14568-A

Model VCP Compliance Statement - Schedule 1: Plan Document Failures for 403(b) Plans

Agency
IRS
Revision
Rev. 7-2023
Fillable fields
18
Pages
2
Official source
IRS form page
Checked
October 21, 2026
Fill 14568-A online
Page 1 of form 14568-A

Form 14568-A: Model VCP Compliance Statement, Schedule 1 for 403(b) Plans

Form 14568-A is the Model VCP Compliance Statement, Schedule 1: Plan Document Failures for 403(b) Plans. It describes how a plan under Internal Revenue Code (IRC) Section 403(b) did not meet the written plan requirement or later required amendment deadlines, and how the failure was corrected.

The statement is completed for the plan by the Applicant (or the plan sponsor), not by plan participants. Section I identifies the failures, Section II describes the proposed method of correction, Section III covers changes in administrative procedures, and Section IV lists the documents enclosed with the VCP submission.

The form says to include the plan name, Applicant's EIN and plan number on each page, including attachments. This page hosts the July 2023 revision. You can fill out the PDF free in your browser on this page and download it without an account.

What's on Form 14568-A

Plan identification

Plan name, Applicant's EIN and plan number, repeated at the top of page 2 and on each attachment.

Section I, part A: all 403(b) plans

Boxes for the written plan requirement under IRC Section 403(b), the final regulations and Notice 2009-3, and for the initial remedial amendment period under Revenue Procedures 2017-18 and 2019-39 and Notice 2020-35.

Section I, part B: individually designed plans

Boxes for Required Amendments List changes not timely adopted, amendments required for a favorable determination letter, and other failures.

Section II: proposed correction

Three prewritten methods: adopting a written plan retroactively, adopting an updated plan document for the initial remedial amendment period, and adopting other necessary amendments.

Section III: administrative procedures

Space for the steps the plan sponsor has taken (or will take) to ensure that the failures will not recur.

Section IV: enclosures

A list of the signed and dated plan documents, amendments or restatements to enclose for each type of failure.

How to fill out Form 14568-A

  1. 1

    Identify the plan

    Enter the plan name, Applicant's EIN and plan number on page 1 and page 2. The form says to include them on each page of the compliance statement, including attachments.

  2. 2

    Section I

    Check each failure that applies. For Required Amendments List changes, the form says to list each item, the year of the Required Amendments List and the IRS Notice that includes it.

  3. 3

    Label attachments

    Label extra pages as the form says, for example "Section I of Form 14568-A, Identification of Plan Document Failure for IRC 403(b) plans", with the plan name, Applicant's EIN and plan number at the top of each page.

  4. 4

    Section II

    Check the correction method that matches each failure. For a written plan not timely adopted, the form describes a plan adopted retroactive to the later of the effective date of the final 403(b) regulations or the initial effective date of the plan.

  5. 5

    Section III

    Describe the steps the plan sponsor has taken or will take so the failures do not recur.

  6. 6

    Section IV

    Enclose the documents the form lists, such as a copy of the signed and dated written 403(b) plan, or the signed and dated amendments or restatement together with the signed plan in effect before the amendments.

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Where it goes and what to include

Where it goes

The form says the documents are enclosed with the VCP submission. The PDF does not print a mailing address or a filing deadline.

Every page identified

The plan name, Applicant's EIN and plan number go on each page of the compliance statement, including attachments.

Signed and dated documents

Section IV calls for signed and dated plan documents, amendments or restatements, depending on the failure being corrected.

Paperwork Reduction Act

The form says to see the current EPCRS Revenue Procedure for Paperwork Reduction Act information.

Related forms

Who completes Form 14568-A?

  • Applicants and plan sponsors

    Section II says the Applicant (or the plan sponsor) adopted the written plan or amendments, and Section IV says the plan sponsor encloses the documents with the VCP submission.

  • All 403(b) plans

    Part A of Section I covers the written plan requirement and the initial remedial amendment period for 403(b) pre-approved and individually designed plans that ended on June 30, 2020.

  • Individually designed plans

    Part B covers Required Amendments List changes first occurring after March 31, 2020 that were not timely adopted, and amendments required for a favorable determination letter.

  • Other plan document failures

    An Other box covers a 403(b) plan document failure not listed in parts A and B, described on an attachment.

  • Not for plan participants

    The statement describes the plan and the sponsor's corrections. It asks nothing of individual participants and is not something a participant files.

The form refers throughout to the Applicant (or the plan sponsor) of a 403(b) plan. The statement goes to the IRS as part of the plan's VCP submission.

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Questions about Form 14568-A

Who completes Form 14568-A?

The form refers to the Applicant (or the plan sponsor) of a 403(b) plan, who describes the plan's failures and corrections and encloses the documents with the VCP submission.

Which failures does Form 14568-A cover?

Plan document failures for 403(b) plans: the written plan requirement, the initial remedial amendment period that ended on June 30, 2020, Required Amendments List changes for individually designed plans, amendments for a favorable determination letter, and other plan document failures.

What goes on each page?

The form says to include the plan name, Applicant's EIN and plan number on each page of the compliance statement, including attachments.

What documents are enclosed?

Section IV lists a signed and dated written 403(b) plan, signed and dated amendments or restatements, and, for a missed initial remedial amendment period, a copy of the signed written plan in effect before the amendments.

Are there separate instructions?

The form prints its directions inside each section and refers to the current EPCRS Revenue Procedure for Paperwork Reduction Act information.