SECTION 9. PAPERWORK

REDUCTION ACT

The collection of information contained in this revenue procedure has been reviewed and approved by the Office of Management and Budget in accordance with the Paperwork Reduction Act (44 U.S.C. section 3507) under control number 1545–1890.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number.

The collection of information in this revenue procedure is in section 3 and Appendix B. This collection of information is required to evaluate, process and obtain approval of the request for an extension of an amortization period. This information will be used to make determinations on extensions of the amortization period under § 412(e) of the Code. The likely respondents are businesses or other for-profit institutions and nonprofit institutions.

The estimated total annual reporting/recordkeeping burden is 2500 hours.

The estimated annual burden per respondent/recordkeeper varies from 71 to 129 hours, depending on individual cir

August 2, 2004 137 2004–31 I.R.B.

APPENDIX A

MODEL NOTICE OF APPLICATION FOR AN EXTENSION OF AN AMORTIZATION PERIOD

TO EMPLOYEE ORGANIZATIONS (UNIONS), PARTICIPANTS, BENEFICIARIES, AND ALTERNATE PAYEES

This notice is to inform you that an application for an extension of an amortization period for unfunded liability under § 412(e) of the Internal Revenue Code (Code) and section 304 of the Employee Retirement Income Security Act of 1974 (ERISA) has been submitted by [ INSERT APPLICANT’S NAME ] to the Internal Revenue Service (Service) for the [ INSERT PLAN NAME ] for the plan year beginning [ INSERT DATE ].

Under § 412(f)(4)(B) of the Code and section 304(a) of ERISA, the Service will consider any relevant information submitted concerning this application for an extension of the amortization period for unfunded liability. You may send this information to the following address:

Director, Employee Plans Internal Revenue Service Attn: SE:T:EP:RA:T:A 1111 Constitution Avenue, N.W. Washington, D.C. 20224

Any such information should be submitted as soon as possible after you have received this notice. Due to the disclosure restrictions of § 6103 of the Code, the Service can not provide any information with respect to the extension request itself.

In accordance with section 104 of ERISA and section 2520.104b–10 of the Department of Labor Regulations (29 C.F.R. Part 2520), annual financial reports for this plan, which include employer contributions made to the plan for any plan year, are available for inspection at the Department of Labor in Washington, D.C. Copies of such reports may be obtained upon request and upon payment of copying costs from the following address:

Public Disclosure Room Room N–5507 Employee Benefits Security Administration U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, D.C. 20210

As required by section 104(b)(2) of ERISA, copies of the latest annual plan report are available for inspection at the principal office of the plan administrator, who is located at [ INSERT ADDRESS ]. Copies of the annual report may be obtained upon request and upon payment of a copying charge of [ INSERT CHARGE ] by writing to the plan administrator at the above address.

The following information is provided pursuant to § 412(f)(4)(A) of the Code and section 303(e)(1) of ERISA:

Present Value of Vested Benefits $

Present Value of Benefits, calculated as though the plan terminated $

Fair Market Value of Plan Assets $

The above present values were calculated using an interest rate or rates of [ INSERT INTEREST RATE(S) ].

[SIGNATURE OF APPROPRIATE OFFICER OF THE PLAN SPONSOR]

[INSERT NAME]

[INSERT TITLE]

2004–31 I.R.B. 138 August 2, 2004

APPENDIX B

REQUEST FOR EXTENSION OF AN AMORTIZATION PERIOD CHECKLIST

IS YOUR SUBMISSION COMPLETE?

Instructions

The Service will be able to respond more quickly to your request for an extension of an amortization period if it is carefully prepared and complete. To ensure your request is in order, use this checklist. Answer each question in the checklist by inserting Y for yes, N for no, or N/A for not applicable, as appropriate, in the blank next to the item. Sign and date the checklist (as taxpayer or authorized representative) and place it on top of your request.

You must submit a completed copy of this checklist with your request. If a completed checklist is not submitted with your request, substantive consideration of your submission will be deferred until a completed checklist is received.

__________ 1. If you want to designate an authorized representative, have you included a properly executed Form 2848 ( Power of Attorney and Declaration of Representative )?

__________ 2. Have you satisfied all the requirements of Rev. Proc. 2004–4 or its successors (especially concerning signatures and penalties of perjury statement)? (See section 3.03(1))

__________ 3. Have you included statement of proposed deletions? (See section 3.03(2))

__________ 4. Have you included the user fee required under Rev. Proc. 2004–8 or its successors? (See section 3.02)

__________ 5. Have you included a copy of the written notification that an application for an extension of an amortization period has been submitted and a statement that such notice was hand delivered or mailed to each employee organization, participant, beneficiary and alternate payee? (See section 3.03(3) and Appendix A)

__________ 6. Have you included the general facts concerning the employer? (See section 3.04(1))

__________ 7. Have you included a description of the employer’s financial condition? (See section 3.04(2))

__________ 8. Have you included information concerning the extension of the amortization period? (See section 3.04(3))

__________ 9. Have you included information concerning the pension plan? (See section 3.04(4))

__________ 10. Have you included information concerning other pension, profit-sharing, or stock bonus plans of the employer? (See section 3.04(5))

__________ 11. Have you included information concerning other matters pertaining to the plan? (See section 3.04(6))

August 2, 2004 139 2004–31 I.R.B.

Signature Date

Title or Authority

Typed or printed name of person signing checklist

to the form, including draft instructions until such instructions are finalized) with the corporation’s timely-filed original tax return (including extensions) for the taxable year is deemed to satisfy the disclosure requirements of § 1.6011–4 with respect to transactions described in § 1.6011–4(b)(6) for that taxable year.

.02 Taxpayer not required to complete Schedule M–3 for a taxable year ending on or after December 31, 2004 . A taxpayer that is required to disclose reportable transactions under § 1.6011–4 with respect to transactions described in § 1.6011–4(b)(6), but is not required to complete Schedule M–3, for a taxable year ending on or after December 31, 2004, will continue to be subject to the disclosure requirements of § 1.6011–4. However, the taxpayer is deemed to satisfy the disclosure requirements of § 1.6011–4 with respect to transactions described in § 1.6011–4(b)(6) for a taxable year ending on or after December 31, 2004, if the taxpayer complies with the alternative disclosure procedures described in section 4.04 of this revenue procedure for that taxable year.

.03 Alternative disclosure procedures for a taxable year ending before Decem- ber 31, 2004, for transactions entered into on or after January 1, 2003 . For a taxable year ending before December 31, 2004, a taxpayer required to disclose reportable transactions under § 1.6011–4 with respect to transactions described in § 1.6011–4(b)(6) that were entered into on or after February 28, 2003, is deemed to satisfy the disclosure requirements of § 1.6011–4 with respect to those transactions if the taxpayer complies with the alternative disclosure procedures described in section 4.04 of this revenue procedure. These rules also may be relied upon for taxable years ending before December 31, 2004, with respect to transactions entered into on or after January 1, 2003, and before

26 CFR 601.105: Examination of returns and claims for refund, credit, or abatement; determination of correct tax liability. (Also, Part I, § 6011; 1.6011–4.)

Rev. Proc. 2004–45