts are not readily available, reasonable estimates based on readily available plan 

records may be reported.

19 Amended filings – Complete this item only if this is an amendedfiling.

a If either the first day or the last day of the premium payment year reported in this amended filing (item 

4b(1)) differs from what was reported in the original filing (i.e., the filing that is being amended), provide 

the dates that were reported in the original filing.
Description of Data Elements

Page 41

b If the EIN and PN reported in this amended filing (item 4c(1)) are not both the same as what was reported 

in the original filing (i.e., the filing that is being amended), report the EIN and PN from the original filing.

c If this is an amended filing for a reason other than reconciling an estimated Variable-rate Premium and 

the amended filing shows a lower premium than the amount that was originally reported, you must 

provide an explanation of the specific circumstances or events that caused the reduction.

Instructions for Part VII – Certifications 

20 Plan Administrator Certification

All of the information reported in this filing must be certified by the Plan Administrator. Follow the 

certification instructions for the electronic filing method that is used to make the filing. Be sure to provide 

the Plan Administrator’s name, the telephone number, and the certification date. If the Plan Administrator 

has an e-mail address, that address must also be reported.

21 Enrolled Actuary Certification

An enrolled actuary must certify the Variable-rate Premium calculation unless:

 The plan is a Multiemployer plan (and thus, there is no Variable-ratePremium).

 The plan is a Single-employer Plan and is either:

- exempt from the Variable-rate Premium, or

- omitting the variable rate premium information in items 7c through 7g because the plan is eligible 

for the Small Employer Cap and is paying the maximum Variable-ratePremium.

Be sure to provide all of the required information related to the enrolled actuary (i.e., name, firm, telephone 

number, enrollment number, and if the enrolled actuary has an e-mail address, email address).

The actuary must follow the certification instructions for the electronic filing method that is used to make 

the filing.
Page 42

Late Payment Charges

General

If you file a premium payment after the due date, we will bill the plan for late charges. The late charges include 

both interest and penalty charges. The charges are based on the outstanding premium amount due on the due 

date. If your due date is extended because it falls on a weekend or federal holiday, and your premium payment 

is filed after the extended due date, interest and penalty will be computed from the actual (unextended) due 

date. PBGC also may assess penalties under ERISA section 4071 for failure to timely provide premium-related 

information.

Late Payment Interest Charges

The late payment interest charge is set by ERISA, and we cannot waive it. Interest accrues at the rate imposed 

under section 6601(a) of the Code (the rate for late payment of taxes) and is compounded daily. These rates are 

published by IRS quarterly and are also posted on the “Interest Rates and Factors” section of the Practitioners

Page of PBGC’s website.

Late Payment Penalty Charges

Late payments are generally subject to a penalty of 21⁄2% of the late amount per month (or partial month) late, 

but no more than 50% of the late amount. However, in the event a plan discovers and corrects an 

underpayment before PBGC sends written notice that there is or may be a premium delinquency, the 21⁄2% rate 

is reduced to 1⁄2% and the cap is reduced from 50% to 25%.

The written notices mentioned above include, but are not limited to:

 Past Due Filing Notice (PDFN) — This notice is sent if we expect to receive a premium filing from the Plan but 

do not. These notices are sent to the Plan Administrator and address reported on the most recent filing.

 Notice of Filing Error (NFE) — This notice is sent if an initial review of a premium filing indicates an error or 

inconsistency that must be corrected before the filing can be processed. If you receive a Notice of Filing 

Error, you must amend your filing to correct the error. If we do not receive an amended filing within 30 days, 

we will send a PDFN (see above).

 Statement of Account (SOA) — If we receive a filing, but the payment is late or less than the reported 

amount owed, we will send a Statement of Account. A SOA is, in essence, an invoice for premium, penalty, 

and interest amounts owed to PBGC. To ensure that the amount due does not increase, the premium and 

interest must be paid within 30 days of the SOA's issue date.

 Notice of a Premium Compliance Evaluation (PCE) — This notice is sent if we select your premium filing to 

assess the accuracy of the reported information. See the Premium Filings page on our web site for further 

information.

Penalty Waivers

Case-by-Case Waivers

If you receive a Statement of Account (“SOA”) that includes a penalty charge, but you believe there is a reason 

why all or a portion of the penalty should be waived (e.g., reasonable cause), you may request a

waiver. Information about what constitutes reasonable cause as well as information about other situations 

where a penalty waiver might be warranted can be found in § 21 of the appendix to PBGC’s premium payment
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Late Payment Charges

regulation, 29 CFR Part 4007, available on the “Law and Regulations” page of the Practitioners Page of PBGC’s 

website.

The instructions and timeframe for requesting a waiver will be provided in the SOA. Be sure to follow the 

instructions carefully. Requests that are submitted late will not be considered.

Hardship (i.e., “Statutory”) Waivers

If, before the filing due date, you can show substantial hardship and that you will be able to pay the premium 

within 60 days after the filing due date, you may request that we waive the late payment penalty charge. If we 

grant your request, we will waive the late payment penalty charge for up to 60 days. To request a waiver, 

contact PBGC at least 30 days before the filing due date. Be sure to include specific information and documents 

to demonstrate both that it will be a substantial hardship to make the payment on or before the filing due date 

and that you will have the ability to make the payment within 60 days after the filing due date.

Automatic Penalty Waiver for Premiums paid Within Seven Days of Due Date

If the sole reason a late payment penalty charge applies is because a premium was paid after the due date, but 

within seven calendar days of the due date, the late payment penalty charge will automatically be waived.

Automatic Penalty Waiver for Certain Compliant Plans

PBGC will automatically waive 80% of the penalties assessed at the 21⁄2% rate if the plan:

 Corrects the underpayment within 30 days of PBGC’s initial notice,and

 Has a good premium compliance history.

For this purpose, a “good premium compliance history” generally means that the plan paid required premiums 

timely for the five plan years immediately preceding the premium payment year. In addition, if, during the

5-year period, the plan paid its premium late, but was not required to pay a late payment penalty (e.g., the 

penalty was waived), the plan is treated as paying timely for that year.

Automatic Penalty Waiver for Certain Late Variable-Rate Premiums

As explained in the “When to File” section, in rare circumstances (e.g., a mid-year merger or change in actuary), 

the Premium Funding Target might not be calculated or finalized by the premium due date. PBGC allows plans 

in this situation to file timely and pay an estimated Variable-rate Premium by the due date and then submit an 

amended filing at a later date to reconcile the actual Variable-rate Premium with the estimate.

Because a plan’s full Variable-rate Premium (not merely an estimate) is due by the due date, if the full amount is 

not paid by that date, the plan will be subject to late payment interest charges and may also be subject to late 

payment penalty charges.

If the actual Variable-rate Premium is greater than the estimate, penalties for late payment will be waived if:

 the reconciliation filing is made and any additional required Variable-rate Premium paid by the end of the 

sixth calendar month that begins on or after the premium due date (generally April 30th after year-end for 

calendar year plans), and

 by the premium due date, you report:

- the fair market value of the plan’s assets, and

- an estimate of the Premium Funding Target that is certified by an enrolled actuary to be a reasonable 

estimate that:
Page 44

Late Payment Charges

o takes into account the most current data available to the enrolledactuary;

o has been determined in accordance with generally accepted actuarial principles and practices; and

o uses the calculation methodology (alternative or standard) in effect for the plan year; and

 by the premium due date, you pay at least the amount of Variable-rate Premium determined from the value 

of assets and estimated Premium Funding Target soreported.

Note that this waiver applies only to estimated Premium Funding Targets, not estimated asset values. If the 

asset value reported in the reconciliation filing differs from what was reported in the original (i.e., estimated) 

filing, this automatic penalty relief will be lost. However, PBGC will consider a request for an appropriate penalty 

waiver in such a situation and, in acting on the request, will consider such facts and circumstances as the reason 

for the mistake, whether assets were overstated or understated, and, if assets were overstated, the extent of 

the overstatement.

If you know the final Premium Funding Target by the time the Variable-rate Premium is due, you should pay the 

amount owed by that date. If you do so, you will avoid the interest charge and any penalty charge. If you report 

that you are making a filing based on an estimated Premium Funding Target, you will be required to make an 

amended filing reflecting the actual Premium Funding Target by the date the variable-rate reconciliation filing is 

due.

Minimizing Late Payment Charges

If you cannot make a filing by the due date because you are having difficulty determining some of the required 

information, you can minimize late payment charges by submitting payment (the amount due or an estimate) 

without submitting the certified filing. If you choose to do this, you must pay outside of My PAA, either via 

www.Pay.gov, or by check or electronic payment. You should then submit your certified filing as soon as 

possible. Additional information on payment options is included in Appendix 3.

PBGC may assess a penalty under ERISA section 4071 for failure to furnish premium-related information by the 

required due date. Making a premium payment without an accompanying premium information filing may cause 

significant delay in providing a statement of account for the plan. However, when the information filing is 

ultimately made, the payment will be credited as of the date it was filed and thus stop the accrual of late 

payment charges on the amount paid.

Saturday, Sunday, and Federal Holidays

As explained in the “When to File” section, if your premium filing due date falls on a Saturday, Sunday or Federal 

Holiday, it is extended automatically to the next business day. However, if your premium payment is filed after 

the extended due date, interest and penalties will be computed from the actual (unextended) due date.

Example –The Normal Due Date for a plan with a plan year beginning on January 1, 2017 would normally be 

October 15, 2017. Because that day is a Sunday, the due date is Monday, October 16, 2017. If the filing is made 

after October 16th, late payment charges, if applicable, will be computed from Sunday, October 15, 2017, not 

October 16th.
Page 45

Correcting Errors, Credit Balances and Reconciling Estimates

Correcting Errors

Making Payment Without Filing Information

If you make a premium payment without filing the related premium information, file the information as soon as 

possible to get proper credit for your payment and minimize any late filing penalty. Follow the instructions in 

this document or on PBGC’s website for identifying your payment so that we can associate it with your 

information filing.

Filing Information Without Making Required Payment

If you make a filing of premium information without making a required payment, send the payment as soon as 

possible to minimize late payment charges. Follow the instructions in this document or in My PAA for identifying 

your payment so that we can associate it with your information filing.

Failure to report a filing as the final premium filing

If you make a premium filing that is a “Final premium filing” as described in item 13 of the comprehensive 

premium filing instructions, and you do not provide the information required by item 13, you must make an 

amended filing if the event referred to in item 13 occurred before you made your original filing, unless —

 The event was a distribution of assets pursuant to plan termination and was reported on PBGC Form 501, or

 The event was a merger into or consolidation with another plan and was reported on a premium filing for 

the surviving plan.

If you make a premium filing that is a “Final premium filing” as described in item 13 of the comprehensive 

premium filing instructions, and you do not provide the information required by item 13 because the event 

referred to in item 13 has not yet occurred when you make the filing, you are not required to make an 

amended filing. However, to avoid the need for correspondence to establish why you are not making any more 

premium filings, we recommend that you contact us to report the event, unless —

 The event was a distribution of assets pursuant to plan termination and is being reported on PBGC 

Form 501, or

 The event was a merger into or consolidation with another plan and is being reported on a premium filing 

for the surviving plan.

Even if an amended filing is not required, you may want to make one where the plan has made a distribution of 

assets pursuant to plan termination, because that event may enable you to reduce the premium through 

proration and request a refund as part of the amended filing. Alternatively, because our system automatically 

pro-rates premiums for plans in this situation based on the information reported on PBGC Form 501 and 

updates the plan’s statement of account to reflect any overpayment, in lieu of submitting an amended filing, 

you may request a refund of such overpayment simply by sending an email to premiums@pbgc.gov.

Amending Filings

If, after submitting a filing, you discover an error has been made (e.g., reported information is incorrect), you 

must amend the filing to report the correct information even if the correction has no impact on the premium 

amount. A filing can be amended by resubmitting the filing with the corrected information. Be sure to indicate 

that the filing is an amendment to a previously submitted filing (see “Description of Data Elements” sections).

In the amended filing, report all of the required information, including information that was correct in the 

original filing (i.e., the filing that is being amended). Include as credits all the credits you previously claimed 

increased by the amount you paid with your most recent filing and reduced by any refund you requested.
Page 46

Correcting Errors, Credit Balances and Reconciling Estimates

If the originally reported premium:

 was too low, the additional premium due will equal the excess of the revised total premium amount over 

the revised total credit. Pay the additional premium due when you submit your amended filing. In this case, 

late payment interest charges will apply and late payment penalty charges may apply. You will receive an 

invoice for these charges after your amended filing is received. You may include payment of anticipated late 

payment charges when you pay the additional premium, but the amount reported on the amended filing 

should reflect only the additional premiumdue.

 was too high, the overpayment will equal the excess of the revised total credit over the revised total 

premium. You must indicate whether you want the overpayment refunded or applied to the next year’s 

premium for the plan. We recommend that small credit amounts be carried over to the next plan year. 

Please verify the credit amount by either reviewing the plan’s account history in My PAA or by contacting our 

Premium Customer Service Center. Then, simply enter the relevant amount under “Premium Credits “in the 

next year’s premium filing. See line 10b on the illustrative form in the “Data to be Submitted” section.

If you prefer a refund by electronic funds transfer (EFT), provide the necessary information in the applicable 

section of the amended filing; we will make the transfer through the ACH system or Fedwire (Fedwire 

transfers are available only for refunds of $100,000 or greater). For Fedwire funds transfers, you can have 

the refund credited to a sub-account within the main account if you provide the sub-account number to us.

With either option, the overpayment will appear as an “Amount Overpaid” on your plan’s account history 

until it is refunded or used to satisfy a future year’s premium. See section below on Premium Credit 

Balances.

Required explanation if premium amount decreases

If you amend a comprehensive filing for a reason other than reconciling an estimated Variable-rate Premium 

and the amended filing shows a lower premium than the amount that was originally reported, you must provide 

an explanation of the specific circumstances or events that caused the reduction. For example, if your original 

comprehensive filing’s Participant Count included employees at a division that is not covered by the plan, you 

would explain why the employees were erroneously counted as participants and how the error was discovered.

Amending a prior year’s filing

Note that if you are amending a filing for an earlier year, you must follow the instructions for that year except 

that current mailing and electronic funds transfer (EFT) addresses should be used instead of the addresses that 

were included in the instructions for the original filing (i.e., the filing that is being amended). Prior year 

instructions are available in the “Premium Payment Instructions and Addresses” section of the Practitioners 

Page of PBGC’s website.

Premium Credit Balances

Premium credit balances, whether resulting from an amended filing or any overpayment, are shown on plans’ 

account histories and can be viewed in My PAA at any time. We recommend you review your plan’s account 

history before you file to ensure that any available credits from the prior plan year have been used. If you have 

a credit from two or more years prior to the Premium Payment year, you will need to contact the Premium 

Customer Service Center in order to use it (See Appendix 2).

Note that an overpayment for one plan cannot be applied to offset an underpayment on another plan.

A plan administrator may request that a premium credit balance be refunded or be credited against the next 

year’s premium. Requests must be made within the statutory limitation period (generally six years).
Page 47

Correcting Errors, Credit Balances and Reconciling Estimates

Reconciling Estimates

For plans that filed an estimated Variable-rate Premium, the reconciliation is made by amending the filing that 

included the Variable-rate Premium estimate. This reconciliation filing serves to finalize a previously estimated 

Premium Funding Target; it does not afford an opportunity to elect to use the alternative method after the due 

date for such election (or to revoke a prior election after the due date for such revocation). See the instructions 

for item 7d in the “Description of Data Elements” section for additional information on how to reconcile an 

estimated Variable-rate Premium.

Failure to reconcile these estimates in a timely manner will result in late payment charges if the estimate to be 

reconciled was too low. PBGC may also assess penalties under ERISA section 4071 for failure to reconcile 

estimated premium filings by the reconciliation due date.
Page 48

Recordkeeping Requirements and PBGC Audits

Recordkeeping Requirements

Plan Administrators are required to retain all plan records that are necessary to establish, support and validate 

the amount of any PBGC premium required to be paid and any information required to be reported. The records 

must include calculations and other data prepared by an enrolled actuary, the Plan Sponsor, and an employer 

required to contribute to the plan with respect to its employees; or for a plan described in section 412(e)(3) of 

the Code, by the insurer from which the insurance contracts are purchased. The records must be kept for six 

years after the premium due date.

Records that must be retained include, but are not limited to, records that establish the number of plan 

participants and the amount of unfunded vested benefits on which the Variable-rate Premium is based. For this 

purpose, the term “records” includes, but is not limited to, plan documents; participant data records; personnel 

and payroll records; actuarial tables, worksheets, and reports; records of computations, projections, and 

estimates; benefit statements, disclosures, and applications; financial and tax records; insurance contracts; 

records of plan procedures and practices; and any other records, whether in written, electronic, or other format, 

that are relevant to the determination of the amount of any premium required to be paid or any premiumrelated information required to be reported.

Records retained must be made available or submitted to PBGC promptly upon request. If a record to be 

produced for PBGC inspection and copying exists in more than one format, it must be produced in the format 

that PBGC specifies.

PBGC Audits

We may audit any premium filing; inspect and copy any records that are relevant to the determination of the 

amount of any premium required to be paid and any premium-related information required to be reported; and 

require disclosure and demonstration of any system used to determine any premium required to be paid or 

premium-related information required to be reported, so that PBGC can assess the system’s effectiveness and 

reliability.

If we determine upon audit that the full amount of the premium due was not paid, late payment interest 

charges under §4007.7 of the Premium Regulations and late payment penalty charges under §4007.8 of the 

Premium Regulations will apply to the unpaid balance from the premium due date to the date of payment (see 

“Late Payment Charges” section for more information on penalties and interest for late payment of premiums).

If, in our judgment, the plan’s records fail to establish the number of participants with respect to whom 

premiums were required, we may rely on data we obtain from other sources (including the Internal Revenue 

Service and the Department of Labor) for presumptively establishing the number of plan participants for 

premium computation purposes. Similarly, if, in our judgment, the plan’s records fail to establish the unfunded 

vested benefits amount reported in the premium filing, we may rely on data we obtain from other sources for 

estimating the unfunded vested benefits for premium computation purposes.

In addition to penalties for late payment of premiums, we may assess a penalty under ERISA section 4071 for 

failure to furnish premium-related information by required due dates.
Page 49

Appendix 1 – Definitions

Definitions for terms shown in capital letters throughout the instructions are shown below. New or modified 

terms are highlighted in green for emphasis.

“Alternative Premium Funding Target” – see “Premium Funding Target”

“Benefit Liabilities” means all liabilities with respect to employees and their beneficiaries under the plan (within 

the meaning of Code section 401(a)(2)). Thus, Benefit Liabilities include liabilities for all accrued benefits, 

whether or not vested. In addition, a plan’s Benefit Liabilities include liabilities for ancillary benefits not directly 

related to retirement benefits, such as disability benefits not in excess of the qualified disability benefit, life 

insurance benefits payable as a lump sum, incidental death benefits, or current life insurance protection (see 

Treasury Regulation § 1.411(a)-7(a)(1)).

“Code” means the Internal Revenue Code of 1986, as amended.

“Consolidation” means a transaction in which two or more plans transfer all of their assets and liabilities to a 

New Plan and, as a result, cease to exist (because the transferor plans become part of the new Transferee Plan). 

It differs from a Merger because in a Merger, the Transferee Plan existed before the transaction. In a 

Consolidation, the Transferee Plan is a New Plan that is created in the Consolidation. Thus, the plan that exists 

after a Consolidation follows the premium filing rules for New Plans.

“Continuation Plan” means a new plan resulting from a consolidation or spinoff that is not de minimis pursuant 

to the regulations under section 414(l) of the Code.

“EIN” means Employer Identification Number. It is always a nine-digit number assigned by the Internal Revenue 

Service for tax purposes.

“ERISA” means the Employee Retirement Income Security Act of 1974, as amended (29 U.S.C. 1001 et seq.).

“Flat-rate Premium” means the portion of the premium determined by multiplying the flat premium rate by the 

number of participants in the plan on the Participant Count Date.

“Form 5500 Series” means Form 5500, Annual Return/Report of Employee Benefit Plan, jointly developed by the 

Internal Revenue Service, the Department of Labor, and PBGC.

“Interest Rate Stabilization Rules” means the rules under which the volatility of certain discount rates used for 

funding purposes is limited by constraining them within a specified corridor as provided in ERISA 303(h)(2)(C)(iv).

“Lookback Rule” means the provision under which the Variable-rate Premium for the Premium Payment Year is 

determined based on UVBs for the plan year immediately preceding the Premium Payment year instead of the 

Premium Payment Year.

“Lookback Year” means the plan year immediately preceding the Premium Payment Year.

“Lump Sum Window” means a temporary opportunity to elect a lump sum in lieu of future annuity payments 

that is offered to individuals meeting specified criteria who would not otherwise be eligible to elect a lump sum.

“MAP-21 Cap” means the per-participant cap on the Variable-rate Premium as provided in The Moving Ahead 

for Progress in the 21st Century Act.

“Merger” means a transaction in which one or more plans transfer all of their assets and liabilities to an existing 

plan and, as a result, cease to exist (because the transferor plan(s) become part of the Transferee Plan). It differs 

from a Consolidation because in a Consolidation, the Transferee Plan did not exist before the transaction. In a 

Merger, the Transferee Plan is an existing plan and follows the rules for preexisting, ongoing plans.
Appendix 1 – Definitions

Page 50

“Multiemployer Plan” (subject to the provisions of ERISA sections 3(37)(E) and (G) and 4303, dealing with 

elections to be treated or not to be treated as a Multiemployer Plan) means a plan:

 to which more than one employer is required tocontribute,

 which is maintained pursuant to one or more collective bargaining agreements between one or more 

employee organizations and more than one employer, and

 which satisfies such other requirements as the Secretary of Labor may prescribe by regulation.

For purposes of determining whether a plan is a Multiemployer Plan or a Single-employer Plan, all trades or 

businesses (whether or not incorporated) that are under common control are considered to be one employer.

“Multiple-employer plan” means a plan to which more than one employer contributes that is not a 

Multiemployer Plan.

“My PAA” means “My Plan Administration Account,” PBGC’s electronic premium filing application.

“New or Newly Covered Plan” means a plan that is either a New Plan or a Newly Covered Plan. In some cases, 

the term “New and Newly Covered Plan” is used for the same purpose.

“New Plan” means a plan that did not exist before the Premium Payment Year. This includes a plan resulting 

from a Consolidation or Spinoff. A plan that meets this definition is considered to be a New Plan even if the plan 

constitutes a successor plan within the meaning of ERISA section 4021(a).

“Newly Covered Plan” means a plan that becomes covered by title IV of ERISA during the premium payment 

year and that existed as an uncovered plan immediately before the first date in the premium payment year on 

which it was a covered plan.

“Normal Premium Due Date” means the date premiums are due unless some special situation applies (i.e., a 

change in plan year, first time filing, or a standard termination). See “When to File” section.

“Participant” of a plan means an individual (whether active, inactive, retired, or deceased) with respect to 

whom the plan has Benefit Liabilities. See “How to Count Participants” section for more information.

“Participant Count” means the number of participants on the Participant Count Date. See “How to Count

Participants” section for more information.

“Participant Count Date” means the date on which participants are counted for purposes of determining the 

Flat-rate Premium, the MAP-21 CAP on the Variable-rate Premium, whether the plan is a Small Plan, and, if 

applicable, the Small Employer Cap on the Variable-rate Premium. In general, it is the last day of the plan year 

preceding the Premium Payment Year, but there are some exceptions. See “How to Count Participants” section 

for more information.

“Plan Administrator” means:

 the person specifically so designated by the terms of the instrument under which the plan is operated;or

 if an administrator is not so designated, the PlanSponsor.

“Plan Adoption Date” means the date on which a plan was formally adopted.
Appendix 1 – Definitions

Page 51

“Plan Sponsor” is determined as follows:

 For a Single-employer Plan with:

- one contributing sponsor, the Plan Sponsor is the contributing sponsor;

- two or more contributing sponsors that are all in a single controlled group, the Plan Sponsor is the 

parent of the controlled group or, if there is no parent, the largest member of the controlled group 

(whether or not the parent or largest member is a contributing sponsor);

- two or more contributing sponsors that are not all in a single controlled group, the Plan Sponsor is 

determined as follows: first identify the controlled group, or contributing sponsor that is not in a 

controlled group, that has the most participants in the plan. If you identify a contributing sponsor that 

is not in a controlled group, the Plan Sponsor is that contributing sponsor. But if you identify a 

controlled group, then the Plan Sponsor is the parent of that controlled group or, if there is no parent,

the largest member of that controlled group (whether or not the parent or largest member is a 

contributing sponsor).

 For a Multiemployer Plan, the Plan Sponsor is the association, committee, joint board of trustees, or other 

entity that establishes or maintains the plan.

“PN” means Plan Number. This is always a three-digit number. The employer maintaining the plan assigns this 

number to distinguish among employee benefit plans established or maintained by the same employer. An 

employer usually starts numbering pension plans at “001” and uses consecutive Plan Numbers for each 

additional plan. Once a PN is assigned, always use it to identify the same plan. If a plan is terminated, retire the 

PN — do not use it for another plan.

“Premium Funding Target” is the liability measure used to determine the Variable-rate Premium. This is similar 

to the funding target that is used to determine the minimum funding requirement except that only vested 

benefits are taken into account. The discount rates used to determine this amount vary depending on which 

calculation method is used (standard or alternative):

 “Standard Premium Funding Target” means a Premium Funding Target determined using the ERISA section 

4006(a)(3)(E)(iv) segment rates.

 “Alternative Premium Funding Target” means a Premium Funding Target determined using ERISA section 

303 (i.e., funding) discount rates, but without regard to the MAP-21 Stabilization Rules. See “How to 

Determine Unfunded Vested Benefits” section for additional information related to the election and use of 

the Alternative Premium Funding Target.

“Premium Payment Year” means the plan year for which the premium is being paid. For example, since this 

document relates to premium filings for plan years beginning in 2017, all references to “Premium Payment Year” 

relate to plan years beginning in 2017.

“Premium Regulations” means PBGC’s regulations on Premium Rates and Payment of Premiums (29 CFR Parts 

4006 and 4007). The premium filing procedures (including the My PAA electronic filing application, paper 

instructions, and forms) are prescribed under and implement the Premium Regulations.

“Schedule SB” means Schedule SB to the Form 5500 Series.

“Single-employer Plan” means any plan that is not a Multiemployer Plan. A Single-employer Plan includes a 

Multiple-employer Plan. For purposes of determining whether a plan is a Multiemployer Plan or a Singleemployer Plan, all trades or businesses (whether or not incorporated) that are under common control are 

considered to be one employer.
Appendix 1 – Definitions

Page 52

“Small-Employer Cap” means the maximum Variable-rate Premium due for certain plans of small employers, 

generally employers with 25 or fewer employees. For these plans, the maximum Variable-rate Premium is the 

product of $5 and the Participant Count squared.

“Small Plan” means a plan:

 With a Participant Count for the Premium Payment Year of not more than 100,or

 With a funding valuation date for the Premium Payment Year, determined in accordance with ERISA section 

303(g)(2), that is not the first day of the Premium Payment Year.

“Spinoff” means a transaction in which the transferor plan transfers only part of its assets and/or liabilities to 

the Transferee Plan. The Transferee Plan may be a New Plan that is created in the Spinoff, or it may be a 

preexisting plan that simply receives part of the assets and/or liabilities of the transferor plan.

“Standard Premium Funding Target” – see “Premium Funding Target”

“Transferee Plan” means a plan that receives assets and/or liabilities from another plan in a transfer (e.g., 

spinoff, merger, or consolidation).

“Transferor Plan” means a plan that gives assets and/or liabilities to another plan in a transfer (e.g., spinoff, 

merger, or consolidation).

“UVB Valuation Date” means the date on which UVBs are determined. This date is the plan’s funding valuation 

date determined in accordance with ERISA section 303(g)(2) for:

 In the case of a plan using the Lookback Rule, the Lookback Year, or

 In the case of any other plan, the Premium Payment Year.

”UVBs” means unfunded vested benefits, the term used to describe the underfunding measure on which the 

Variable-rate Premium is based.

“Variable-rate Premium” means the portion of the single-employer premium based on a plan’s unfunded 

vested benefits.

“We” or “us” refers to the Pension Benefit Guaranty Corporation. 

“You” or “your” refers to the Plan Administrator.
Page 53

Appendix 2 – Contact information

1. PBGC’s Web site (www.pbgc.gov) contains pension plan information of interest to Plan Administrators 

and practitioners, such as electronic premium filing, current and prior premium filing booklets, frequently 

asked questions, interest rates, regulations, etc. This information can typically be accessed via the 

Practitioners Page. Note that you can access or subscribe to “What’s New for Practitioners” that provides 

information on recent events (e.g., disaster relief,etc.).

2. Submit electronic premium filings (including electronic amended filings) through “My Plan Administration 

Account” (My PAA) via the “Online Premium Filing (My PAA)” section of the Practitioners Page of PBGC’s 

website and follow instructions about how to use My PAA for submitting premiumpayments.

3. For all premium-related inquiries and requests, including requests for exemption from the requirement 

to file electronically, premium filing questions, requests for instructions, address changes, requests for 

refunds (that are not submitted with premium filings), and requests for penalty waivers:

a. Mail (U.S. Postal Service or private delivery service): Send to the address posted on Web site under 

Premium Filings.

b. Call: 1-800-736-2444 or 202-326-4242 and select option 2 (premiums). Note – requests for 

exemptions from e-filing requirement cannot be made by phone.

c. Fax: 202-326-4250

d. E-mail: premiums@pbgc.gov

4. For current interest rate information: 

a. Call: 202-326-4041

b. See: “Interest Rates and Factors” section on the Practitioners Page of PBGC’s website.

5. For assistance on coverage determination or plan termination: 

a. Call: 1-800-736-2444 or 202-326-4242

b. E-mail:standard@pbgc.gov

c. Write to:

Pension Benefit Guaranty Corporation 

Standard Termination Compliance Division, Suite 930

Processing and Technical Assistance Branch 

1200 K Street, NW

Washington, DC 20005-4026
Page 54

Appendix 2 – Contact information

6. If you have a complaint about the service you have received or still need assistance after calling our 

practitioner telephone numbers listed in item 4 (1-800-736-2444 or 202-326-4242), please contact the 

Problem Resolution Officer(Practitioners):

a.Call: 1-800-736-2444, ext. 4136 or 202-326-4136

b.E-mail: practitioner.pro@pbgc.gov

c. Write to:

Pension Benefit Guaranty Corporation 

Problem Resolution Officer (Practitioners); Suite 610

1200 K Street, NW 

Washington, DC 20005-4026

7. For questions about our Premium Compliance Evaluation Program: 

a. Call: 1-800-736-2444, ext. 6855 or 202-326-4161, ext. 6855

b. E-mail: pce@pbgc.gov

8. For software developers requesting approval of XML files produced by private-sector software for use in 

My PAA, follow the submission instructions on the “Software Developer E-filing Resources for Integrating 

with PBGC” webpage. The link to this webpage is found in the section titled “Related Information” on the 

right side of the “Online Premium Filing with My PAA” webpage.

PBGC’s business hours are 8:00 am to 5:00 pm Eastern Time, Monday through Friday, except Federal Holidays.

TTY/TDD users may call the Federal relay service toll-free at 1-800-877-8339 and ask to be connected to any 

telephone number.

Note – We cannot accept collect calls.
Page 55

Appendix 3 – On-line Premium Filing with My PAA

Introduction

My Plan Administration Account (My PAA) is a secure, Web-based application that enables you to electronically 

submit premium filings and payments to PBGC. Although electronic filing of premium information is mandatory, 

payments may be made either electronically or by paper check.

Information about how to use My PAA may be accessed on PBGC’s website as well as within the My PAA 

application itself. Detailed information (e.g., FAQs and Demos) is located in the “Online Premium Filing (My

PAA)” section (accessible via the Practitioners Page of PBGC’s website).

To use My PAA, you must set up a My PAA account which includes a user ID and password. Each My PAA user 

needs only one account, which can include an unlimited number of plans.

My PAA offers three e-filing methods:

 You can use My PAA’s data entry and editing screens to create a filing; route it to others for review, editing, 

and electronic certification; and submit it electronically to PBGC. Each person who participates in the 

electronic processing of the filing must have a My PAAaccount.

 You can use private-sector software that is compatible with My PAA to create a filing, and then import the 

filing data into My PAA’s data entry and editing screens for routing, review, editing, electronic certification, 

and electronic submission to PBGC. Each person who participates in the electronic processing of the filing 

must have a My PAA account.

 You can use private-sector software that is compatible with My PAA to create a filing, and then upload the 

filing to PBGC via the My PAA application. The filing cannot be routed, reviewed, or edited in My PAA. In 

most cases, a paper copy or copies of the filing must be certified outside of My PAA (before the filing is 

uploaded) and retained in plan records. Only the person who uploads the filing must have a My PAA 

account.

My PAA’s Data Entry and Editing Screens

Entering information

My PAA’s data entry and editing screens walk you through a step-by-step process to create a premium filing. For 

example, in the first step you identify the type of plan (Single-employer or Multiemployer) for which the filing is 

being submitted, and the plan year. Instructions are provided at each step.

The information entered in each step determines the content of the successive steps. For example, if you 

indicate that you are preparing a comprehensive premium filing for a Single-employer Plan, the later steps will 

request information needed to determine the amount of the Variable-rate Premium (if applicable). However, if 

you indicate that you are preparing a comprehensive premium filing for a Multiemployer Plan, the Variable-Rate 

Premium screens will be suppressed.

The required mathematical calculations are automated. For example, My PAA automatically multiplies your 

Participant Count by the applicable flat premium rate to generate the Flat-rate Premium.
Page 56

Appendix 3 – On-line Premium Filing with My PAA

E-filing team

Multiple people can contribute to a plan’s filing in My PAA’s data entry and editing screens. For example, some 

information might be entered by the Plan Administrator and other information by an actuary. The people 

authorized to contribute to a plan’s premium filing in My PAA’s data entry and editing screens are those who 

have the plan in their My PAA accounts, and are referred to as the plan’s “e-filing team.”

Routing filings

Filings in progress can be routed among e-filing team members through My PAA for input, review, editing, ecertification of information, authorization of payment, and submission to PBGC. The person routing the filing to 

another member of the e-filing team can provide comments and instructions for the person to whom the filing is 

being routed. My PAA sends that person an e-mail notice (with the comments and instructions) stating that the 

filing has been routed for the recipient’s action and that the recipient is now “holding” that filing. After all 

information has been provided and certified, and payment (if any) has been authorized, the filing can be 

electronically submitted to PBGC by the Plan Administrator or Filing Coordinator.

Using Private-Sector Software with My PAA

Compatibility with My PAA

You can use private-sector software to prepare a premium e-filing, but the software you use must be compatible 

with My PAA. That means that the software must be able to place your filing in an electronic file that is in “XML” 

format and meets PBGC specifications. The specifications are posted on the “Online Premium Filing (My PAA)”

webpage. Private-sector software providers and developers submit to PBGC sample filings in XML format for 

PBGC review and assignment of vendor numbers; you should review PBGC’s Web site or check with your 

software provider or developer to find out whether your software is capable of creating an XML file in the 

proper format for use with My PAA. If your compatible private-sector software permits, you can create batch 

files containing more than one premium filing for use with MyPAA.

Importing a filing

A premium filing that has been prepared with compatible private-sector software can be “imported” into My 

PAA’s data entry and editing screens. That means that the information in the filing is placed into the data entry 

and editing screens and can then be electronically routed, reviewed, edited, certified, and submitted to PBGC as 

previously described in the My PAA’s Data Entry and Editing Screens section. To import a filing for a plan, the 

plan must be in your My PAA account. My PAA provides instructions for importing filings. My PAA’s import 

feature also allows multiple filings to be imported at the same time.

Uploading a filing

A premium filing that has been prepared with compatible private-sector software can also be “uploaded” 

through My PAA. That means that the fully-completed filing is submitted directly to PBGC and, therefore, cannot 

be reviewed or edited in My PAA before submission to PBGC. My PAA’s upload feature also allows multiple 

filings to be uploaded at the same time (i.e., a batch upload).

To upload a filing for a plan, the plan need not be in your My PAA account, but you must have a My PAA account 

with at least one plan in it. You must electronically certify in My PAA that you have authority to submit the filing 

for the plan, but in most cases the information in the filing must be certified on paper outside My PAA before 

the filing is uploaded, and the certified information must be retained in plan records. (The Plan Administrator’s 

(or enrolled actuary’s) certification can be made on-line if it is the Plan Administrator (or enrolled actuary) who
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Appendix 3 – On-line Premium Filing with My PAA

uploads the filing.) My PAA provides instructions for uploading filings and for certifying the information in 

uploaded filings.

Filing Coordinator

A central role in the e-filing process is played by the “filing coordinator,” who is the person designated by the 

plan or Plan Sponsor to be responsible for coordinating the plan’s on-line premium filings. The filing coordinator 

for a plan is the one who adds that plan to the account of each other person in the e-filing team and assigns 

each e-filing team member one or more filing roles, such as the authority to certify a filing (e.g., as the Plan 

Administrator). My PAA provides instructions for becoming a plan’s filing coordinator, adding plans, adding

e-filing team members, assigning roles, etc.

Premium Payment Options

If you owe a premium, there are several ways to submit payment:

 Automated Clearing House (ACH) payment within My PAA: This is an electronic transfer of funds from an 

account that you specify by entering your account number and bank routing number. Additional 

information about this payment option is available in My PAA. This option is not available if you are 

uploading multiple filings at the same time (i.e., batchuploads).

 Electronic Payment via Pay.gov: This is a website from which you can make secure electronic payments 

directly to many Federal Agencies, including PBGC. It involves entering information about your plan (i.e., 

EIN, plan number, the date the applicable plan year began, information about the account from which 

payment will be made) and then authorizing payment. To pay using this option, go to www.pay.gov and 

select Pension Benefit Guaranty Corporation from the “Find an Agency” List, and then select PBGC’s online 

Premium Insurance Payments Form.

 Paper Check: You can mail a paper check to our premiumlockbox.

 Federal Wire and ACH: You can direct your bank to send us apayment.

See the “Premium Payment Instructions and Addresses” section of the Practitioners Page of PBGC’s website for 

additional information about payment options and addresses. Be sure to use the most current payment 

addresses for all plan year filings, including prior year filings.

Other Important My PAA Features

Filing receipts

My PAA gives you a filing receipt. For a filing submitted from My PAA’s data entry and editing screens (including 

a filing imported into My PAA), the filing receipt shows the date and time that PBGC received the filing, a 

confirmation number, and all of the information submitted in the filing.

For an uploaded filing, the filing receipt shows the name of the uploaded XML file, the date and time of receipt 

by PBGC, and a confirmation number. This confirmation number must be written on the signed paper copy of 

the “form” retained the Plan Administrator’s records. After a filing is uploaded, the uploader can view the 

information submitted in each uploaded filing.

In either case, provide the confirmation number to the preparer of the Form 5500 or Form 5500-SF, because 

that number is generally reported as part of the Form 5500 filing.
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Appendix 3 – On-line Premium Filing with My PAA

Account history

A member of a plan’s e-filing team may, if authorized by the filing coordinator, view the plan’s account history 

on-line through My PAA. The account history shows the results of PBGC’s processing of your premium filings and 

payments for each plan year. We recommend that you review the account history after your premium filing is 

processed.

Instructions

My PAA provides full filing instructions and help screens. In addition, PBGC’s website information and “demos” 

about how to get started and how to use My PAA. To access the My PAA information, click the “Online Premium

Filing (My PAA)” link from the Practitioners Page of PBGC’s website.

For More Information

If you have questions about e-filing with My PAA, please contact us. See Appendix 2 for information.
Appendix 4 — Paperwork Reduction Act Notice

Page - 59 -

We need this information to determine the amount of premium due to PBGC under Title IV of ERISA. You are 

required to give us this information. An agency may not conduct or sponsor, and a person is not required to 

respond to, a collection of information unless it displays a currently valid OMB control number.

OMB has approved this collection of information under control number 1212-0009. 

Confidentiality is that provided by the Privacy Act and the Freedom of Information Act.

PBGC estimates that preparation and submission of a premium filing takes 7 hours if UVBs are reported and 31⁄2 

hours if they are not. PBGC assumes that most of the work (95 percent) is contracted out at a rate of $350 per 

hour. Thus the estimated burden associated with premium filing is about 20 minutes and $2,330 if UVBs are 

reported and about 10 minutes and $1,165 if they are not. The actual time will vary depending on the 

circumstances of each plan.

If you have comments concerning the accuracy of these burden estimates or suggestions for making the forms 

or the electronic filing process simpler, please send your comments to Pension Benefit Guaranty Corporation, 

Office of General Counsel, Regulatory Affairs, 1200 K Street, NW, Washington, DC 20005-4026.