APPENDIX D

CHECKLIST - IS THE SUBMISSION COMPLETE?

Instructions. The application must include a completed checklist placed on top of the 

application. This will help ensure that the application is complete. Answer each question 

in the checklist by circling Y for yes, N for no or N/A for not applicable, as appropriate, in 

the blank next to the item. Also insert in the appropriate blank next to each item the 

page number or numbers where the item appears in the application.

APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR SHEET METAL 

WORKERS LOCAL PENSION PLAN

Response

Item

number Description of item

Page number 

in application

Yes No 

N/A 

1. Does the application include an original signature of the plan 

sponsor or an authorized representative of the plan sponsor? See 

section 2.01 of this revenue procedure. 

SMW 0001-

0005; 0022 

Yes No 

N/A 

2. Does the application include a description of the proposed benefit 

suspension - calculated as if no other limitations apply - that

includes: 

 the suspension’s effective date (and its expiration date, if 

applicable), 

 whether the suspension provides for different treatment of 

participants and beneficiaries, 

 a description of the different categories or groups of 

individuals affected, and 

 how the suspension affects these individuals differently? 

See section 2.02 of this revenue procedure. 

SMW 0007-

0009 

Yes No 

N/A 

3. Does the application include a penalties-of-perjury statement signed 

by an authorized trustee on behalf of the board of trustees? See 

Section 2.03 of this revenue procedure. 

Exhibit 1 

SMW 

0071

SMW0061
Item 

Response number

Page number 

Description of item in application

Yes No 

N/A 

4. Does the application include a statement, signed by an authorized 

trustee on behalf of the board of trustees, acknowledging that the 

application and the application’s supporting material will be 

publicly disclosed on the Treasury Department’s website? See 

section 2.04 of this revenue procedure. 

Exhibit 1 

SMW 

0071

Yes No 

N/A 

5. Does the application include the plan actuary’s certification of 

critical and declining status and the supporting illustrations, 

including: 

 the plan-year-by-plan-year projections demonstrating 

projected insolvency during the relevant period, and 

 separately identifying the available resources (and the 

market value of assets and changes in cash flow) during each of

those years? See section 3.01 of this revenue procedure. 

Exhibit 2 

SMW 

0072-

0077 

Exhibit 3 

SMW 

 0078-0083

Yes No 

N/A 

6. Does the application include the plan actuary’s certification that, 

taking into account the proposed suspension and, if applicable, a 

proposed partition, the plan is projected to avoid insolvency if the 

suspension takes effect, and the supporting illustrations, including: 

 the plan-year-by-plan-year projections demonstrating 

projected solvency during the relevant period, 

 separately identifying the available resources (and the 

market value of assets and changes in cash flow) during each of

those years? See section 3.02 of this revenue procedure. 

Exhibit 4 

SMW 

 0084-0118

Yes No 

N/A 

7. Does the application include the plan sponsor’s determination of 

projected insolvency that includes the documentation set forth in 

section 5 of the revenue procedure? See section 3.03 of this revenue 

procedure. 

Exhibit 4 

SMW 

 0084-0118

Yes No 

N/A 

8 Does the application include a demonstration that the limitations on 

individual suspensions are satisfied, including a description of each 

benefit based on disability, as defined under the plan, that is paid to 

an individual under the plan (without regard to whether the 

disability benefits are available to newly disabled participants) and 

calculations regarding: 

Exhibit 6 

SMW 

 00131-0141

SMW0062
Item 

Response number

Page number 

Description of item in application

 the guarantee-based limitation, 

 the disability-based limitation, 

 the age-based limitation, taking into account the guaranteebased limitation, and 

 if applicable, the age-based limitation taking into account 

both the guarantee-based limitation and the disability-based 

limitation? See section 4.01 of this revenue procedure. 

Yes No 

N/A 

9. Does the application include a demonstration that the proposed 

suspension is reasonably estimated to achieve the level necessary to 

avoid insolvency for the extended period, including illustrations 

regarding the plan’s solvency ratio and available resources? See 

section 4.02(1) of this revenue procedure. 

Exhibit 4 

SMW 

 0084-0118

Yes No 

N/A 

10. Does the application include an illustration that the proposed 

suspension is reasonably estimated to achieve the level necessary to 

avoid insolvency for the extended period utilizing stochastic 

projections? (This illustration is optional if the plan is not required 

to appoint a retiree representative under § 432(e)(9)(B)(v)(I).) See 

section 4.02(2) of this revenue procedure. 

n/a

Yes No 

N/A 

11. Does the application include a demonstration that the proposed 

suspension is not projected to materially exceed the level necessary 

to avoid insolvency, including: 

 the plan-year-by-plan-year projections demonstrating 

projected insolvency during the relevant period, and 

 a separate identification of the available resources (and the 

market value of assets and changes in cash flow) during each of

those years? See section 4.03 of this revenue procedure. 

Exhibit 4 

SMW 

 0084-0118

Yes No 

N/A 

12. Does the application include a demonstration that the proposed 

suspension is equitably distributed, including: 

 information on the effect of the suspension on the plan in 

the aggregate, 

 information on the effect of the suspension for different 

categories or groups, 

Exhibit 7 

SMW 

 0142-0149

SMW0063
Item 

Response number

Page number 

Description of item in application

 a list of the factors taken into account, 

 an explanation of why none of the factors listed in § 

432(e)(9)(D)(vi) were taken into account (if applicable), 

 for each factor taken into account that is not one of the 

factors listed in § 432(e)(9)(D)(vi), an explanation why the factor is 

relevant, and 

 an explanation of how any difference in treatment among 

categories or groups of individuals results from a reasonable 

application of the relevant factors? See section 4.04 of this revenue 

procedure. 

Yes No 

N/A 

13. Does the application include a copy of the notices (excluding 

personally identifiable information) that meet the requirements

under § 432(e)(9)(F)? See section 4.05(1) of this revenue 

procedure. 

Appendix A 

SMW 

 0024-0043

Yes No 

N/A 

14. Does the application include a description of the efforts that are 

being taken to contact participants, beneficiaries in pay status, and 

alternate payees? See section 4.05(2) of this revenue procedure. 

SMW 

 0017

Yes No 

N/A 

15. Does the application describe the steps the plan sponsor has taken 

to ensure that notices delivered electronically are reasonably 

accessible to the recipients? See section 4.05(3) of this revenue 

procedure. 

SMW 

 0018

Yes No 

N/A 

16. Does the application include a list of each employer who has an

obligation to contribute under the plan and each employee 

organization representing participants under the plan? See section 

4.05(4) of this revenue procedure. 

Exhibit 8 

SMW 

 0150-0152

Yes No 

N/A 

17. Does the application include information on past and current 

measures taken to avoid insolvency? See section 5.01 of this 

revenue procedure. 

Exhibit 4 

SMW

 0084-0118 

 Exhibit 10 

 SMW 0154-0157

SMW0064
Item 

Response number

Page number 

Description of item in application

Yes No 

N/A 

18. Does the application include information regarding the plan factors 

described in § 432(e)(9)(C)(ii), for the past 10 plan years 

immediately preceding the plan year in which the application is

submitted? See section 5.02 of this revenue procedure. 

Exhibit 4 

SMW

 0084-0118

Yes No 

N/A 

19. Does the application describe how the plan sponsor took into 

account – or did not take into account – the factors listed in section 

5.02 of this revenue procedure in the determination that all 

reasonable measures were taken to avoid insolvency? See section

5.03 of this revenue procedure. 

SMW 0006-

0022 

Yes No 

N/A 

20. Does the application describe how the plan sponsor took into 

account - or did not take into account - in the determination that all 

reasonable measures have been taken to avoid insolvency, the 

impact of: 

 benefit and contribution levels on retaining active 

participants and bargaining groups under the plan, and 

 past and anticipated contribution increases under the plan on 

employer attrition and retention levels? See section 5.03 of this 

revenue procedure. 

SMW 0006-

0022 

Exhibit 10 

SMW 

 0154-0187

Yes No 

N/A 

21. Does the application include a discussion of any other factors the 

plan sponsor took into account including how and why those factors 

were taken into account? See section 5.04 of this revenue 

procedure. 

SMW 0006-

0022 

Exhibit 10 

SMW 

 0154-0157

Yes No 

N/A 

22. Does the application include a copy of the proposed ballot, 

excluding the information regarding the statement in opposition, the 

individualized estimate, and the voting procedures? See section

6.01 of this revenue procedure. 

Appendix A 

 SMW 0024-0045

SMW0065
Item 

Response number

Page number 

Description of item in application

Yes No 

N/A 

23. Does the application indicate whether the plan sponsor is requesting 

approval from PBGC of a proposed partition under section 4233 of 

ERISA? See section 6.02 of this revenue procedure. 

SMW 

 0019

Yes No 

N/A 

24. If the answer to item 23 is yes, does the application specify the 

effective date of the proposed partition and include a plan-year-byplan-year projection of the amount of the reduction in benefit 

payments attributable to the partition? See section 6.02 of this 

revenue procedure. 

n/a 

Yes No 

N/A 

25. Does the application include: 

 a description of each of the assumptions used in the 

projections required under sections 3.01, 3.02, 4.02(1), 4.02(2), and 

4.03 of this revenue procedure, 

 supporting evidence for the selection of those assumptions, 

and 

 an explanation of any differences among the assumptions 

used for various purposes? See section 6.03 and Appendix B of this 

revenue procedure. 

Exhibit 4 

SMW 

 0084-0118; 

 0119-0120

Yes No 

N/A 

26. Does the application describe the plan’s experience with certain 

critical assumptions, including a disclosure for each of the 10 plan 

years immediately preceding the application that separately 

identifies: 

 the total contributions, 

 the total contribution base units, 

 the average contribution rates, 

 the withdrawal liability payments, and 

 the rate of return on plan assets? See section 6.04 of this 

revenue procedure. 

Exhibit 4 

SMW 

 0119-0120

Yes No 

N/A 

27. Does the application include deterministic projections of the 

sensitivity of the plan’s solvency ratio throughout the extended 

period by taking into account the more conservative assumptions of 

investment experience and future contribution base units than 

assumed elsewhere in the application? See section 6.05 of this 

Exhibit 4 

SMW 

0084-

0118 

SMW0066
Item 

Response number

Page number 

Description of item in application

revenue procedure. 

Yes No 

N/A 

28. Does the plan include deterministic projections for each year in the 

extended period of: 

 the value of plan assets, 

 the plan’s accrued liability, and 

 the plan’s funded percentage? See section 6.06 of this 

revenue procedure. 

Exhibit 4 

SMW 

 0084-0118

Yes No 

N/A 

29. Does the application include the plan sponsor’s representation that, 

if it receives the Treasury Department’s final authorization to

suspend and then chooses to implement the suspension, it will also 

amend the plan: 

 to provide that the suspension will cease upon the plan 

sponsor’s failure to maintain a written record of its annual 

determination that (i) all reasonable measures continue to be taken 

to avoid insolvency and (ii) the plan would not be projected to

avoid insolvency without a suspension, 

 to require that any future benefit improvements must satisfy 

§ 432(e)(9)(E), and 

 to specify that the plan sponsor will not modify these 

amendments, notwithstanding any other provision of the plan 

document? See section 6.07 of this revenue procedure. 

Exhibit 9 

SMW 

 0153

Yes No 

N/A 

30. Does the application indicate whether the plan is a plan described in 

§ 432(e)(9)(D)(vii) and, if it is, how that is reflected in the proposed 

benefit suspension? See section 6.08. 

SMW 

 0020

Yes No 

N/A 

31 Does the application include a narrative statement of the reasons the 

plan is in critical and declining status? See section 6.09. 

Exhibit 10 

SMW 

 0154-0157

Yes No 

N/A 

32. Does the application include the required plan sponsor 

identification and contact information? See section 7.01 of this 

revenue procedure. 

SMW 

 0020-0021

SMW0067
Item 

Response number

Page number 

Description of item in application

Yes No 

N/A 

33. Does the application include the required plan identification 

information? See section 7.02 of this revenue procedure. 

SMW 0021 

Yes No 

N/A 

34. Does the application include the required retiree representative 

information (if applicable)? See section 7.03 of this revenue 

procedure. 

n/a 

SMW 

 0021

Yes No 

N/A 

35. Does the application include the required enrolled actuary 

information? See section 7.04 of this revenue procedure. 

SMW 

 0021

Yes No 

N/A 

36. Does the application include a designation of power of attorney for 

each authorized representative who will represent the plan sponsor 

in connection with the application? See section 7.05 and Appendix 

C of this revenue procedure. 

Appendix C 

(SMW 

Yes No 

N/A 

37. Does the application include: 

 the required plan documents 

 any recent amendments 

 the summary plan description (SPD) 

 any summary of material modifications, and 

 the most recent determination letter? See section 7.06 of this 

revenue procedure. 

Exhibit 11 

SMW 

 0046-0051

Yes No 

N/A 

38. Does the application include the required excerpts from the relevant 

collective bargaining agreements and side agreements? See section 

7.07 of this revenue procedure. 

Exhibit 12 

SMW 

 0311-0341

Yes No 

N/A 

39. Does the application include the required excerpts from the most 

recently filed Form 5500? See section 7.08 of this revenue 

procedure. 

Exhibit 13 

SMW 

0342-

0421 

Yes No 

N/A 

40. Does the application include the most recently updated 

rehabilitation plan? See section 7.09 of this revenue procedure. 

Exhibit 14 

SMW 

 0422-0430

SMW0068
Item 

Response number

Page number 

Description of item in application

Yes No 

N/A 

41 Does the application include the two most recent actuarial valuation 

reports? See section 7.10 of this revenue procedure. 

Exhibit 15 

SMW 

0431-

0468 

Exhibit 16 

SMW 

 0466-0499

Yes No 

N/A 

42. Does the application include this checklist, completed and placed 

on top of the application? See section 7.11 of this revenue 

procedure and this Appendix D. 

Appendix D 

SMW 

 0061-0070

Yes No 

N/A 

43. If the application is being submitted for resubmission review, does 

the application include: 

 cross-references to information in the prior application with 

respect to information that has not changed from the prior 

application, 

 a statement that the application is being submitted for 

resubmission review, and 

 the date on which the Treasury Department indicated that 

the application is a candidate for resubmission review? See section 

8 of this revenue procedure. 

n/a 

Philip Chiarappa, Chairman of the Board of Trustees 

Date 

SMW0069
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SMW0070