Cat. No. 24501W

Instructions for Form 6406

(Revised November 1992)

Short Form Application for Determination

for Amendment of Employee Benefit Plan

(Section references are to the Internal Revenue Code

unless otherwise noted. )

Department of the Treasury

Internal Revenue Service

Paperwork Reduction Act Notice.—We ask for the information

on this form to carry out the Internal Revenue laws of the United

States. If you want to have your plan approved by IRS, you are

required to give us this information. We need it to determine

whether you meet the legal requirements for plan approval.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated average

time is:

Recordkeeping 12 hr., 55 min.

Learning about the law or the form 3 hr., 23 min.

Preparing the form 6 hr., 32 min.

Copying, assembling, and sending 

the form to the IRS 48 min.

If you have comments concerning the accuracy of these time

estimates or suggestions for making this form more simple, we

would be happy to hear from you. You can write to both the

Internal Revenue Service, Washington, DC 20224, Attention:

IRS Reports Clearance Officer, T:FP; and the Office of

Management and Budget, Paperwork Reduction Project

(1545-0229), Washington, DC 20503. DO NOT send the form to

either of these offices. Instead, see Where To File on page 2.

Public Inspection.—The application is open to public inspection

if there are more than 25 participants. The total number of

participants must be shown on line 4e. “Participant” includes

retirees, other former employees, and a beneficiary of a

deceased employee who is receiving or will in the future receive

benefits under the plan.

Disclosure Requested by Taxpayer.—The Tax Reform Act of

1976 permits a taxpayer to request the IRS to disclose and

discuss their return and/or return information with any person(s)

the taxpayer designates in a written request. You may use Form

2848, Power of Attorney and Declaration of Representative, or

submit a privately designed authorization form. A privately

designed authorization form must provide the following:

1. Your name, address, employer identification number, and

plan number(s).

2. A paragraph that clearly identifies the person or persons

authorized to receive the return and/or return information. This

must include the name, address, telephone number(s), and

social security number(s) of the authorized person(s).

3. A paragraph that clearly and explicitly describes the return

and/or return information that you authorize the IRS to disclose.

4. Your signature as the taxpayer making the authorization.

Signature.—The application must be signed by the employer,

plan administrator, or an authorized representative.

General Instructions

Purpose of Form

Form 6406, Short Form Application for Determination for

Amendment of Employee Benefit Plan, is used to apply for a

determination for an amendment for an employee benefit plan

and the exempt status of any related trust, if that plan has

already been issued a favorable determination letter.

Practitioners and employers may rely on regulations for the

Tax Reform Act of 1986 to the extent specified in those

regulations.

Type of Plan

1. A Defined Contribution Plan is a plan that provides for an

individual account for each participant and for benefits based

only on the amount contributed to the participant’s account, and

any income, expenses, gains and losses, and any forfeitures of

accounts of other participants that may be allocated to the

participant’s account.

2. A Defined Benefit Plan is any plan that is not a defined

contribution plan.

Note: A qualified plan must contain provisions that satisfy

section 401(a) and include but are not limited to participation,

vesting, nondiscriminatory contributions and benefits,

distributions, and contribution and benefit limitations.

Completing the Application

Determination applications are screened for completeness by

computer. Incomplete applications will be returned to the

applicant. For this reason, it is important that an appropriate

response be entered for each line item (except as indicated in 5

below). In completing the application, be sure to pay careful

attention to the following:

1. N/A (not applicable) is accepted as a response only if an

N/A block is provided.

2. If a numeric response is requested, a numeric response

must be entered.

3. If an item provides a choice of boxes to be checked, only

one box should be checked unless instructed otherwise.

4. If an item provides a box or boxes to be checked, written

responses are not acceptable.

5. If the governmental or church plan box is checked in line 7,

certain line items need not be completed. See What To File on

page 2.

6. All applications must include the appropriate user fee and

Form 8717, User Fee for Employee Plan Determination Letter

Request. Form 8717 may be obtained by contacting your local

IRS District office or by calling 1-800-TAX-FORM

(1-800-829-3676).

7. The IRS may, at its discretion, require a plan restatement,

additional information, or the submission of a Form 5300 series

application anytime it is deemed necessary.

Who May File

This form may be filed by any:

1. Employer, including a sole proprietor, a partnership, a plan

sponsor or a plan administrator that has adopted an individually

designed plan desiring a determination letter on the qualification

of an amendment on a plan, provided the plan has an

outstanding favorable determination letter.

2. Plan sponsor or plan administrator desiring a determination

letter as to the qualification of an amendment of a plan that

involves a controlled group of corporations (section 414(b)), or

trades or businesses under common control (section 414(c)), or

an affiliated service group (section 414(m)).

Note: This form may not be filed by anyone desiring approval of

an amendment, if:

a. The amendment results in a plan termination, merger,

consolidation, or a transfer of plan assets or liabilities to another

plan. Amendments to these plans must be submited on Form

5310, Application For Determination Upon Termination.

b. The plan is restated. Amendments to these plans must be

submitted on Form 5300, Application For Determination For

Employee Benefit Plan.

c. The employer is an adopter of a master or prototype,

regional prototype or volume submitter plan. Amendments to

these plans must be submitted on Form 5307, Application for
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Determination for Adopters of Master or Prototype, Regional

Prototype or Volume Submitter Plans.

d. The plan is a multiple-employer plan described in Section

413(c). Use Form 5300, Application for Determination for

Employee Benefit Plan.

e. If you are not sure if you have leased employees or not, file

Form 5300 instead of Form 6406.

What To File

All Plans

1. Form 8717, User Fee for Employee Plan Determination

Letter Requests.

2. Form 5302, Employee Census. One copy of the form must

accompany each plan (other than a governmental or church

plan) of an employer.

3. Two copies of page one of Form 6406. One copy must be

an original (printed in special red ink). The other copy may be a

reproduction or carbon, however the signature must be original.

4. The first page of this application must be typed. Use 10

pitch type except that you may use 12 pitch or Elite, Courier 12

or Titan 12 type. Contact your key district office if you wish to

computer generate this application form.

5. All applications must be accompanied by a:

a. Copy of the new amendments;

b. Copy of the latest determination letter including caveats;

and

c. Statement as to how the amendments affect or change the

plan or any other plan maintained by the employer.

Specific Plans—Additional Requirements

1. A restated plan is required if four or more amendments

have been made since the last restated plan was submitted. For

restatement purposes, an amendment making only

nonsubstantive plan changes need not be counted as a plan

amendment. You may not use Form 6406 if your plan is

required to be restated. If you have a restated plan, you must

use either Form 5300 or Form 5303.

2. You may not use Form 6406 for plan amendments made

to comply with the Tax Reform Act of 1986.

3. For a termination, use Form 5310. For a partial termination,

use Form 5300 or 5303, depending on your particular

circumstances.

4. For amendments to a governmental or church plan, a plan

administrator may request a determination letter by filing the

following:

a. For a plan that is subject to ERISA, complete all items of

Form 6406; or

b. For a plan that is not subject to ERISA, file Form 6406

skipping line 8.

5. For plans of controlled groups of corporations, trades or

businesses under common control, and affiliated service

groups, attach the documents and statements listed above, if

applicable. Also, attach a list of the member employers. Explain

in detail their relationships, the types of plans each member has

and the plans common to all member employers.

Where To File

1. Single Employer Plans.—File the form where the employer’s

or employee organization’s principal place of business is located.

2. Plan Maintained by More Than One Employer.—File the

form where the principal place of business of the plan sponsor is

located. This means the principal place of business of the

association, committee, joint board of trustees, or other similar

group or representatives of those who established or maintain

the plan.

3. Domestic Employers Using Foreign Situs Trust.—File the

form where the principal place of business of the employer is

located.

4. Foreign Employers.—File the form with the Internal Revenue

Service, EP/EO Division, P.O. Box 17288, Baltimore, MD 21203.

If entity is in

Send fee and request for 

determination letter or

notification letter to

this address

Ä Ä

Connecticut, Maine, Massachusetts,

New Hampshire, New York, Rhode

Island, Vermont

Internal Revenue Service

EP/EO Division 

P.O. Box 1680, GPO 

Brooklyn, NY 11202

Delaware, District of Columbia,

Maryland, New Jersey, Pennsylvania,

Virginia, any U.S. Possession or

foreign country

Internal Revenue Service

EP/EO Division 

P.O. Box 17288 

Baltimore, MD 21203

Indiana, Kentucky, Michigan, Ohio,

West Virginia

Internal Revenue Service

EP/EO Division 

P.O. Box 3159 

Cincinnati, OH 45201

Arizona, Colorado, Kansas,

Oklahoma, New Mexico, Texas, Utah,

Wyoming,

Internal Revenue Service

EP/EO Division 

Mail Code 4950 DAL 

1100 Commerce Street 

Dallas, TX 75242

Alabama, Arkansas, Florida, Georgia,

Louisiana, North Carolina,

Mississippi, South Carolina,

Tennessee

Internal Revenue Service

EP/EO Division 

P.O. Box 94l 

Atlanta, GA 30370

Alaska, California, Hawaii, Idaho,

Nevada, Oregon, Washington

Internal Revenue Service

EP/EO Division

McCaslin Industrial Park

2 Cupania Circle

Monterey Park, CA 91784-7406

Illinois, Iowa, Minnesota, Missouri,

Montana, Nebraska, North Dakota,

South Dakota, Wisconsin

Internal Revenue Service

EP/EO Division 

230 S. Dearborn, DPN 20-6 

Chicago, IL 60604

Specific Instructions

Line 1a. Enter the name, address, and telephone number of the

plan sponsor. “Plan Sponsor” means in the case of a plan:

1. That covers the employees of one employer, the employer;

2. Maintained by two or more employers (other than a plan

sponsored by a group of entities required to be combined under

section 414(b), (c), or (m)), the association, committee, joint

board of trustees or other similar group of representatives of

those who established or maintain the plan;

3. Sponsored by two or more entities required to be combined

under section 414(b), (c), or (m), one of the members

participating in the plan; or

4. That covers the employees and/or partner(s) of a

partnership, the partnership.

The plan sponsor should be the same name that was or will

be used when the Form 5500 series returns/reports are filed for

the plan.

Address.—Include the suite, room, or other unit number after

the street address. If the Post Office does not deliver mail to the

street address and the plan has a P.O. box, show the box

number instead of the street address.

Note: If a change in address occurs after the application is filed,

the plan should use Form 8822, Change of Address, to notify

the IRS of the new address.

Line 1b. Enter the 9-digit employer identification number (EIN)

assigned to the plan sponsor. This should be the same EIN that

was or will be used when the Form 5500 series returns/reports

are filed for the plan. (Please do not use a social security

number.) An EIN may be obtained by using Form SS-4,

Application for Employer Identification Number, which may be

obtained by calling 1-800-TAX-FORM.

The plan of a group of entities required to be combined under

section 414(b), (c), or (m) whose sponsor is more than one of the

entities required to be combined should enter only the EIN of

one of the sponsoring members. This EIN must be used in all
Page 3

subsequent filings of determination letter requests, and for filing

annual returns/reports unless there is a change of sponsor.

Line 1c. Enter the two digits representing the month the

employer’s tax year ends. This is the employer whose EIN was

entered on line 1b. For plans of more than one employer, enter

N/A.

Line 2. The contact person will receive copies of all

correspondence as authorized in a power of attorney or other

written designation. This line must be completed as described; a

reference such as “see attached” is not acceptable. If there is

no other person to contact, please leave this line blank.

See Disclosure Requested by Taxpayer on page 1, If you

want to designate a person or persons to represent you before

the IRS in connection with an application for a determination.

Line 3a. If a determination is requested based on a proposed

amendment, enter 9/9/99. The term “Date amendment effective”

means the date the amendment becomes operative, takes

effect, or changes.

Line 3b. If you checked “Yes,” and do not have a copy of the

latest determination letter, explain in the cover letter. Form 6406

may not be used if the plan has never received a favorable

determination letter.

Line 3c. Section 3001 of ERISA requires the applicant to provide

evidence that each employee who qualifies as an interested

party has been notified of the filing of the application. Rules

defining “interested parties” and providing for the form of

notification are contained in regulations section 1.7476-1. For an

example of an acceptable format, see Rev. Proc. 92-6, 1992-1

I.R.B. 105. If you check “No” or leave this blank, the application

will be returned.

Line 3d. If your plan contains provisions for a cash or deferred

arrangement (CODA) under section 401(k), or for employee or

matching contributions described in section 401(m), check

“Yes.” Otherwise, “No” must be checked.

Line 4a. Designate and enter a name for your plan.

Line 4b. Assign and enter a three digit number, beginning with

“001” and continuing in numerical sequence for each plan you

adopt. This numbering will differentiate your plans. The number

assigned to a plan must not be changed or used for any other

plan.

Line 4c. Plan-year means the calendar, policy, or fiscal year on

which the records of the plan are kept. Enter four digits in

month-day order. For example, March 31 would be 0331.

Line 4d. Enter the date the plan originally became effective.

Enter six digits in month-day-year order.

Line 4e. Include retirees and other former employees and the

beneficiaries of both who are receiving or at some future time

will receive benefits under the plan. Enter the total of: (1) the

total number of employees participating in the plan including

employees under a section 401(k) qualified cash or deferred

arrangement who are eligible, but do not make elective deferrals,

(2) former employees who are receiving or will at some future

date receive benefits under the plan, and (3) beneficiaries of

former employees who are receiving benefits under the plan.

(This means one beneficiary for each former employee

regardless of the number of individuals receiving benefits. For

example, payment of a former employee’s benefit to three

children is considered as a payment to one beneficiary.)

Line 6. If the plan sponsor is a member of a controlled group of

corporations, trades or businesses under common control, or an

affiliated service group, all employees of the group will be

treated as employed by a single employer for purposes of

certain qualification requirements such as coverage. Attach a

statement showing in detail all members of the group, their

relationship to the plan sponsor, the type of plans each member

has, and the plans common to all members.

Line 8. COVERAGE.

Note: In completing line 8, include all employees of all employers

combined with the employer under section 414(b), (c) or (m). In

addition, include all self-employed individuals, common law

employees and leased employees as defined in section 414(n) of

any of the entities above, other than those excluded by section

414(n)(5).

The part of a plan that is an ESOP must be treated as an

independent plan that must separately satisfy the coverage

rules. If this plan contains an ESOP component, submit a

demonstration that the ESOP component separately satisfies the

coverage rules. For purposes of testing the rest of the plan,

disregard the ESOP.

Line 8a. In general, if the employer operates separate lines of

business or operating units as defined in section 414(r) for a

year, the employer may apply the coverage requirements

separately for employees in each separate line of business.

Attach a demonstration using applicable regulations, revenue

rulings or revenue procedures that shows the separate lines of

business are qualified separate lines of business satisfying the

rules of sections 414(r) and 410(b)(5).

In addition, if this plan, or any plan combined with this plan for

purposes of satisfying the coverage requirements, covers

employees in more than one separate line of business or

operating unit, submit the coverage data requested in line 8

separately for each separate line of business or operating unit.

Line 8c. In general, if the plan satisfies one of the tests on at

least one day in each quarter of the year being tested, the plan

will be considered as passing the coverage tests for the entire

year if the quarterly testing dates reasonably represent the

coverage of the plan over the entire plan year. Enter the date for

which the coverage data is submitted on line 8c.

Line 8d. Divide the number of nonexcludable employees who

benefit and are not highly compensated employees, as defined

in section 414(q), by the total number of nonexcludable

nonhighly compensated employees; show the result as a

percentage on line 8d.

Generally, a qualified plan may exclude from coverage all

employees who have not attained age 21 and completed one

year of service. However, if a plan covers any such excludable

employee, it must test coverage based on the lowest minimum

age and service requirements for any employee under this or any

other plan combined with this plan for the purpose of satisfying

the coverage rules. To compute the percentage on line 8d,

exclude employees who have not attained the lowest age and

service requirements for any employee under this or any other

plan combined with this plan for the purpose of satisfying the

coverage requirements.

On the other hand, employees who are not yet age 21 and

have completed one year of service may be tested for coverage

separately. If electing this alternative, demonstrate in an

attachment that the group of employees who are not yet age 21

and have one year of service but have attained the lowest age

and service requirements under this or any other plan combined

with this plan to satisfy the coverage requirements,

independently passes one of the coverage tests.

When testing a plan covering noncollectively bargained

employees for coverage, employees who are included in a unit

of employees covered by an agreement as defined in section

7701(a)(46) that the Secretary of Labor finds to be a collective

bargaining agreement between employee representatives and

one or more employers are generally excluded if there is

evidence that the retirement benefits were the subject of good

faith bargaining between employee representatives and employer

or employers.

To compute the percentage on line 8d, exclude the employees

that are covered by a collective bargaining agreement described

above, including employees covered under this plan. However,

do not exclude any employee covered under a collective

bargaining agreement if more than 2% of the employees who

are covered under the collective bargaining agreement are

professionals as defined in Regulations section 1.410(b).

In computing the percentage on line 8d, exclude the total

number of nonresident aliens who receive no earned income as

defined in section 911(d)(2)) from the employer that constitutes

income from sources within the United States as defined in

section 861(a)(3).

In computing the percentage on line 8d, exclude the

employees who do not accrue a benefit or receive an allocation

only because they do not satisfy a minimum hour of service or a

last day of the plan year requirement under the plan, provided
Page 4

they do not have more than 500 hours of service, and they are

not employed on the last day of the plan year. Do not exclude

any employees who have more than 500 hours of service,

because they are not employed on the last day of the plan year.

In general, an employee is treated as benefiting, for purposes

of the coverage tests, only if the employee receives an allocation

of contributions or forfeitures, or accrues a benefit under the

plan for the plan year. Certain other employees are treated as

benefiting if they fail to receive an allocation of contributions

and/or forfeitures, or to accrue a benefit only because the

employee is subject to plan provisions that limit plan benefits,

such as a provision for maximum years of service, maximum

retirement benefits, or limits designed to satisfy section 415.

An employee is treated as benefiting under a plan (or part of a

plan) to which elective contributions or after tax employee

contributions and matching contributions subject to section

401(k) or 401(m) may be made if the employee is currently

eligible to make elective or after tax employee contributions,

whether or not the employee actually makes the contributions.

However, for purposes of line 8d, do not treat these employees

as benefiting only because they are eligible under a plan (or part

of a plan) subject to section 401(k) or (m). Data for these

employees will be entered on lines 8f and 8g.

Line 8e. To compute the ratio on line 8e, divide the number of

nonexcludable employees who benefit under the plan and are

not highly compensated, as defined in section 414(q), by the

total number of nonexcludable nonhighly compensated

employees; put the result in the numerator. Divide the number of

nonexcludable employees who benefit under the plan and who

are highly compensated by the total number of nonexcludable

highly compensated employees; put the result in the

denominator.

See the instructions for line 8d to determine which employees

are nonexcludable employees and which employees benefit

under the plan. For purposes of line 8e, do not include

employees who are treated as benefiting only because they are

eligible under a plan (or part of a plan) subject to section 401(k)

or (m). Data for these employees will be entered on lines 8f and

8g.

Line 8f. If the plan (or part of the plan) contains a CODA

component, enter the ratio (using the instructions for line 8e) for

the CODA component in line 8f. Note: The instructions in the

last paragraph for line 8d contain a special definition of who is

benefiting under a CODA.

Line 8g. If the plan (or part of the plan) consists of employee

and/or matching contributions subject to section 401(m), enter

the ratio for this portion on line 8g. Note: The instructions in the

last paragraph for line 8d contain a special definition of who is

benefiting under the plan or part of a plan that consists of

employee and matching contributions.

Line 8h. If this plan does not, by itself, satisfy the coverage

requirements, certain other qualified plans may be combined

with this plan for purposes of satisfying the coverage

requirements.

Note: The following plans may not be combined: (1) an ESOP

with a non-ESOP, (2) a collectively bargained plan with a

noncollectively bargained plan, and (3) a plan that contains a

CODA (section 401(k)), or employee or matching contributions

(section 401(m)) with a plan that does not include such a feature.

If any other plan is considered in combination with this plan,

complete line 8 as though the combined plans were a single

plan. Also attach a description, including the allocation or benefit

formula, of the other plan(s) along with a demonstration in

accordance with applicable regulations, revenue rulings, or

revenue procedures that shows the combined plans provide

comparable benefits and together satisfy section 401(a)(4).

Line 8i. If any one of lines 8e, 8f or 8g, if applicable, is less than

70%, the plan must satisfy the average benefit test to pass

coverage. A plan satisfies the average benefit test if it satisfies

both the nondiscriminatory classification test and the average

benefit percentage test.

Line 8i. (1) A plan satisfies the Nondiscriminatory

classification test if benefiting employees are defined by

reasonable and objective business criteria set out in the plan

and the classification is nondiscriminatory. A classification will be

considered nondiscriminatory if the ratio on line 8e, 8f or 8g,

whichever applies, is equal to or greater than the safe harbor

percentage.

The safe harbor percentage is 50%, reduced by 3⁄4 of a

percentage point for each percentage point by which the

nonhighly compensated employee concentration percentage

exceeds 60%. The nonhighly compensated employee

concentration percentage is the percentage of all the employees

of the employer who are not highly compensated employees.

Enter the safe harbor percentage on line 8i(1). See Regulations

section 1.410(b)-4.

Line 8i. (2) A plan satisfies the average benefit percentage test

if the average benefit percentage for nonhighly compensated

employees is at least 70% of the average benefit percentage for

highly compensated employees.

All qualified plans (or parts of plans) of the employer, including

CODAs and plans containing employee or matching

contributions (section 401(k) or (m)) are combined in determining

the average benefit percentage. Do not combine plans that may

not be combined for purposes of satisfying the ratio percentage

test, other than plans subject to section 401(k) or (m). See the

instructions for line 8h.

Also, all nonexcludable employees, including those with no

benefit under any qualified plan of the employer, are included in

determining the average benefit percentage. Enter the average

benefit percentage on line 8i.(2). Also, attach a demonstration in

accordance with applicable regulations, revenue rulings or

revenue procedures that shows the plan satisfies the average

benefit percentage test.

Line 9a. Section 411(d)(6) protected benefits include the accrued

benefit of a participant as of the later of the amendment’s

adoption date or effective date, any early retirement benefit,

retirement-type subsidy or optional form of benefit for benefits

from service before the amendment. If the answer is “Yes,”

attach an explanation of how the amendment satisfies one of the

exceptions to the prohibition, reduction or elimination of section

411(d)(6) protected benefits.