14568-D

Model VCP Compliance Statement - Schedule 4 SIMPLE IRAs

Agency
IRS
Revision
Rev. 7-2023
Fillable fields
142
Pages
6
Official source
IRS form page
Checked
October 21, 2026
Fill 14568-D online
Page 1 of form 14568-D

Form 14568-D: Model VCP Compliance Statement, Schedule 4 SIMPLE IRAs

Form 14568-D is the Model VCP Compliance Statement, Schedule 4, for SIMPLE IRAs. It describes failures that occurred in a SIMPLE IRA plan and the proposed method of correcting each one, as part of a VCP submission filed with the IRS. The form says to include the plan name, the Applicant's EIN and the plan number on each page, including attachments.

Section I covers five failure types: employer eligibility, failure to make required employer contributions, failure to provide eligible employees with the opportunity to make elective deferrals, excess amounts contributed, and a written arrangement not timely updated for tax law changes. Each one prints its proposed method of correction. Sections II to IV cover changes in administrative procedures, a request for excise tax relief and the enclosures.

For Paperwork Reduction Act information, the form points to the current EPCRS Revenue Procedure. You can fill out Form 14568-D free in your browser on this page and download the result without an account.

What's on Form 14568-D

Header on each page

Plan name, Applicant's EIN and plan number, repeated at the top of every page.

Section I, A: Employer eligibility failure

For a sponsor that had more than 100 employees who earned $5,000 or more in compensation, or that maintained another tax favored retirement plan. The correction states that all contributions ceased as of a date entered.

Section I, B and C: Missed contributions and deferrals

B covers required employer contributions not made, under a 2% nonelective or a matching formula. C covers eligible employees not given the opportunity to make elective deferrals, corrected at 1.5% of compensation adjusted for earnings.

Section I, D and E: Excess amounts and plan updates

D covers excess amounts contributed, corrected by distribution or return, with a separate box for excess amounts of $250 or less. E covers a plan not timely updated for EGTRRA as required by Revenue Procedure 2002-10.

Sections II and III

Section II explains how and why the failures arose and the measures to keep them from recurring. Section III is a box requesting relief from the excise tax under IRC Section 4972.

Section IV: Enclosures

A list of what to enclose: the plan document, a written explanation, any updated EGTRRA document, calculations for corrective contributions or distributions, and explanations for excise tax relief.

How to fill out Form 14568-D

  1. 1

    Fill in the header

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

  2. 2

    Check each failure

    In Section I, check each failure that applies, check the boxes inside it and enter the plan years. For failure B, check the contribution formula the plan document required.

  3. 3

    Enter the amounts

    Enter the total corrective contribution or distribution for each year, and for failure D the number of participants affected. Check one earnings method: actual investment results, the rate in the Department of Labor's VFCP Online Calculator, or a combination.

  4. 4

    Former employees

    Check whether former employees are affected and, if so, describe the actions the plan sponsor will take to locate those who cannot be found.

  5. 5

    Sections II and III

    Explain how and why the failures arose and the measures to keep them from recurring. Check Section III only to request excise tax relief, and the form says to enclose a written explanation supporting it.

  6. 6

    Gather the enclosures

    Assemble the items Section IV lists, including the plan document in effect at the time of the failures and the supporting calculations. The form says to use estimates, including an estimated correction date, if corrections are not yet made.

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Where it goes and key amounts

Where it goes

The compliance statement is part of a VCP submission filed with the IRS. The form prints no mailing address.

Contribution cutoff

For an employer eligibility failure, the date contributions ceased is a date no later than the date the VCP submission is filed with the IRS, the form says.

Excess amounts of $250 or less

The form says that when a participant's total excess amount is $250 or less before earnings, the excess amount will not be distributed.

Returned employer contributions

The form says the amount returned to the plan sponsor is reported on Form 1099-R as a distribution to the affected participant with the taxable amount as zero, and the sponsor is not entitled to a deduction for it.

Paperwork Reduction Act

The form points to the current EPCRS Revenue Procedure.

Related forms

Who fills out Form 14568-D?

  • The Applicant

    The Applicant's EIN goes on every page. Section III is the Applicant's request that the IRS not pursue the excise tax under IRC Section 4972.

  • The plan sponsor

    The proposed corrections are actions of the plan sponsor: stopping contributions, making corrective contributions adjusted for earnings, or distributing or returning excess amounts.

  • Employees the corrections cover

    Eligible employees who were excluded or not given the chance to defer receive corrective contributions. The form says a SIMPLE IRA is established for an affected employee who does not have one.

  • Former employees and beneficiaries

    Boxes show whether former employees are affected and, if so, the steps the plan sponsor will take to locate those who cannot be found after a mailing to the last known address.

  • The IRS

    The form refers to the date the VCP submission is filed with the IRS, and the compliance statement is part of that submission.

The form is completed for a SIMPLE IRA plan as part of a VCP submission. Its correction text describes what the plan sponsor has done or will do.

Official sources and the blank

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Questions about Form 14568-D

What is Form 14568-D used for?

It is Schedule 4 of the model VCP compliance statement, for SIMPLE IRAs. It lists failures in a SIMPLE IRA plan and the proposed method of correction for each.

Which failures does it cover?

Employer eligibility failures, failure to make required employer contributions, failure to provide eligible employees with the opportunity to make elective deferrals, excess amounts contributed, and a written arrangement not timely updated for tax law changes.

How is a missed deferral opportunity corrected?

The form says the corrective contribution is 50% of an assumed deferral of 3% of compensation, which equals 1.5% of compensation, adjusted for earnings.

How are earnings figured?

The form offers actual investment results of the employee's SIMPLE IRA, the interest rate in the Department of Labor's VFCP Online Calculator when actual earnings cannot be ascertained, or a combination of both.

What goes with the statement?

Section IV lists the plan document in effect at the time of the failures, a written explanation, any updated EGTRRA document, supporting calculations, and explanations for excise tax relief requests.