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If the 2009 Form 8955-SSA is being used to report

the box on line C and enter the exact language describing

information for the 2010 plan year and the 2010 plan year

the announcement in the space provided. For example,

Form 5500 annual return/report was the final return/report of

indicate “Disaster Relief Extension” or “Combat Zone

the plan, the 2009 Form 8955-SSA must report information

Extension.”

on deferred vested participants for the 2010 plan year,

Amended Registration Statement

including reporting that previously reported deferred vested

participants are no longer deferred vested participants under

File a 2009 Form 8955-SSA to correct errors and/or

the plan.

omissions in a previously filed statement for the 2009 plan

year. Check the box for Part I, line B (“amended registration

When To File

statement”). The amended Form 8955-SSA must conform to

the requirements in the How To File section.

Special filing due date for 2009 and 2010 plan year

A full and complete Form 8955-SSA must be filed to

filings. In general, if a Form 8955-SSA must be filed for a

correct any such errors and/or omissions. Thus, for

plan year, it must be filed by the last day of the seventh

example, a full and complete Form 8955-SSA must be filed

month following the last day of that plan year (plus

if the plan administrator determines that incorrect

extensions). However, in order to provide plan

information was provided as to a single plan participant.

administrators with additional time to complete and file the

new Form 8955-SSA, the due date for filing the Form

It is important to use a 2009 Form 8955-SSA to report

8955-SSA for the 2009 and the 2010 plan years is the later

revisions to a participant’s information previously filed on a

of (1) the due date that generally applies for filing the Form

2009 Form 8955-SSA or a Schedule SSA (Form 5500).

8955-SSA for the 2010 plan year, or (2) August 1, 2011. For

Because SSA provides information that it has on file to

example, in the case of a 2009 plan year or a short 2010

individuals who file for benefits, if this information is not

plan year, the Form 8955-SSA is not required to be filed

up-to-date, the individual may contact the plan administrator

before August 1, 2011. See Announcement 2011-21,

to resolve the difference.

2011-12 I.R.B. 567.

Prior Year Statement

If the filing due date falls on a Saturday, Sunday, or

federal holiday, the annual registration statement may be

Prior year (before plan year 2009) Schedule SSA (Form

filed on the next day that is not a Saturday, Sunday, or

5500) filings should be sent to:

federal holiday.

Department of the Treasury

Extension of Time To File

Internal Revenue Service Center

Ogden, UT 84201-0024

Using Form 5558

When To Report a Separated

If filing under an extension of time based on the filing of

Participant

Form 5558, Application for Extension of Time To File

Certain Employee Plan Returns, check the appropriate box

In general, for a plan to which only one employer

on the Form 8955-SSA, Part I, line C. A one-time extension

contributes, a participant must be reported on Form

of time to file the Form 8955-SSA (up to 2

months) may be

8955-SSA if:

obtained by filing Form 5558 on or before the normal due

1. The participant separates from service covered by the

date (not including any extensions) of the Form 8955-SSA.

plan in a plan year, and

See the instructions for Form 5558. You must file the Form

2. The participant is entitled to a deferred vested benefit

5558 with the Department of the Treasury, Internal Revenue

under the plan.

Service Center, Ogden, UT 84201-0045. Because approved

copies of the Form 5558 will not be returned to the filer, you

In general, information on the deferred vested retirement

should retain a copy of the Form 5558 that is filed.

benefit of a plan participant must be filed no later than on

the Form 8955-SSA filed for the plan year following the plan

Using Extension of Time To File Federal

year in which the participant separates from service covered

Income Tax Return

by the plan. However, you can report a deferred vested

participant in the plan year in which the participant

An automatic extension of time to file Form 8955-SSA until

separates from service under the plan if you want to report

the due date of the federal income tax return of the

earlier. Do not report a participant more than once unless

employer will be granted if both of the following conditions

you are revising or updating information on a prior Form

are met.

8955-SSA or Schedule SSA (Form 5500). See the Specific

1. The plan year and the employer’s tax year are the

Instructions for Part III, line 9, codes B, C, or D.

same.

2. The employer has been granted an extension of time

For purposes of determining when to report a separated

to file its federal income tax return to a date later than the

participant, a single employer plan is a plan to which only

normal due date for filing the Form 8955-SSA.

one employer contributes. A single employer plan includes a

plan maintained by a controlled group of corporations which

An extension of time granted by using this automatic

are treated as a single employer under Code section 414(b),

extension procedure CANNOT be extended further by filing

and a plan maintained by trades or business under common

a Form 5558. It also cannot be extended beyond more than

control which are treated as a single employer under Code

months beyond the close of the plan year.

section 414(c).

Other Extensions of Time To File

In general, for a plan to which more than one employer

contributes, a participant must be reported on Form

The IRS may from time to time announce special extensions

8955-SSA if:

of time under certain circumstances, such as extensions for

presidentially-declared disasters or for service in, or in

1. The participant incurs two successive one-year breaks

support of, the Armed Forces of the United States in a

in service (as defined in the plan for vesting purposes), and

combat zone. See IRS.gov for announcements of special

2. The participant is (or may be) entitled to a deferred

extensions. If you are relying on a special extension, check

vested benefit under the plan.

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Instructions For Form 8955-Ssa - Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits - Internal Revenue Service - 2009 Page 2

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