Partial Plan Termination Assessment Form
Use this form to assess and review a request to partially terminate a plan. Please answer each section to provide a comprehensive evaluation.
Plan Name or Identifier
*
Requestor's Name
*
Date of Termination Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Plan Affected
*
Please Select
Defined Benefit
Defined Contribution
Other
Primary Reason for Partial Termination
*
Organizational Restructuring
Reduction in Workforce
Plan Merger or Spin-off
Other
Estimated Percentage of Plan to be Terminated
*
0%
0
1
2
3
4
5
6
7
8
9
100%
10
0 is 0%, 10 is 100%
Impact Assessment: Please rate the expected impact on plan participants.
*
1
2
3
4
5
Assessment of Communication to Affected Participants
*
Rows
Not Initiated
In Progress
Completed
Notification Sent
1
2
3
Support Provided
4
5
6
Feedback Collected
7
8
9
Please provide any additional relevant details regarding the partial termination request.
Overall Assessment: Do you recommend approval of this partial plan termination?
*
Recommend Approval
Do Not Recommend Approval
Recommend Further Review
Submit Assessment
Should be Empty: