Catalog Number 66153Y www.irs.gov
Form
14568-H (Rev. 6-2018)
For Paperwork Reduction Act information see current EPCRS Revenue Procedure.
Form 14568-H
(June 2018)
Department of the Treasury - Internal Revenue Service
Model VCP Compliance Statement - Schedule 8:
Failure to Pay Required
Minimum Distributions Timely
OMB Number
1545-1673
Include the plan name, Applicant’s EIN and plan number on each page of the submission.
Plan name
EIN Plan number
Section I - Identification of Failure (DO NOT USE THIS FORM IF PLAN BENEFITS DID NOT COMMENCE
IN A TIMELY MANNER, AT THE PLAN’S NORMAL RETIREMENT AGE OR UPON THE PARTICIPANT’S
DEATH. IF YOU CANNOT USE THIS FORM, ATTACH A WRITTEN NARRATIVE TO FORM 14568 AND
PROVIDE THE NECESSARY INFORMATION REQUESTED BY THAT FORM.)
The plan identified above did not comply with the requirements of Section 401(a)(9) of the Internal Revenue Code (IRC)
as required minimum distributions (RMD) were not paid in a timely manner or were less than what was required. When
completing this table, affected plan participants should be counted separately under each year that an RMD was not
made and not just in the first year of the failure.
Calendar Years Number of Participants
Affected
Total Amount of Missed Required Minimum Distributions
(Do Not Include Earnings)
Section II - Description of the Proposed Method of Correction
Defined contribution plan only - The plan will distribute the required minimum distributions (adjusted for earnings
from the date of the failure to the date of distribution) to affected participants. For each affected participant, the
required minimum distribution amount for each year in which the failure occurred will be determined by dividing the
adjusted account balance on the applicable valuation date by the applicable distribution period. For this purpose,
adjusted account balance means the actual account balance, determined in accordance with Section 1.401(a)(9)-5
Q&A-3 of the Income Tax Regulations, reduced by the amount of the total missed minimum distributions for prior
years. Earnings will be determined as follows
Defined benefit plan only - The plan will distribute the required minimum distributions plus an additional
payment representing the loss of use of such amounts. (Note the additional payment is determined in
accordance with the plan’s written terms for actuarial equivalence). The additional payment is determined as
follows