(a) General. In accordance with section 103(a)(2) of the Act, an
insurance carrier or other organization which provides benefits under
the plan or holds plan assets, a bank or similar institution which holds
plan assets, or a plan sponsor shall transmit and certifty such
information as needed by the administrator to file the annual report
under section 104(a)(1) of the Act and Sec. 2520.104a-5 or Sec.
2520.104a-6:
(1) Within 9 months after the close of the plan year which begins in
1975 or September 30, 1976, whichever is later, and
(2) Within 120 days after the close of any plan year which begins
after December 31, 1975.
(b) Application. This requirement applies with respect to--
(1) An insurance carrier or other organization which:
(i) Provides from its general asset account funds for the payment of
benefits under a plan, or
(ii) Holds assets of a plan in a separate account;
(2) A bank, trust company, or similar institution which holds assets
of a plan in a common or collective trust, separate trust, or custodial
account; and
(3) A plan sponsor as defined in section 3(16)(B) of the Act.
(c) Contents. The information required to be provided to the
administrator shall include--
(1) In the case of an insurance carrier or other organization which:
(i) Provides funds from its general asset account for the payment of
benefits under a plan, upon request of the plan administrator, such
information as is contained within the ordinary business records of the
insurance carrier or other organization and is needed by the plan
administrator to comply with the requirements of section 104(a)(1) of
the Act and Sec. 2520.104a-5 or Sec. 2520.104a-6;
(ii) Holds assets of a plan in a pooled separate account and files a
Form 5500 report pursuant to Sec. 2520.103-9 for the participating
plan's plan year--
(A) A copy of the annual statement of assets and liabilities of the
separate account for the fiscal year of such account ending with or
within the plan year for which the participating plan's annual report is
made,
(B) A statement of the value of the plan's units of participation in
the separate account,
(C) The Employer Identification Number (EIN) of the separate
account, entity number required for purposes of completing the Form 5500
and any other identifying number assigned by the insurance carrier to
the separate account,
(D) A statement that a filing pursuant to Sec. 2520.103-9(c) will
be made for the separate account (for its fiscal year ending with or
within the participating plan's plan year) on or before the filing due
date for such account in accordance with the Form 5500 instructions, and
(E) Upon request of the plan administrator, any other information
that can be obtained from the ordinary business records of the insurance
carrier and that is needed by the plan administrator to comply with the
requirements of section 104(a)(1) of the Act and Sec. 2520.104a-5 or
Sec. 2520.104a-6;
(iii) Holds assets of a plan in a pooled separate account and does
not file a Form 5500 report pursuant to Sec. 2520.103-9 for the
participating plan's plan year--
(A) A copy of the annual statement of assets and liabilities of the
separate
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account for the fiscal year of such account that ends with or within the
plan year for which the participating plan's annual report is made,
(B) A statement of the value of the plan's units of participation in
the separate account,
(C) The EIN of the separate account and any other identifying number
assigned by the insurance carrier to the separate account,
(D) A statement that a filing pursuant to Sec. 2520.103-9(c) will
not be made for the separate account for its fiscal year ending with or
within the participating plan's plan year, and
(E) Upon request of the plan administrator, any other information
that can be obtained from the ordinary business records of the insurance
carrier and that is needed by the plan administrator to comply with the
requirements of section 104(a)(1) of the Act and Sec. 2520.104a-5 or
Sec. 2520.104a-6.
(iv) Holds assets of a plan in a separate account which is not
exempted from certain reporting requirements under Sec. 2520.103-4, a
listing of all transactions of the separate account and, upon request of
the plan administrator, such information as is contained within the
ordinary business records of the insurance carrier and is needed by the
plan administrator to comply with the requirements of section 104(a)(1)
of the Act and Sec. 2520.104a-5 or Sec. 2520.104a-6.
(2) In the case of a bank, trust company, or similar institution
holding assets of a plan--
(i) In a common or collective trust that files a Form 5500 report
pursuant to Sec. 2520.103-9 for the participating plan's plan year--
(A) A copy of the annual statement of assets and liabilities of the
common or collective trust for the fiscal year of such trust ending with
or within the plan year for which the participating plan's annual report
is made,
(B) A statement of the value of the plan's units of participation in
the common or collective trust,
(C) The EIN of the common or collective trust, entity number
assigned for purposes of completing the Form 5500 and any other
identifying number assigned by the bank, trust company, or similar
institution,
(D) A statement that a filing pursuant to Sec. 2520.103-9(c) will
be made for the common or collective trust (for its fiscal year ending
with or within the participating plan's plan year) on or before the
filing due date for such trust in accordance with the Form 5500
instructions, and
(E) Upon request of the plan administrator, any other information
that can be obtained from the ordinary business records of the bank,
trust company or similar institution and that is needed by the plan
administrator to comply with the requirements of section 104(a)(1) of
the Act and Sec. Sec. 2520.104a-5 or 2520.104a-6.
(ii) In a common or collective trust that does not file a Form 5500
report pursuant to Sec. 2520.103-9 for the participating plan's plan
year--
(A) A copy of the annual statement of assets and liabilities of the
common or collective trust for the fiscal year of such account that ends
with or within the plan year for which the participating plan's annual
report is made,
(B) A statement of the value of the plan's units of participation in
the common or collective trust,
(C) The EIN of the common or collective trust and any other
identifying number assigned by the bank, trust company or similar
institution,
(D) A statement that a filing pursuant to Sec. 2520.103-9(c) will
not be made for the common or collective trust for its fiscal year
ending with or within the participating plan's plan year, and
(E) Upon request of the plan administrator, any other information
that can be obtained from the ordinary business records of the bank,
trust company or similar institution and that is needed by the plan
administrator to comply with the requirements of section 104(a)(1) of
the Act and Sec. Sec. 2520.104a-5 or 2520.104a-6.
(iii) In a trust which is not exempted from certain reporting
requirements under Sec. 2520.103-3, a listing of all transactions of
the separate trust and, upon request of the plan administrator, such
information as is contained within the ordinary business records of the
bank, trust company, or similar institution
[[Page 408]]
and is needed by the plan administrator to comply with the requirements
of section 104(a)(1) of the Act and Sec. 2520.104a-5.
(iv) In a custodial account, upon request of the plan administrator,
such information as is contained within the ordinary business records of
the bank, trust company, or similar institution and is needed by the
plan administrator to comply with the requirements of section 104(a)(1)
of the Act and Sec. 2520.104a-5 or Sec. 2520.104a-6.
(3) In the case of a plan sponsor, a listing of all transactions
directly or indirectly involving plan assets engaged in by the plan
sponsor and such information as is needed by the plan administrator to
comply with the requirements of section 104(a)(1) of the Act and Sec.
2520.104a-5 or Sec. 2520.104a-6.
(d) Certification. (1) An insurance carrier or other organization, a
bank, trust company, or similar institution, or plan sponsor, as
described in paragraph (b) of this section, shall certify to the
accuracy and completeness of the information described in paragraph (c)
of this section by a written declaration which is signed by a person
authorized to represent the insurance carrier, bank, or plan sponsor.
Such certification will serve as a written assurance of the truth of the
facts stated therein.
(2) Example of Certification. The XYZ Bank (Insurance Carrier)
hereby certifies that the foregoing statement furnished pursuant to 29
CFR 2520.103-5(c) is complete and accurate.
[43 FR 10140, Mar. 10, 1978, as amended at 65 FR 21082, Apr. 19, 2000] 
