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How To File

For these purposes, a multiemployer plan and a multiple

employer plan are treated as a plan to which more than one

Follow the 2009 line-by-line instructions to complete the

employer contributes.

Form 8955-SSA. Answer all questions about the plan,

In general, information about the deferred vested

unless otherwise specified.

retirement benefit of a plan participant must be reported on

The Form 8955-SSA must be filed with the IRS. The

the Form 8955-SSA filed for the plan year in which the

Form 8955-SSA and previous years’ Schedules SSA

participant completes the second of two consecutive

(Form 5500) and any attachments with the form or

CAUTION

one-year breaks in service. Consecutive one-year breaks in

schedules are NOT open to public inspection. DO NOT

service are defined in the plan for vesting percentage

attach a Form 8955-SSA or a previous year’s Schedule SSA

purposes. The participant may be reported earlier on the

(Form 5500) to a Form 5500 or Form 5500-SF required to

Form 8955-SSA filed for the plan year in which the

be filed with the Department of Labor (DOL) filing system

participant completed the first one-year break in service.

(“EFAST2”). Because of privacy concerns, the inclusion of a

social security number on the Form 5500, Form 5500-SF, or

When Not To Report a Participant

on a schedule or attachment that is filed with the DOL using

EFAST2, may result in the return of the filing.

A participant is not required to be reported on Form

8955-SSA if, before the date the Form 8955-SSA is required

Electronic and paper filing. You can:

•

to be filed (including any extension of time for filing), the

Use SSA approved software, if available, to complete and

participant:

electronically file a Form 8955-SSA.

•

Use a personal computer to complete the online fillable

1. Is paid some or all of the deferred vested retirement

Form 8955-SSA on the IRS website at

benefit (see the Caution below),

before printing, signing, and mailing

2. Returns to service covered by the plan and/or accrues

it to the IRS. A barcode capturing the data you entered on

additional retirement benefits under the plan, or

the form will appear on the completed pages when printed.

3. Forfeits all the deferred vested retirement benefit.

A form partially completed online and partially completed

(other than the signature) on printed paper will cause

If payment of the deferred vested retirement benefit

processing delays and may result in correspondence.

ceases before ALL of the participant’s benefit is paid

•

Use a printed Form 8955-SSA ordered from the IRS by

to the participant or beneficiary, information on the

CAUTION

calling 1-800-TAX-FORM (1-800-829-3676). When

participant’s remaining benefit shall be filed on the Form

completing the form, use as many pages 2 as necessary

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

and number them in sequential order.

within which the payment ceased.

Note. If you complete and file the printed form with a

nonstandard page 2, the page 2 must contain the same

Transfer of a Participant’s Benefit to a

information and format as the page 2 of the Form

New Plan

8955-SSA. Filing a nonstandard page 2 may result in

correspondence and delay processing the form.

When the benefit of a separated participant with deferred

Processing tips. To reduce the possibility of

vested benefits is transferred from one plan to a new plan,

correspondence and penalties:

1. The new plan administrator should complete a Form

•

Sign and date the Form 8955-SSA.

8955-SSA using:

•

Check your information to avoid errors.

•

Entry Code C for Part III, line 9, column (a), when the

•

Complete all lines on the form unless otherwise specified.

original plan information is available, or

•

All information should be printed in the specific fields

•

Entry Code A for Part III, line 9, column (a), when the

provided on the form.

original plan information is not available.

•

Do not mark on or near any barcode.

2. The original plan administrator should complete a

•

Paper should be clean without glue or other sticky

Form 8955-SSA using Entry Code D for Part III, line 9,

substances.

column (a).

•

Do not staple the form pages. Use binder clips or other

fasteners that do not perforate the paper.

•

Where To File

Do not submit extraneous material or information, such as

arrows used to indicate where to sign, notes between

Send the completed Form 8955-SSA to:

preparers of the report, or notations on the form.

•

File the Form 8955-SSA using the address specified in

Department of the Treasury

the instructions under Where To File.

Internal Revenue Service Center

•

You may round off cents to whole dollars. If you do round,

Ogden, UT 84201-0024

you must round all amounts. To do so, drop any amount

Private delivery services (PDSs). In addition to the United

less than 50 cents and increase any amount from 50 to 99

States mail, you can use the private delivery services

cents to the next higher dollar.

designated by the IRS to meet the “timely mailing as timely

filing/paying” rule for tax returns and payments. These

Penalties

delivery services include only the following.

The Internal Revenue Code imposes a penalty for failure to

•

DHL Express (DHL): DHL Same Day Service.

file a registration statement (including failure to include all

•

Federal Express (FedEx): FedEx Priority Overnight,

required participants). The penalty is $1 for each participant

FedEx Standard Overnight, FedEx 2Day, FedEx

not reported and for each day multiplied by the number of

International Priority, and FedEx International First.

days the failure continues. The penalty, up to a maximum of

•

United Parcel Service (UPS): UPS Next Day Air, UPS

$5,000, is imposed on the person failing to so file unless it is

Next Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air

shown the failure is due to reasonable cause.

A.M., UPS Worldwide Express Plus, and UPS Worldwide

In the case of a failure to file a notification of a change in

Express.

the status of the plan (such as a change in the plan name or

The private delivery service can tell you how to get

a termination of the plan), or a change in the name or

written proof of the mailing date.

address of the plan administrator, the Code imposes a

-3-

Instructions For Form 8955-Ssa - Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits - Internal Revenue Service - 2009 Page 3

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