Paperwork Burden Disclosure Notice
OMB Control Number 1210-0118; expires 03/31/2028
The Department is providing this model notice to facilitate compliance with the notice requirements in PTE 2002-51. The model notice is a collection of information instrument subject to the Paperwork Reduction Act. Use of the model notice to meet the notice requirements is optional. You may also develop your own notice, provided it contains all the information required by PTE 2002-51. The Department of Labor estimates that it will take an average of approximately one hour for plan administrators to complete the notice. You may send comments on this collection of information, including suggestions for reducing burden to: US Department of Labor, Office of Research and Analysis, Attention: PRA Officer, 200 Constitution Avenue, NW, Room N-5718, Washington, DC 20210; or send to ebsa.opr@dol.gov. The public is not required to respond to a collection of information unless it displays a currently valid OMB control number.
Do not include this Paperwork Reduction Act banner in notices
Dear [Participant or Beneficiary],
The purpose of this letter is to notify you that the [Insert Name of Applicant] is participating in the U.S. Department of Labor’s Voluntary Fiduciary Correction (VFC) Program with respect to the [Insert Name of Plan]. The VFC Program is a voluntary enforcement program that encourages the correction of possible breaches of Title I of the Employee Retirement Income Security Act (ERISA).
ERISA is the federal law that covers most employee benefit plans in the private sector. The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) enforces many parts of ERISA. If the terms and conditions of the VFC Program are met by [Insert Name of Applicant], EBSA will not initiate a civil investigation under Title I of ERISA with respect to the transaction and voluntary correction described below.
The VFC Program is accompanied by a “class exemption” from certain excise taxes imposed under the Internal Revenue Code on parties participating in “prohibited transactions” as defined in ERISA and the Code. The purpose of the prohibited transaction rules is to prevent dealings with persons or entities that may be in a position to exercise improper influence over employee benefit plan assets including [Name of the Plan]. If the terms of the class exemption are met, [Insert Name of Applicant] will qualify for relief from the excise taxes that would otherwise apply.
One of the requirements for excise tax relief is for [Insert Name of Applicant] to provide you with this notice so you have an opportunity to provide comments to EBSA about the prohibited transaction and the steps taken to correct the prohibited transaction, both of which are described below. To the extent that you are interested in providing your written comments to EBSA, you may contact them [Insert the Name of the Appropriate EBSA Regional Office from the VFC Program Notice, Appendix C]. The written comments should be made to the attention of the “VFC Program Coordinator.” The address and telephone number for this office are [Insert from VFC Program Notice, Appendix C]. You have 30 calendar days, beginning on the date this notice was distributed, to provide written comments. Individuals submitting written comments on this matter are advised not to disclose sensitive personal data such as social security numbers.
[Insert An Objective Description of the Transaction and the Steps Taken to Correct the Transaction]
Please feel free to contact me if you have any questions at [Insert Telephone Number of a Person Employed by the Applicant Who Is Knowledgeable About this Matter].
Sincerely,
[Insert Name and Title of Person Employed by the Applicant]