Looking for a Form 8955-ssa Templates? Download it for free!

•

Any other person prescribed by regulations if an

If information for the 2010 plan year is combined on this

administrator is not designated and a plan sponsor cannot

form with the information for the 2009 plan year, add the

be identified.

number of participants for the 2010 plan year to the number

of participants included for the 2009 plan year. Enter the

Note. Employees of the plan sponsor who perform

total number of participants for the 2009 plan year and for

administrative functions for the plan are generally not the

the 2010 plan year on line 6b. Thus, for a plan to which only

plan administrator unless specifically designated in the plan

one employer contributes, provide on line 6b the total

document. If an employee of the plan sponsor is designated

number of participants entitled to a deferred vested benefit

as the plan administrator, that employee must obtain an

who separated from service under the plan in either the

EIN.

2009 plan year or the 2010 plan year and who are reported

Line 3b. Enter the plan administrator’s nine-digit EIN. Plan

in Part III of this form. Similarly, for a plan to which more

administrators who do not have an EIN, must apply for one

than one employer contributes, provide the total number of

as described in the instructions for line 2b.

participants entitled to a deferred vested benefit who

Line 3c. If you want a third party to receive mail for the

separated from service under the plan in either the 2009

plan year or the 2010 plan year or who completed the first

plan administrator, enter “C/O” followed by the third party’s

one-year break in service in either the 2009 plan year or the

name and complete the applicable mailing address in lines

3e through 3k.

2010 plan year, and who are reported in Part III of this form.

Line 7. The sum of lines 6a and 6b should equal the

Line 3e. Enter the plan administrator’s street address. A

number on line 7.

post office box may be entered if the Post Office does not

deliver mail to the sponsor’s street address.

Line 8. Check the appropriate box as to whether the plan

administrator provided the individual statement to each

Line 3f. Enter the name of the city.

participant required to receive one. See Penalties.

Line 3g. Enter the two-character abbreviation for the U.S.

Signature. The Form 8955-SSA must be signed and dated

state or possession.

by the plan sponsor and by the plan administrator. If the

Line 3i. Enter the foreign province or state, if applicable.

plan administrator and the plan sponsor are the same

Line 3j. Enter the foreign country, if applicable.

person, include only the signature as plan administrator on

the form. If more than one page 2 of the form is filed for one

Line 3k. Enter the foreign routing code, if applicable. Leave

plan, only one page 1 of the Form 8955-SSA should be

the U.S. state and zip code blank if completing line 3j or line

signed and filed with the pages 2 for the plan.

3k.

Line 4. If the plan administrator’s name and/or EIN have

PART III

changed since the most recent Schedule SSA (Form 5500)

Enter the name of the plan, the plan number, and the plan

or Form 8955-SSA was filed for this plan, enter the plan

sponsor’s EIN at the top of each page 2.

administrator’s name and EIN as they appeared on the most

Line 9, column (a). Enter the appropriate code from the

recently filed Schedule SSA (Form 5500) or Form

following list:

8955-SSA.

Failure to indicate on line 4 that a plan administrator

Code A Use this code for a participant not previously reported.

was previously identified by a different name or EIN

Also complete columns (b) through (g).

could result in correspondence from the IRS.

Code B Use this code for a participant previously reported under

CAUTION

the plan number shown on this form to modify some of the

Line 5. If the plan sponsor’s name and/or EIN have

previously reported information. Enter all the current

changed since the most recently filed Schedule SSA (Form

information for columns (b) through (g). You do not need

5500) or Form 8955-SSA for this plan, enter the plan

to report a change in the value of a participant’s account

sponsor’s name, EIN, and the three-digit plan number as

since that is likely to change. However, you may report

they appeared on the most recently filed Schedule SSA

such a change if you want.

(Form 5500) or Form 8955-SSA.

Code C Use this code for a participant previously reported under

the plan of a different plan sponsor and who will now be

Failure to indicate on line 5 that a plan sponsor was

receiving a future benefit from the plan reported on this

previously identified by a different name or EIN could

form. Also complete columns (b), (c), (h), and (i).

result in correspondence from the IRS.

CAUTION

Code D Use this code for a participant previously reported under

Line 6a. For a plan to which only one employer contributes,

the plan number shown on this form who is no longer

provide the total number of participants entitled to a deferred

entitled to those deferred vested benefits. This includes a

vested benefit who separated from service in the 2008 plan

participant who has begun receiving benefits, has

year and who were not reported on the 2008 Schedule SSA

received a lump-sum payout, or has been transferred to

(Form 5500). For a plan to which more than one employer

another plan. (For example, in the case of a plan

contributes, provide the total number of participants entitled

termination.) Also complete columns (b) and (c).

to a deferred vested benefit who completed the second of

Line 9, column (b). Enter the exact SSN of each

two consecutive one-year breaks in service in the 2009 plan

participant listed. If the participant is a foreign national

year and who were not reported on the 2008 Schedule SSA

employed outside the United States who does not have an

(Form 5500).

SSN, enter the word “FOREIGN.”

Line 6b. For a plan to which only one employer

Line 9, column (c). Enter each participant’s name exactly

contributes, provide the total number of participants entitled

as it appears on the participant’s social security card. Do not

to a deferred vested benefit who separated from service

enter periods; however, initials, if on the social security card,

under the plan in the 2009 plan year and who are reported

are permitted.

in Part III of this form. For a plan to which more than one

employer contributes, provide the total number of

After the last name column, there is a check mark

participants entitled to a deferred vested benefit who

column. Check the box for each participant whose

separated from service under the plan in 2009 or who

information is based on incomplete records. Information for

completed the first one-year break in service in the 2009

a participant may be based on incomplete records where

plan year, and who are reported in Part III of this form. See

more than one employer contributes to the plan and the

When To Report a Separated Participant.

records at the end of the plan year are incomplete regarding

-5-

Instructions For Form 8955-Ssa - Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits - Internal Revenue Service - 2009 Page 5

Related Articles

Related forms

Related Categories