Form 14581-E - Retirement Plan Coverage Compliance Self-Assessment For State And Local Government Entities Page 2

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Department of the Treasury - Internal Revenue Service
14581-E
Form
Retirement Plan Coverage Compliance Self-Assessment
(June 2017)
For State and Local Government Entities
Retirement Plan Coverage – Publication 963
1.
Does the entity have a public retirement system that qualifies as a replacement for
Yes
No
Follow Up
Social Security coverage
Note: A governmental retirement plan must meet certain minimum benefit or contribution standards to qualify as a public retirement
system, and thereby serve as a “replacement” plan exempting the participants from mandatory Social Security coverage. These
standards are based solely on meeting a minimum benefit level either:
1) Provided to (defined benefit plan) the participant, or
2) Contributed by (defined contribution plan) the participant.
Any person working for a public employer after July 1, 1991, who is not covered in a public retirement plan that meets the requirements
discussed above and, if applicable, the defined benefit system safe harbor rules of Revenue Procedure (Rev. Proc.) 91-40, must be
covered by Social Security and Medicare under the mandatory coverage provisions of Section 210 of the Social Security Act, except for
exclusions from mandatory Social Security and Medicare.
For more information about public retirement systems (Social Security replacement plans), see Chapter 6 of Publication 963, Federal-
State Reference Guide.
Comments
2.
Is the public retirement plan offered to all employees
Yes
No
Follow Up
If not, specify categories of employees that are NOT covered. (Specify all that apply)
Note: Employees in these categories must be covered for Social Security either under mandatory coverage or under a Section 218
Agreement.
Comments
3.
Are the contributions to retirement plans subject to applicable employment taxes
Yes
No
Follow Up
Comments
a. Internal Revenue Code (IRC) Section 3121(b)(7)(F) retirement system
Yes
No
Follow Up
• Employee deferrals are exempt from federal income tax withholding but are subject to Social Security and Medicare taxes.
• Employer contributions are exempt from federal income tax withholding, Social Security and Medicare taxes. However, if the
retirement system is not an “exempt governmental deferred compensation plan,” employer contributions are subject to Social
Security and Medicare withholding as of the later of when the services are performed or when there is no substantial risk of
forfeiture.
Comments
b. IRC Section 401(a) and/or Section 403(b) plan
Yes
No
Follow Up
• Employee deferrals are exempt from federal Income tax withholding but are subject to Social Security and Medicare taxes.
• Employer contributions are exempt from federal Income tax withholding, Social Security and Medicare taxes.
Comments
14581-E
Catalog Number 69848Q
Form
(6-2017)

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