Form 8717 User Fee for Employee Plan Determination Letter Request

Version A, Cycle 1

Form

8717

User Fee for Employee Plan Determination,
Opinion, and Advisory Letter Request

(Rev. May 2011)
▶ Attach to determination letter application.
Department of the Treasury
▶ For the latest information about this form, go to www.IRS.gov/form8717.
Internal Revenue Service
1 Name of plan sponsor (employer if single-employer plan)
2 Sponsor’s employer identification number

3 Plan number

For
IRS
Use
Only

OMB No. 1545–1772

Amount paid

4 Plan name

Caution. If you qualify for the exemption from user fees for small business employers, complete only the certification below (see the instructions
on page 2 for details). For all other applications, leave the certification blank and check the appropriate box in column A or B of line 5.

Certification
I certify that the application for a determination letter on the qualified status of the plan listed above meets the conditions for
exemption from user fees described in section 620 of the Economic Growth and Tax Relief Reconciliation Act of 2001.
Date ▶

Sign Here ▶
Type or print name and title ▶

Fee Schedule
A
B
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6

Form Submitted

Attach Check or Money Order Here

5a
b
c
d
e

Form 5300:
Form 5307:
Form 5310:

$ 4,500
$ 1,800
$ 4,000

DRAFT AS OF
May 5, 2011

Multiple employer plans (Form 5300):
(1) $ 5,000
(1) 2 to 10 Forms 5300 submitted . . . . . . . . . . . . . .
(2) $ 5,000
(2) 11 to 99 Forms 5300 submitted . . . . . . . . . . . . .
(3) $ 25,000
(3) 100 to 499 Forms 5300 submitted . . . . . . . . . . . . .
(4) $ 25,000
(4) Over 499 Forms 5300 submitted . . . . . . . . . . . . .
f Multiple employer plans (Form 5310):
(1) $ 5,000
(1) 2 to 10 employers maintaining the plan . . . . . . . . . . .
(2) $ 5,000
(2) 11 to 99 employers maintaining the plan
. . . . . . . . . .
(3) $ 25,000
(3) 100 to 499 employers maintaining the plan . . . . . . . . . .
(4) Over 499 employers maintaining the plan . . . . . . . . . .
(4) $ 25,000
g Volume submitter:
(1a) Specimen plan (nonmass) with no/one adoption agreement . . . . . . . . . . .
(1b) Specimen plan (nonmass) - per each additional adoption agreement . . . . . . . .
(2a) Mass submitter specimen plan with no/one adoption agreement
. . . . . . . . .
(2b) Mass submitter - per each additional adoption agreement . . . . . . . . . . . .
(3) Specimen plan identical to mass submitter specimen plan
. . . . . . . . . . .
(4) Assumption of sponsorship of an approved specimen plan - per basic plan document . .
h Master & Prototype (M&P):
(1a) Mass submitter - per basic plan document with one adoption agreement . . . . . . .
(1b) Mass submitter - per each additional adoption agreement . . . . . . . . . . . .
(2) Sponsor’s identical adoption of mass submitter basic plan document - per adoption agreement . .
(3) Sponsor’s minor modification of mass submitter basic plan document - per adoption agreement . .
(4a) Nonmass submitter - per basic plan document with one adoption agreement . . . . .
(4b) Nonmass submitter - per each additional adoption agreement . . . . . . . . . .
(5) Advisory letter for additional optional provisions - per mass submitter basic plan document .
(6) Assumption of sponsorship of an approved M&P plan - per basic plan document . . . .
. . .
(7) Mass submitter/non-mass submitter sponsor - per trust document in excess of 10
i Group trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cat. No. 64727O

$ 2,500
$
300
$ 2,000

(1)
(2)
(3)
(4)

$
$
$
$

3,000
3,000
15,000
15,000

(1)
(2)
(3)
(4)

$
$
$
$

3,000
3,000
15,000
15,000

(1a)
(1b)
(2a)
(2b)
(3)
(4)

$
$
$
$
$
$

12,000
9,500
12,000
1,000
300
300

(1a)
(1b)
(2)
(3)
(4a)
(4b)
(5)
(6)
(7)

$
$
$
$
$
$
$
$
$
$

12,000
1,000
300
1,000
12,000
9,500
1,000
300
1,000
1,000

Form 8717 (Rev. 5-2011)

Version A, Cycle 1
Page 2

Form 8717 (Rev. 5-2011)

What’s New

Where To File

The user fees have been updated in
accordance with Rev. Proc. 2011-8, 2011-1
I.R.B. 237, corrected by announcement
2011-8, 2011-5 I.R.B. 446.

Include Form 8717 and user fee with your request or application. See the table below.

Instructions
(Section references are to the Internal
Revenue Code unless otherwise noted.)
Generally, a user fee is required with each
application for a determination letter. The
user fees are shown on page 1. For more
information, see Rev. Proc. 2011-8, 2011-1
I.R.B. 237, corrected by announcement
2011-8, 2011-5 I.R.B. 446; Rev. Proc.
2005-16, 2005-10 I.R.B. 674; Rev. Proc.
2007-44, 2007-28 I.R.B. 54; and Rev. Proc.
2008-56, 2008-40 I.R.B. 826.

Effective Date

IF you have this type of
request or application . . .

THEN use this address if you send it by:

Exemption from User Fee
The exemption from the user fee applies to
all eligible employers (defined below) who
request a determination letter within the first
five plan years or, if later, the end of the
remedial amendment period that begins
within the first five plan years with respect to
a plan. Under section 620 of the Economic
Growth and Tax Relief Reconciliation Act of
2001 (EGTRRA), an application for a defined
contribution plan from an eligible employer
for a plan that was first effective on or after
January 2, 1997, will automatically meet this
requirement. An application for a defined
benefit plan from an eligible employer for a
plan that was first effective on or after January
3, 1996, will automatically meet this
requirement. See Notice 2002-1, 2002-1 C.B.
283 as amplified by Notice 2003-49, 2003-2
C.B. 294.

Express Mail or
private delivery service

Determination letter
Internal Revenue Service
(Form 5307, 5300, 5310, 5310-A, P.O. Box 12192
and group trust applications)
Covington, KY 41012-0192

Internal Revenue Service
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011

Volume submitter plan or
Internal Revenue Service
Master or Prototype plan
P.O. Box 2508
(Forms 4461, 4461-A, or 4461-B) Attn: Pre-Approved Plans
Coordinator
Room 5106
Cincinnati, OH 45201

Internal Revenue Service
550 Main Street
Attn: Pre-Approved Plans
Coordinator
Room 5106
Cincinnati, OH 45202

Payment of User Fee

The user fee schedule in Form 8717 is
effective for opinion, advisory, and
determination letter applications postmarked
on or after February 1, 2011.

US mail

If you do not meet the conditions for
exemption discussed above, a user fee is due.
Check the appropriate box in column A of
line 5 if (a) your plan uses the average benefit
test to satisfy minimum coverage
requirements and/or the general test to
demonstrate nondiscrimination in the amount
of contributions or benefits, and (b) you want
to receive a determination letter that covers
these issues (that is, your application includes
Schedule Q (Form 5300), Elective
Determination Requests and a demonstration
labeled Demo 5 and/or Demo 6).

plan approved by the IRS, you are required to
give us the information. We need it to
determine whether you meet the legal
requirements for plan approval. Section 7528
authorizes us to charge a user fee; section
6109 requires you to provide your identifying
number.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB control
number. Books or records relating to a form
or its instructions must be retained as long as
their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information
are confidential, as required by section 6103.
However, section 6103 allows or requires us
to disclose this information to the Department
of Justice and to other federal agencies as
provided by law. We may also give it to cities,
states, the District of Columbia, and U.S.
commonwealths or possessions to carry out
their tax laws. We may give it to certain
foreign countries under tax treaties, to federal
and state agencies to enforce federal nontax
criminal laws, or to federal law enforcement
and intelligence agencies to combat terrorism.

DRAFT AS OF
May 5, 2011

An eligible employer as defined in section
408(p)(2)(C)(i)(l) is an employer which had no
more than 100 employees who received at
least $5,000 of compensation from the
employer for the preceding year. In addition,
an eligible employer must have at least one
employee who is not a highly compensated
employee (as defined in section 414(q)) and is
participating in the plan.
The determination of whether an employer
is an eligible employer under this section is
made as of the date of the request described
above. If your application meets these
requirements, complete only the Certification.
Do not complete any part of line 5.

Check the appropriate box in column B of
line 5 if you do not want to receive a
determination letter that covers the average
benefit test and/or the general test (that is, the
plan is not required to use these tests or you
do not want these issues considered). A
general test plan is a plan that is other than a
design-based safe harbor or nondesignbased safe harbor plan.
Attach a check or money order payable to
the “United States Treasury” for the full
amount of the user fee to Form 8717, if
applicable. If you do not include the full
amount, your application may be returned.
Attach Form 8717 to your determination letter
application.
If you have multiple plans (for example, a
profit-sharing plan and a money purchase
plan), submit a separate determination letter
application and Form 8717 for each plan.
Privacy Act and Paperwork Reduction Act
Notice. We ask for the information on this
form to carry out the Internal Revenue laws of
the United States. If you want to have your

The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is
4 hours, 21 minutes.
If you have comments concerning the
accuracy of this time estimate or suggestions
for making this form simpler, we would be
happy to hear from you. You can write to the
Internal Revenue Service, Tax Products
Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
NW, IR-6526, Washington, DC 20224. Do not
send this form to this address. Instead, see
Where To File above.