Form PR Form PR Registration Requirement to Serve as Pooled Plan Provide

U.S. Department of Labor
Employee Benefits Security
Administration
Room N5511
200 Constitution Avenue, NW
Washington, DC 20210
P-450

Instructions for Form PR

(Registration for Pooled Plan
Provider)
This package contains the following form and
related instructions:

Instructions for Form PR

Form PR
Department of Labor
Employee Benefits Security
Administration

Registration for Pooled Plan Provider

This filing is required under section 3(44) of the Employee Retirement Income
Security Act of 1974 (ERISA) and Section 413(e) of the Internal Revenue Code

OMB No.
1210-0164

Complete all entries in accordance with the instructions
This Form is Open
to Public Inspection

Part I

Filing Type

Check the appropriate box to indicate filing type (see instructions)
[] Initial Filing

[] Supplemental Reportable Event Filing

[] Amended Filing

[] Final Filing

Part II Registration Information
1a Legal business name and any trade (d/b/a) name of pooled plan provider

1b Pooled plan provider contact
telephone number
1c Pooled plan provider public website(s)
(see Instructions)

1d Mailing address

1e Pooled plan provider Employer
Identification Number (EIN)

1f(1) Identity of responsible compliance official.

1g Compliance official email address

1f(2) Mailing address for the responsible compliance official of the pooled plan
provider
1h Compliance official telephone number

1i Identity of agent for service of legal process for the pooled plan provider.
__________________________________________________________________________________________________________
1j Enter the address at which legal process may be served on the agent.

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2 Enter the approximate date the pooled plan provider expects to begin operating pooled employer plan(s) (use MM/DD/YYYY
format) __/__/__
3 Will the pooled plan provider or an affiliate offer or provide any products or services described in Lines 3a through 3f? [] Yes []
No
If you answer “Yes”, check each service or product that is being provided through the registrant or an affiliate and complete Lines
3a-f to indicate each service or investment product, with a separate entry to indicate each affiliate who provides such service or
product. For elements 3a-f, if such service is being provided by the pooled plan provider, rather than an affiliate, enter
“registrant” as the first entry in each element.
3a(1) [] Investment management, including selecting plan investment alternatives
(2) Enter name and EIN of each affiliate providing such service.
3b(1) [] Investment advice, including recommending plan investment alternatives
(2) Enter name and EIN of each affiliate providing such service.
3c(1) [] Investment products (propriety funds, annuities, etc.)
(2) Enter name and EIN of each affiliate providing such service.
3d(1) [] Plan administration
(2) Enter name and EIN of each affiliate providing such service.
3e(1) [] Custodial or trustee services
(2) Enter name and EIN of each affiliate providing such service.
3f(1) [] Other administrative, fiduciary or investment services (describe).
(2) Enter name and EIN of each affiliate providing such service.
____________________________________________________________________________
4a Are there any ongoing federal or state criminal proceedings, or have there been any criminal convictions (not including
convictions or related term of imprisonment served that are outside ten years of the date of registration statement), related to
the provision of services to, operation of, or investments of, any employee benefit plan against the pooled plan provider or any
officer, director, or employee of the pooled plan provider? [] Yes [] No
4b If you answer “Yes” to 4a, you must complete elements (1)-(3) in 4b for each such matter.
4b(1) Enter date of conviction, end of imprisonment, or start of ongoing proceeding, as applicable. ______________________
(2) Enter name of tribunal or court where action was concluded or is proceeding. _____________________________
(3) Enter caption and docket, case, or other identifying or tracking number.
_____________________________________________
5a Are there any ongoing civil or administrative proceedings in any court or administrative tribunal by the federal or state
government or other regulatory authority against the pooled plan provider, or any officer, director, or employee of the pooled
plan provider involving a claim of fraud or dishonesty with respect to any employee benefit plan, or involving the mismanagement
of plan assets?
[] Yes [] No
5b If you answer “Yes” to 5a, you must complete elements (1)-(4) in 5b for each such matter.
5b(1) Name of agency or other regulatory authority__________________________________________________
(2) Enter date of start of proceeding_____________________________________________________________________
(3) Enter name of tribunal or court where action is proceeding. _____________________________________
(4) Enter caption and docket, case, or other identifying or tracking number._______________________________________

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Part III Supplemental Reportable Event Information

6a Type of Supplemental Information.
Check which supplemental information is being reported (see instructions).
6a(1) [] Change in information previously reported (line 6b)
(2) [] New or terminating pooled employer plan (line 7)
(3) [] Other change in pooled plan provider circumstances (line 8)
(4) [] Removal of criminal information based on acquittal (line 6b) (see instructions)
You may report multiple changes in the same supplemental registration, as long as you meet the timing requirements for
reporting each change, including the timing of beginning operations of a plan as a pooled employer plan (see instructions).
6b Change in Information Previously Reported. Enter the line number(s) on which you are providing changed information. (see
Instructions) Enter as many line numbers as applicable. ____________________________________________
7 Pooled Employer Plan Information. Enter the name and Plan Number (PN) for each pooled employer plan that the registrant
will begin operating, or has terminated, and the name, address, and EIN for the trustee for each such plan. Complete as many
entries as needed to identify all pooled employer plans. (see instructions)
7a Name of pooled employer plan __________________________________________________________
7b Plan number (PN) for pooled employer plan (see instructions) _____________________________
7c(1) Legal and d/b/a name of trustee for pooled employer plan _________________________
(2) Address of the trustee. ___________________________________
(3) EIN of trustee for pooled plan ___________________________________________
7d(1) Enter the date the plan will begin operating as a pooled employer plan____________________________
(2) Enter the date the plan was terminated and ceased operating as a pooled employer plan (if applicable)______________
8 Change in Pooled Plan Provider Circumstances. If the pooled plan provider has experienced an event described in Lines 8a
through 8g, you must check the appropriate box(es) and complete as many entries as needed to provide all the information.
(see instructions)
8a [] Merger
8a(1) Enter effective date of merger: __________________________________________
8a(2) Enter name of merged entity:___________________________________________
8b [] Acquisition
8b(1) Enter effective date of acquisition: __________________________________________
8b(2) Enter name of entity acquired:___________________________________________
8c [] Initiation of bankruptcy, receivership, or other insolvency proceeding for the pooled plan provider or an affiliate of the
pooled plan provider that provides services to any pooled employer plan
8c(1) Enter date of filing _________________________________________________________
(2) Enter name of court where action is proceeding. _________________________________
(3) Enter caption and docket, case, or other identifying or tracking number for the
proceeding._____________________________

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8d [] Cessation of operations as a pooled plan provider Enter Date_______________________________
8e [] Received written notice of the initiation of any administrative proceeding or enforcement action in any court or
administrative tribunal by any federal or state governmental agency or other regulatory authority, against the pooled plan
provider, or any officer, director, or employee of the pooled plan provider involving a claim of fraud or dishonesty with respect to
any employee benefit plan, or involving the mismanagement of plan assets. (see instructions). If you check this box, you must
complete lines 8e (1)-(4).
8e(1) Name of agency, state, other regulatory authority taking action _____________________
(2) Enter date proceeding initiated. _______________________________________________
(3) Enter name of court or other tribunal where action is proceeding. ___________________
(4) Identify caption and docket, case, or other identifying or tracking number for the proceeding. ___________
8f [] Received written notice of a finding involving a claim of fraud or dishonesty with respect to any employee benefit plan, or
involving the mismanagement of plan assets in any matter described in line 5a or 8e. If you check this box, you must complete
lines 8f (1)-(4).
8f(1) Name of agency, state, other regulatory authority, or other person taking action __________________________________
(2) Enter date of finding ________________________________________________________________
(3) Enter name of court or other tribunal where action is proceeding ______________________________________________
(4) Identify caption and docket, case, or other identifying or tracking number for the proceeding
________________________________
8g [] Received written notice of the filing of any federal or state criminal charges related to the provision of services to, operation
of, or investments of any pooled employer plan or other employee benefit plan against the pooled plan provider or any officer,
director, or employee of the pooled plan provider. If you check this box, you must complete lines 8g (1)-(4).
8g(1) Name of agency, state, other regulatory authority taking action ______________________
(2) Enter date proceeding initiated. ________________________________________________
(3) Enter name of court or other tribunal where action is proceeding. _____________________
(4) Identify caption and docket, case, or other identifying or tracking number for the proceeding. _____________________

Part IV Amended Filing
9 Amended Information. Enter the line number(s) that you amended. (see Instructions) Enter as many line numbers as
applicable. ________________________________________________________________________________________

SIGNATURE AND DATE: I hereby acknowledge that the pooled plan provider will serve as the named fiduciary and plan
administrator of its pooled employer plans. I also declare under penalties of perjury that I have examined this registration, and to
the best of my knowledge and belief, it is true, correct, and complete.

Sign
Here____________________________________________________________________________________
Sign and
Date

Spell Out
Name___________________________________________________________________________________
Date_______________________________

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Instructions for
Form PR (Registration

for Pooled Plan Provider)
About the Form PR

the Department of the Treasury. The effective date
for these provisions allows “pooled employer plans”
to begin operating on January 1, 2021.

The Form PR is used to report information for a
person or entity that intends to serve as a pooled
plan provider to pooled employer plans within the
meaning of sections 3(43) and 3(44) of the Employee
Retirement Income Security Act of 1974 (ERISA) and
section 413(e) of the Internal Revenue Code (the
Code). See 29 CFR 2510.3-44.

Under section 3(2) of ERISA, a pooled employer plan
is treated for purposes of ERISA as a single plan that
is a multiple employer plan. A “pooled employer
plan” is defined in section 3(43) of ERISA as a plan:
(1) that is an individual account plan established or
maintained for the purpose of providing benefits to
the employees of two or more employers, (2) that is a
qualified retirement plan or a plan funded entirely
with individual retirement accounts (IRA plan), and
(3) the terms of which must meet certain
requirements set forth in the statute. Specifically, the
plan document for the pooled employer plan must –
• designate a pooled plan provider and provide
that the pooled plan provider is a named
fiduciary of the plan;
• designate one or more trustees (other than an
employer in the plan) to be responsible for
collecting contributions to, and holding the

You must file the Form PR electronically through the
all-electronic ERISA Filing Acceptance System
(EFAST2). You cannot file a paper Form PR by mail
or other delivery service. Your Form PR will be
initially screened electronically.
For more information, see the instructions in Section
3-Electronic Filing.
For assistance with using the EFAST2 system or
completing the Form PR, call the EFAST2 Help Line
at 1-866-GO-EFAST (1-866-463-3278) (toll-free) or
access the EFAST2 (www.efast.dol.gov) or IRS
(www.irs.gov) websites. The EFAST2 Help Line is
available Monday through Friday from 8:00 am to
8:00 pm, Eastern Time.

Table of Contents
SECTION 1: WHO MUST FILE .................................... 6
SECTION 2: WHEN TO FILE ....................................... 8

SECTION 1: Who Must File

Registration ............................................................... 8
Supplemental Filing .................................................. 8

Any person who wishes to serve as a pooled plan
provider to one or more pooled employer plans must
file Form PR (Registration for Pooled Plan Provider)
with the Department of Labor and Department of the
Treasury. See ERISA sections 3(43) and 3(44) and
section 413(e) of the Code, enacted by the Setting
Every Community Up for Retirement Enhancement
Act of 2019 (SECURE Act), Division O of the Further
Consolidated Appropriations Act, 2020 (Pub. L. 11694) (December 20, 2019).

Amended Filing ......................................................... 8
Final Filing ................................................................ 8
SECTION 3: ELECTRONIC FILING............................. 8
Getting Started .......................................................... 8
SECTION 4: LINE-BY-LINE INSTRUCTIONS ............. 9
Part I-Filing Type ...................................................... 9

Note. “Person” for these purposes includes
corporations, partnerships, and sole proprietorships.

Part II-Registration Information ............................... 10

Section 3(44) of ERISA and section
413(e)(3)(A)(ii) of the Code establishes
requirements for “pooled plan providers,” including
a requirement that a person wishing to so act
must register with the Department of Labor and

Information .............................................................. 11

Part III-Supplemental Reportable Event
Part IV- Amended Filing.......................................... 13
PAPERWORK REDUCTION ACT NOTICE ............... 13

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•

•

•

•

assets of, the plan, and require the trustee(s)
to implement written contribution collection
procedures that are reasonable, diligent, and
systematic;
provide that each employer in the plan retains
fiduciary responsibility for the selection and
monitoring, in accordance with ERISA
fiduciary requirements, of the person
designated as the pooled plan provider and
any other person who is also designated as a
named fiduciary of the plan, and, to the
extent not otherwise delegated to another
fiduciary by the pooled plan provider (and
subject to the ERISA rules relating to selfdirected investments), the investment and
management of the portion of the plan’s
assets attributable to the employees of that
employer (or beneficiaries of such
employees) in the plan;
provide that employers in the plan, and
participants and beneficiaries, are not subject
to unreasonable restrictions, fees, or
penalties with regard to ceasing participation,
receipt of distributions, or otherwise
transferring assets of the plan in accordance
with applicable rules for plan mergers and
transfers;
require the pooled plan provider to provide to
employers in the plan any disclosures or
other information that the Secretary of Labor
may require, including any disclosures or
other information to facilitate the selection or
any monitoring of the pooled plan provider by
employers in the plan, and require each
employer in the plan to take any actions that
the Secretary of Labor or pooled plan
provider determines are necessary to
administer the plan or to allow for the plan to
meet the ERISA and Code requirements
applicable to the plan, including providing any
disclosures or other information that the
Secretary of Labor may require or that the
pooled plan provider otherwise determines
are necessary to administer the plan or to
allow the plan to meet such ERISA and Code
requirements; and
provide that any disclosure or other information
required to be provided to participating
employers may be provided in electronic form
and will be designed to ensure only reasonable
costs are imposed on pooled plan providers and
employers in the plan.

Note. The term “pooled employer plan” does not
include a multiemployer plan or plan maintained
by employers that have a common interest other
than having adopted the plan. The term also does
not include a plan established before the date the
SECURE Act was enacted unless the plan

administrator elects to have the plan treated as a
pooled employer plan and the plan meets the Code
and ERISA requirements applicable to a pooled
employer plan established on or after such date.
The fidelity bonding requirements in ERISA section
412 apply to fiduciaries and other persons handling
the assets of a pooled employer plan, but the
maximum bond amount for each pooled employer
plan official is $1,000,000 as compared to the
$500,000 maximum that applies in the case of other
ERISA-covered plans that do not hold employer
securities. See 29 CFR 2550.412-1, 29 CFR Part
2580; see also Field Assistance Bulletin 2008-04
(providing a general description of statutory and
regulatory requirements for bonding).
A “pooled plan provider” with respect to a pooled
employer plan is defined in ERISA section 3(44) to
mean a person that:
•

•
•

•

is designated by the terms of the pooled
employer plan as a named fiduciary under
ERISA, as the plan administrator, and as the
person responsible to perform all administrative
duties (including conducting proper testing with
respect to the plan and the employees of each
employer in the plan) that are reasonably
necessary to ensure that the plan meets the
Code requirements for tax-favored treatment
and the requirements of ERISA and to ensure
that each employer in the plan takes actions as
the Secretary or the pooled plan provider
determines necessary for the plan to meet Code
and ERISA requirements, including providing to
the pooled plan provider any disclosures or
other information that the Secretary may require
or that the pooled plan provider otherwise
determines are necessary to administer the plan
or to allow the plan to meet Code and ERISA
requirements;
acknowledges in writing its status as a named
fiduciary under ERISA and as the plan
administrator;
is responsible for ensuring that all persons who
handle plan assets of, or who are plan
fiduciaries are bonded in accordance with
ERISA requirements; and
registers as a pooled plan provider.

Filing a true, complete, and correct registration
statement, including any required updates, satisfies
the requirement under section 3(44) of ERISA to
register as a pooled plan provider with the
Department of Labor. Filing the Form PR also
satisfies the requirement under section
413(e)(3)(A)(ii) of the Code to register with the
Department of the Treasury.

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reportable events listed in Line 8. These
supplemental filings are due within the later of 30
days after the calendar quarter in which specified
reportable events occurred or 45 days after the
actual event. See 29 CFR 2510.3-44(b)(3).

SECTION 2: WHEN TO FILE
Registration (Initial Filing). You must file your
initial registration statement at least 30 days
before beginning operations as a pooled plan
provider. See 29 CFR 2510.3-44(b)(1). For this
purpose, a pooled employer plan is treated as
beginning operations when the first employer
executes or adopts a participation, subscription, or
similar agreement for the plan specifying that it is
a pooled employer plan, or, if earlier, when the
trustee of the plan first holds any assets in trust.
See 29 CFR 2510.3-44(b)(6).

Amended Filing. You may amend a filing at any time
if you discover a mistake in previously reported
information. This is called an “amended filing” and
differs from “supplemental filings,” which are more
formal changes. Amended filings must be submitted
as soon as is reasonable upon discovering an error
in your previous filing.
Final Filing. File the final Form PR filing within the
later of: (a) 30 days after the calendar quarter in
which the final Form 5500 for the last pooled
employer plan operated by the pooled plan provider
was filed, or (b) 45 days after such filing.

Note: Special Transition Provision Relief From
30-day Advance Filing Rule Only for Registrations
Before February 1, 2021. The final rule at 29 CFR
2510.3-44(c) contains a special provision that
allows an initial registration to be filed any time
before February 1, 2021, provided that it is filed
“on or before” the initiation of operations of a plan
as a pooled employer plan. This waives the
otherwise applicable 30-day waiting period
between initial registration and operating a plan.
The provision applies with respect to pooled plan
providers that initiate operations of a plan as a
pooled employer plan on or after January 1, 2021
and before February 1, 2021. After that date,
registrants must comply with the rule that the
initial registration must be filed at least 30 days
before the pooled plan provider begins operating.

SECTION 3: ELECTRONIC FILING
EFAST account needed: The Form PR must be filed
electronically with the Department of Labor through
EFAST2.

Getting Started:
Go to EFAST2 website at
https://www.efast.dol.gov/welcome.html.
Failure to file: You are not permitted to act as a
pooled plan provider unless you electronically file and
sign a registration statement in accordance with the
Department’s regulation at 29 CFR 2510.3-44 and
these instructions. You may be liable for breaches of
fiduciary duty under ERISA and other state and
federal law violations, including for misrepresentation
regarding status as a pooled plan provider. The
failure to file a required update does not
automatically result in a conclusion that, by operation
of law, the pooled employer plans administered by
the pooled plan provider are no longer single plans
but instead, a group of individual plans that use the
same arrangement for operating their plans.

Supplemental Filing to Report New Pooled
Employer Plan. You must supplement, in Line 7,
your initial or most recent registration statement
with the name and Plan Number for each pooled
employer plan you begin operating, including the
name, address, and EIN for the trustee for the
plan, if this information was not included in your
initial filing. This supplemental filing must be
made for any plan(s) before the first employer
executes or adopts a participation, subscription, or
similar agreement for the plan(s), or if earlier,
when the trustee(s) of the plan(s) first holds any
assets in trust.
Supplemental Filing to Report Termination of
Pooled Employer Plan. You must supplement, in
Line 7, your initial or most recent registration if you
terminate or cease operating any particular pooled
employer plan.
Other Supplemental Reportable Event Filings.
You must also supplement your registration
statement if there are any changes to the
information you provided in your initial registration
and also upon the occurrence of any of the

Identifying information and EIN: You must use the
same identifying information for the pooled plan
provider on Form PR that you use on the Form 5500
for each pooled employer plan you administer.
Specifically, lines 1a and 1e of this Form PR must
match lines 1a and 2b of Form 5500, respectively.
Signature and date: To satisfy the conditions of
section 3(44) of ERISA and 29 CFR 2510.3-44, you
must sign this registration statement, indicating that

8

the contents are true and correct to the best of the
signer’s knowledge. If you do not electronically
sign a filing, the filing status will indicate that there
is an error with the filing. If the pooled plan
provider is an entity, a person authorized to sign
on behalf of the pooled plan provider must
electronically sign the Form PR submitted to the
electronic filing system.

recent Supplemental Report Event Filing. In addition,
submit a Supplemental Reportable Event Filing to
identify the termination of a pooled employer plan.
Finally, submit a Supplemental Reportable Event Filing
to report certain changes in the pooled plan provider’s
status; the specific changes necessitating a
supplement of this type are set forth in 29 CFR 2510.344(b)(3) and described below in the portion of these
instructions dealing with Line 8. Check “Supplemental
Reportable Event Filing” in Part I, and on Line 6 (which
is in Part III) check the relevant box to identify why you
are supplementing your registration.

Retain your electronic receipt: A completed filing
will generate an online receipt. The pooled plan
provider must keep a copy of the receipt as part of
the plan’s records as required by section 107 of
ERISA.

Amended Filing. Check “Amended Filing” only if you
are correcting information previously reported on a
Form PR you filed; for example, if you entered an
incorrect name for the agent for service of legal
process for the pooled plan provider. Amended
filings are to correct inadvertent or good faith errors
and/or omissions on a previously filed Form PR, for
example, typographical errors and other matters that
do not constitute supplemental reportable events. To
make an amended filing, check the “Amended filing”
box in Part I. Then correct the previously reported
incorrect information, as necessary. Then, identify
on Line 9 (Part IV) the line or lines that you just
amended. For example, if amending the Form PR to
correct the name for the agent for service of legal
process, check “Amended Filing” in Part I. Then on
Line 1i, enter the correct information for the agent for
service of legal process. Then, on Line 9, enter “Line
1i.”

SECTION 4: LINE-BY-LINE
INSTRUCTIONS
Important: “Yes/No” questions must be marked
“Yes” or “No,” but not both. “N/A” is not an
acceptable response unless expressly permitted
in the instructions to that line. Your entries must
be in the proper format in order for the electronic
system to process your filing. For example, if a
question requires you to enter a number, you
cannot enter a word. Do not enter social security
numbers in response to questions asking for an
employer identification number (EIN). Because of
privacy concerns, the inclusion of a social security
number on the Form PR may result in the
rejection of the filing.

Final Filing. Once an entity has ceased operating all
pooled employer plans and terminated operations as
a pooled plan provider, the pooled plan provider must
submit a Final Filing. For purposes of the Form PR,
a pooled employer plan is treated as terminated and
having ceased operations when a resolution has
been adopted terminating the plan, all assets under
the plan (including insurance/annuity contracts) have
been distributed to the participants and beneficiaries
or legally transferred to the control of another plan,
and a final Form 5500 Annual Return/Report has
been filed for the plan. The Form PR Final Filing is
due within the later of (a) 30 days after the calendar
quarter in which the final Form 5500 for the last
pooled employer plan operated by the pooled plan
provider was filed, or (b) 45 days after such filing.
Check the “Final Filing” box, then complete Lines
7d(2) and 8(d).

Part I-Filing Type.
Check the appropriate box to indicate filing type.
There are four filing types.
Initial Filing. This is the registration statement for a
person that intends to serve as a pooled plan
provider to pooled employer plans. Only one
registration must be filed for each such person
regardless of the number of pooled employer plans
the pooled plan provider operates. Check “Initial
Filing” in Part I and complete Lines 1 through 5.
You also may complete Line 7 as part of the Initial
Filing if you know the information; otherwise Line 7
may be completed at a later date as part of a
“Supplemental Reportable Event Filing.”
Supplemental Reportable Event Filing. This is to
report certain information in addition to the
information reported in the Initial Filing or a previous
Supplemental Reportable Event Filing. For
example, submit a Supplemental Reportable Event
Filing to identify the start of a pooled employer plan,
if not already reported in the Initial Filing or most

Caution: You cannot submit a Form PR Final Filing
unless every pooled employer plan you administer
has met the conditions for and submitted a complete
final Form 5500 Annual Return/Report. See
Instructions for the Form 5500. A Form PR Final
Filing will not be valid unless a termination date is

9

entered in Line 7 for every pooled employer plan
that was operated by the registrant.

number or any portion thereof on the Form PR may
result in the rejection of the filing.

Part II-Registration Information.

Persons wishing to act as pooled plan providers that
are without an EIN must apply for one as soon as
possible. The Employee Benefits Security
Administration does not issue EINs. To apply for an
EIN from the IRS:

Make sure to use the same identifying information
as you use for other state and federal registration
and reporting requirements. Using different
information on the Form PR and on any of the
Forms 5500 for pooled employer plans operated
by the pooled plan provider could result in
correspondence from the agencies.

•
•

Line 1a. Enter the legal name of the person
(person includes both individuals and entities)
registering as the plan provider. If the person
uses a “trade” or “doing business as” name, also
enter that name (both the legal and trade (d/b/a)
name). The name used here must match the
name you use on Line 2a of the Form 5500 when
you file that form.

Mail or fax Form SS-4, Application for Employer
Identification Number, obtained at
https://www.irs.gov/pub/irs-pdf/fss4.pdf
See https://www.irs.gov/forms-pubs/aboutform-ss-4 for additional information. The EIN is
issued immediately once the application
information is validated. (The online application
process is not yet available for corporations with
addresses in foreign countries.)

Lines 1f, 1g, and 1h. Enter the identity, mailing
address, telephone number, and email address for
the responsible compliance official of the pooled plan
provider. “Responsible compliance official” means
the person or persons, identified by name, title, or
office, responsible for addressing questions
regarding the pooled plan provider’s status under, or
compliance with, applicable provisions of ERISA and
the Code as pertaining to a pooled employer plan.

Line 1b. Enter a telephone number where
participating employers, plan participants, and
agencies will be able to reach the pooled plan
provider.
Line 1c. Enter any public website address of the
pooled plan provider or an affiliate, if the address
is or will be used to market such person as a
pooled plan provider to the public or to provide
public information on pooled employer plans
operated by the pooled plan provider (regardless
of whether there is a registration requirement for
full access). For example, a public website to
provide prospective participating employers with
information about the pooled employer plans in
which they are interested would be entered on this
line.

Line 1i. Enter the full name of the agent for service
of legal process and the address at which process
may be served on the agent.
Line 2. Enter the approximate date the pooled plan
provider expects to begin operating a pooled
employer plan(s). (Use MM/DD/YYYY format.)
Caution: Beginning February 1, 2021, the date
entered here must be at least 30 days after the Initial
Filing.

Line 1d. Enter the business mailing address (include
room, apt., suite no., and street; or P.O. Box, city or town,
state, and ZIP code) of the pooled plan provider.

Line 3. Identify whether the pooled plan provider or
an affiliate will offer or provide listed services, by
checking “yes” or “no,” and then answering Lines 3a
through 3f. For elements 3a-3f, if such services are
being provided by the pooled plan provider, rather
than an affiliate of the pooled plan provider, enter
“Registrant” in the “Affiliate Name” field and leave the
Affiliate EIN box blank. Complete as many entries as
necessary.

Line 1e. Enter the Employer Identification
Number (EIN) the pooled plan provider obtained
from the Internal Revenue Service (IRS). You
must use the same EIN that the pooled plan
provider uses for other federal and state filings,
including with the IRS and the U.S. Securities and
Exchange Commission (SEC). You must also use
this EIN in the plan administrator field for all
Forms 5500 filed for the pooled employer plans
administered by the pooled plan provider.
Do not enter social security numbers in response
to questions asking for an EIN. Because of
privacy concerns, the inclusion of a social security

10

For purposes of the Form PR, the term affiliate
includes all persons who are treated as a single
employer with the person intending to be a pooled
plan provider under section 414(b), (c), (m), or (o) of
the Code and who will provide services to pooled
employer plans sponsored by the pooled plan
provider, and any officer, director, partner, employee,
or relative (as defined in section 3(15) of ERISA) of

such person; and any corporation or partnership
of which such person is an officer, director, or
partner.

any foreign regulatory authorities. If you answer “Yes,”
you must complete elements in Line 5b.

Part III- Supplemental Reportable Event
Information.

Note. The pooled plan provider must serve as a
named fiduciary and acknowledge in writing its
status as such. In addition, the pooled plan
provider must acknowledge in writing that it is the
plan administrator and that it is responsible for the
administration of each pooled employer plan.

You must supplement your registration statement in
various circumstances by submitting a Supplemental
Reportable Event Filing. For instance, you must
submit a supplemental filing to identify the start of a
pooled employer plan, if the start of the pooled
employer plan had not already been reported in the
Initial Filing or a prior Supplemental Reportable Event
Filing. You must also submit a Supplement
Reportable Event Filing to identify the termination of
a pooled employer plan. You must also supplement
your registration statement by reporting any change
in the information previously reported or other
change in pooled plan provider circumstances.

Line 4a. You must answer Line 4a; do not leave it
blank. Answer “Yes” if there are any ongoing
federal or state criminal proceedings related to the
provision of services to, operation of, or
investments of, any employee benefit plan,
against the pooled plan provider, or any officer,
director, or employee of the pooled plan provider.
Also answer “Yes” if there has been any federal or
state criminal conviction related to the provision of
services to, operation of, or investments of, any
employee benefit plan, against the pooled plan
provider, or any officer, director, or employee of
the pooled plan provider, if the conviction, or
related term of imprisonment served, is within ten
years of the date of registration. For purposes of
Line 4a (and Lines 5 and 8), employees of the
pooled plan provider include employees of the
pooled employer plan, but only those who handle
assets of the plan within the meaning of section
412 of ERISA or who are responsible for the
operations or investments of the plan.

Line 6. Type of Supplemental Information. Check
the appropriate box in Line 6a to identify the type of
supplemental information being provided.
Line 6a(1). If you check the box for Line 6a(1), you
must complete Line 6b to identify the specific line
items for changes made to previously reported
information. For example, to report a change in the
type or types of services that will be offered or
provided to the pooled employer plan by the pooled
plan provider or an affiliate, such as if an affiliate will
begin to offer investment management services, after
checking Line 6a(1), complete Line 3 and then enter
“Line 3” in Line 6b.

If you answer “Yes,” you must complete all the
elements in Line 4b for each such proceeding or
conviction. For Line 4b(1), in the case of an ongoing
criminal proceeding, enter the date the proceeding
first started. This is the date of filing of a criminal
charge. In the case of a past criminal conviction,
enter the date of conviction. If a conviction resulted
in imprisonment, enter the ending date of the related
term of imprisonment.
Line 5a. You must answer Line 5a; do not leave it
blank. Answer “Yes” if there any ongoing civil or
administrative proceedings in any court or
administrative tribunal by the federal or state
government or other regulatory authority against the
pooled plan provider, or any officer, director, or
employee of the pooled plan provider, involving a
claim of fraud or dishonesty with respect to any
employee benefit plan, or involving the
mismanagement of plan assets. For this purpose,
the term “administrative proceedings” means a
judicial-type proceeding of public record before an
administrative law judge or similar decision-maker.
Also, the term “other regulatory authority” means
federal or state authorities and self-regulatory
organizations authorized by law, but does not include

Line 6a(2). To report information about a new or
terminated pooled employer plan, check the box for
Line 6a(2) and complete Lines 7a, 7b, and 7c(1)- (3).
If you are reporting a new plan, complete Line 7d(1)
in addition to Lines 7a-7c. If you are reporting a
terminating plan, complete Line 7d(2) in addition to
Lines 7a-7c.
Line 6a(3). To report other enumerated reportable
events, such as mergers and acquisitions involving
the pooled plan provider, bankruptcy proceedings of
the pooled plan provider, and other potentially
negative information specified in Line 8, check the
box for Line 6a(3) and complete the applicable
elements in Line 8. For example, if the pooled plan
provider merged with another company, check Line
6a(3) and complete Line 8 by checking the box at
Line 8a and completing Lines 8a(1) and 8a(2).
Line 6a(4). In the event you receive notice that a
criminal matter previously reported in Line 4a or 8g
has resulted in an acquittal, you may remove this
information from Line 4a or 8g. Check

11

“Supplemental Reportable Event Filing” in Part I.
Remove the criminal information from Line 4a or
Line 8g. Check the box for Line 6a(4) and then
enter “Line 4a” or “Line g” on Line 6b. For this
purpose, the term “acquittal” means a finding by a
judge or jury that a defendant is not guilty or any
other dismissal or judgment, which the
government may not appeal and includes
situations where a prosecuting authority
voluntarily dismisses charges with an ability to
subsequently re-file.

applicable, d/b/a), address, and EIN of the trustee for
the pooled employer plan.
Line 7d. In element d(1) enter the effective date of the
plan. For this element, the plan’s effective date is the
first day of the first plan year of the plan’s existence.
In element d(2) enter the date the plan terminated and
ceased operating as a pooled employer plan. For this
purpose, a pooled employer plan is treated as
terminated and having ceased operations when a
resolution has been adopted terminating the plan, all
assets under the plan (including insurance/annuity
contracts) have been distributed to the participants and
beneficiaries or legally transferred to the control of
another plan, and a final Form 5500 Annual
Return/Report has been filed for the plan.

Line 6b. If you are making changes to more than
one line item (and have indicated so in Lines 6a(1)
and/or 6a(4)), separate those multiple changes
with commas, for example, “Line 1f, Line 3, Line 4
Line 8.”
Line 7. Pooled Employer Plan Information. A
Form PR Supplemental Reportable Event Filing
must be filed each time the pooled plan provider
begins to operate a pooled employer plan.
Complete as many repeating entries as necessary
to identify each pooled employer plan that the
pooled plan provider begins operating. Also, a
Form PR Supplemental Reportable Event Filing
must be filed if an existing pooled employer plan
terminates or ceases to operate.

Caution: Line 7 information for pooled employer plans
must match the information that will be reported on the
Forms 5500 Annual Return/Report for such plans.
Failure to use consistent identifying information on this
form and the Forms 5500 Annual Return/Report for any
pooled employer plan for which you serve as the
pooled plan provider could result in correspondence
from the Department of Labor or the Internal Revenue
Service.
Line 8. Change in Pooled Plan Provider
Circumstances. Check the appropriate box(es) if
applicable and enter all requested information. Use
as many repeating entries as necessary. For
example, if more than one criminal or other
enforcement action pursuant to Lines 8e or 8g, has
been initiated, complete an entry for each such
action.

Note. Some Line 7 information may be included
in the Initial Filing if known at that time. This
includes the information on Lines 7a through
7d(1), which some pooled plan providers may
know at the time of their Initial Filing. A
Supplemental Reportable Event Filing is not
necessary if this information is reported as part of
the Initial Filing.

Line 8a. If there has been a merger between the
pooled plan provider and another entity, enter the
date of the merger and name of the merged entity.
For this purpose, the “merged entity” is the surviving
or new entity. For instance, if the pooled plan
provider (i.e., the registrant as reflected in Line 1a)
merges with Company B, and Company B is the
surviving entity, enter “Company B” in Line 8a(2).
Similarly, if Company B merges with the pooled plan
provider, and the pooled plan provider is the
surviving entity, enter the name of the pooled plan
provider or “Registrant” in Line 8a(2) along with the
name of the non-surviving entity designated as such.
For example, “Registrant (surviving), Company B” or
“Registrant, Company B (non-survivor).”

Line 7a. Enter the name of the pooled employer plan
in Line 7a.
Line 7b. Enter in Line 7b, the three-digit plan
number (PN) that the pooled plan provider, as the
plan administrator, assigns for Form 5500 purposes
to the pooled employer plan. This three-digit
number, in conjunction with the EIN entered on line
1e, is used by the IRS and DOL as a unique 12-digit
number to identify the plan. Do not use 888 or 999.
The PN you use on Form PR must be the same PN
that will be used on the pooled employer plan’s Form
5500 Annual Return/Report. Once you use a plan
number, continue to use it for that plan on all future
filings, and do not use it for any other plan, even if
the plan using that plan number has been terminated.
See the Instructions for Form 5500, Line 1b, for more
information on how to select a PN.
Line 7c. In elements c(1),c(2), and c(3),
respectively, enter the name (legal and, if

12

Line 8b. If there has been an acquisition by or of the
pooled plan provider, enter the date of the acquisition
and name of entity acquired. For instance, if the
pooled plan provider (i.e., the registrant as reflected
in Line 1a) acquires Company B, enter “Company B”
in Line 8b(2). Similarly, if Company B acquires the

Part IV- Amended Filing.

pooled plan provider, enter the name of the
pooled plan provider or “Registrant” in Line 8b(2).
If the pooled plan provider is acquired by
Company B, also include in Line 8b(2) the name
of the acquiring entity separated by a comma, for
example, “Registrant, by Company B.”

Line 9. Submit an “Amended Filing” only if you are
correcting information previously reported on a Form PR
you filed; for example, you entered an incorrect name
for the agent for service of legal process for the pooled
plan provider. Amended filings are to correct
inadvertent or good faith errors and/or omissions on a
previously filed Form PR, for example, typographical
errors and other matters that do not constitute
supplemental reportable events. To make an amended
filing, check the “Amended Filing” box in Part I. Then
correct the previously reported incorrect information, as
necessary. Then, identify on Line 9 the line or lines that
you just amended. For example, if amending the Form
PR to correct an incorrect name for the agent for service
of legal process, check “Amended Filing” in Part I. Then
on Line 1i, enter the correct information for the agent for
service of legal process. Then, on Line 9, enter “Line
1i.”

Line 8c. If the pooled plan provider (or any
affiliate that provides services to a pooled
employer plan) files for bankruptcy, receivership,
or other insolvency proceedings (including
involuntary bankruptcy petitions made pursuant to
11 USC 303), enter the date of filing, the name of
the court (or other tribunal) where the action is
proceeding, the case caption, and the docket,
case, or other identifying or tracking number for
the proceeding. If there is more than one docket,
case, or other identifying or tracking number, use
a comma or semicolon to separate each such
number.
Line 8d. Pooled plan providers who have ceased
operations should check the box in 8d and also
enter the date the pooled plan provider ceased
operations.

Paperwork Reduction Act Notice
We ask for the information on this form to carry out
the law as specified in ERISA sections 3(43) (29
U.S.C. 1002(43)) and 3(44) (29 U.S.C. 1002(44)) and
section 413(e) of the Code. You are required to give
us the information if you wish to operate as a pooled
plan provider. We need it to determine whether the
pooled plan provider is eligible to operate as such
under ERISA and the Code. 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
and records relating to a form or its instructions must
be retained as long as their contents may become
material in the administration of the Code or are
required to be maintained pursuant to ERISA.

Line 8e. You must complete Line 8e upon
receiving written notice that there has been an
initiation of any administrative proceeding or civil
enforcement action in any court or administrative
tribunal by any federal or state government
agency or other regulatory authority against the
pooled plan provider or any officer, director, or
employee of the pooled plan provider, involving a
claim of fraud or dishonesty with respect to any
employee benefit plan, or that involves the
mismanagement of plan assets. For this purpose,
the term “administrative proceedings” means a
judicial-type proceeding of public record before an
administrative law judge or similar decision-maker.
Also, the term “other regulatory authority” means
federal or state authorities and self-regulatory
organizations authorized by law, but does not
include any foreign regulatory authorities.

Generally, filings on Form PR (Registration
Statement for Pooled Plan Providers) are open to
public inspection and are subject to publication on
the Internet. You are not required to respond to this
collection of information unless it displays a current,
valid OMB control number. The average time
needed to complete and file the form is estimated
below. These times will vary depending on individual
circumstances.

Line 8f. You must complete Line 8f upon receiving
written notice of a finding involving a claim of fraud or
dishonesty with respect to any employee benefit
plan, or involving the mismanagement of plan assets
in any matter described in Line 5a or Line 8e.

The estimated average times to complete each type
of filing are as follows:

Line 8g. You must complete Line 8g upon learning
that any criminal charges have been filed in any
federal or state court against the pooled plan provider
or any officer, director, or employee of the pooled
plan provider, related to the provision of services to,
operation of, or investments of any pooled employer
plan or other employee benefit plan.

13

Initial filing:

45 minutes

Supplemental filing:

30 minutes

Amended filing:

30 minutes

Final filing:

30 minutes

If you have comments concerning the accuracy of
these time estimates or suggestions for making
this form simpler, we would be happy to hear from
you. You can write to: U.S. Department of Labor,
Office of Regulations and Interpretations,
Attention: PRA Official, 200 Constitution Avenue,
NW, Room N-5655, Washington, DC 20210 and
reference Form PR (Registration for Pooled Plan
Providers). Do not send this form to this address.
The forms and schedules must be filed
electronically. See How To File–Electronic Filing
Requirement.

OMB Control Numbers
Agency
Number

OMB

Employee Benefits Security
Administration................................... 1210-0164

14