Employee Benefits Security Administration

Fee Disclosure Failure Notice

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General Instructions

Before beginning, you may want to locate a copy of your plan's most recent Annual Report/Return (Form 5500 or Form 5500-SF). If you do not have a copy available, you can use the Department of Labor’s Form 5500/Form 5500-SF Filing Search webpage to locate a copy.

The Annual Report should contain information which will help you complete your Fee Disclosure Failure Notice. Some of this information will be on the first page of your Annual Report, and other information will be in Schedule C. However, if your plan is small (generally those with less than 100 participants), you are not required to file a Schedule C. For those filers, your service provider contract or other documentation provided by your service provider may be helpful to you in completing your filing.

Fill in the information requested on the following pages. Once you have completed and filed your notice, you will receive immediate confirmation that your notice has been received by the Office of Enforcement of the Department of Labor’s Employee Benefits Security Administration. Use the "Print Confirmation and Summary" button to print your confirmation of receipt and a summary of your notice for your records. Keep in mind that once you exit the filing web page, you will not be able to retrieve a copy of your filing from the Department of Labor. If you would like to receive an electronic copy of your confirmation and a summary of your notice, you can provide your email address in your filing for this purpose.

This notice includes mandatory fields (denoted by a red asterisk *) that help you provide the information required by the class exemption. You will not be able to file the notice unless the required information is provided.

U.S. Department of Labor | Frances Perkins Building, 200 Constitution Avenue, NW, Washington, DC 20210
www.dol.gov | Telephone: 1.866.4.USA-DOL (1.866.487.2365) | TTY: 1.877.889.5627