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c. An explanation if the employer’s

arrangement who are eligible but don’t

Do not use a social security

corporate status changed after the

make elective deferrals;

number or the EIN of the trust.

ESOP was originally adopted.

2. Retirees and other former

CAUTION

Note. Do not use staples (except to

employees who have a nonforfeitable

The plan sponsor/employer must

attach the check to the Form 8717),

right to benefits under the plan; and

have an EIN. A plan sponsor/employer

paper clips, binders, or sticky notes. Do

3. The beneficiary of a deceased

without an EIN can apply for one.

not punch holes in the documents.

employee who is receiving or will in the

Online—Generally, a plan sponsor/

Note. See the Procedural

future receive benefits under the plan.

employer can receive an EIN by Internet

Requirements Checklist to ensure that

Include one beneficiary for each

and use it immediately to file a return.

the application package is complete

deceased employee regardless of the

Go to the IRS website at

before submitting it. Incomplete

number of individuals receiving benefits.

businesses/small

and click on Employer

applications may be closed if required

ID Numbers (EINs).

Example. Payment of a deceased

items aren’t included in the submission.

By mail or fax—Send in a completed

employee's benefit to three children is

If the application package is closed as

Form SS-4, Application for Employer

considered a payment to one

incomplete, the application won’t be

Identification Number, to apply for an

beneficiary.

returned and any user fee paid with the

EIN.

application won’t be refunded. (See

Lines 3f and 3g. See Notice 2011-86,

Lines 1g and 1h. Enter the telephone

Rev. Proc. 2016-6.)

2011-45 I.R.B. 698 (or later guidance)

and fax numbers of the plan sponsor.

for further details, including how to

Specific Instructions

determine compensation.

Line 1i. Enter the two digits

representing the month the plan

Line 4a. Enter the number that

Line 1. Enter the name, address, and

sponsor/employer's tax year ends.

corresponds to the request being made

telephone and fax numbers of the plan

(enter one number only).

Lines 1j through 1m. If a foreign

sponsor/employer.

entity, follow the country's practice for

Enter 1 if the plan is a new plan

A plan sponsor means:

entering the name of the city or town,

that's being submitted within its initial

1. In the case of a plan that covers

province/country, and the postal code.

remedial amendment period described

the employees of one employer, the

under Regulations section 1.401(b)-1(d)

Line 2. If Form 2848 or Form 8821 is

employer;

(1) or as extended in other guidance.

attached, check the box only. If not

See Rev. Proc. 2016-37.

2. In the case of a plan sponsored

attached, enter a contact person. The

by two or more entities required to be

Enter 2 if this plan is an existing plan

contact person listed on line 2 will

combined under section 414(b), (c), or

that has never received a favorable DL.

receive copies of all correspondence.

(m), one of the members participating in

Enter 3 if neither 1 nor 2 apply and

Lines 2h through 2k. If a foreign

the plan; or

the plan is specifically authorized to

contact, follow the country's practice for

3. In the case of a plan that covers

apply for a DL under applicable IRS

entering the name of the city or town,

the employees and/or partner(s) of a

guidance. Include an attachment that

province/country, and the postal code.

partnership, the partnership.

cites the applicable IRS guidance and

Line 3a. This field is limited to 70

explain how the plan meets the criteria

Note. The name of the plan sponsor/

characters, including spaces. Fill in the

for a DL submission.

employer should be the same name that

plan name as it should appear on the

Partial termination request. Enter 3 if

is used when the Form 5500, Annual

DL. If the plan name contains more than

requesting a determination with respect

Return/Report of Employee Benefit

70 characters, abbreviations should be

to a partial termination. Employers and

Plan, series annual return/report is filed

used.

plan administrators that request a

for the plan. Line 1a is limited to 70

Line 3b. Enter the three-digit plan

determination on a potential partial

characters.

number, beginning with "001" and

termination may not request a DL on

Line 1f. Enter the nine-digit employer

continuing in numerical order for each

their entire plan unless the plan is

identification number (EIN) assigned to

plan you adopt (001–499). The

otherwise eligible for a DL. Indicate in

the plan sponsor/employer. This should

numbering will differentiate your plans.

the cover letter if a partial termination

be the same EIN that is used when the

The number assigned to a plan must not

may have occurred or might occur as a

Form 5500 series annual return/report is

be changed or used for any other plan.

result of proposed actions. If the

filed for the plan.

This should be the same number that is

submission is only for a partial

used on the Form 5500 series annual

The plan of a group of entities

termination request, only complete lines

return/report for the plan.

combined under section 414(b), (c), or

1–5 and submit the Form 8717 with the

(m), whose sponsor is more than one of

user fee. DO NOT submit the other

Line 3c. Plan month means the month

the combined entities, should only enter

items under What To File.

in which the plan year ends. Enter the

the EIN of one of the sponsoring

two-digit month (MM).

Provide detailed information

members.

regarding the partial termination,

Line 3d. Enter the plan's original

This EIN must be used in all

including data specified on the Partial

effective date.

subsequent filings of DL requests for the

Termination Worksheet in these

Line 3e. Enter the total number of

plan, and annual returns/reports for the

instructions.

participants. A participant is:

plan, unless there is a change of

1. Using the format in the Partial

sponsor.

1. Any employee participating in the

Termination Worksheet, submit a

plan, including employees under a

schedule of information for the plan year

section 401(k) qualified cash or deferred

in which the partial (or potential partial)

Instructions for Form 5300

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Instructions For Form 5300 - Application For Determination For Employee Benefit Plan Page 3

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