Form 8717 - User Fee For Employee Plan Determination Letter Request

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8717
User Fee for Employee Plan Determination
OMB No. 1545–1772
For
Letter Request
Form
IRS
(Rev. February 2013)
Use
Amount paid
Attach to determination letter application.
▶
Department of the Treasury
Only
For the latest information about this form, go to
Internal Revenue Service
▶
1 Name of plan sponsor (employer if single-employer plan)
2 Sponsor’s employer identification number
3 Plan number
4 Plan name
Caution. If you qualify for the exemption from user fees for small business employers, complete only the certification below (see the instructions
on page 2 for details). For all other applications, leave the certification blank and check the appropriate box in column B of line 5.
Certification
I certify that the application for a determination letter on the qualified status of the plan listed above meets the conditions for
exemption from user fees described in section 7528(b)(2)(B) of the Internal Revenue Code.
Sign Here
Date
▶
▶
Type or print name and title
▶
Fee Schedule
B
A
Form Submitted
no Demo 5 and
no Demo 6:
5a Form 5300:
$ 2,500
b Form 5307:
$
300
c Form 5310:
$ 2,000
d
e Multiple employer plans (Form 5300):
(1)
(1)
2 to 10 Forms 5300 submitted .
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$ 3,000
(2)
(2)
11 to 99 Forms 5300 submitted
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$ 3,000
(3)
(3)
100 to 499 Forms 5300 submitted .
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$ 15,000
(4)
(4)
Over 499 Forms 5300 submitted .
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$ 15,000
f
Multiple employer plans (Form 5310):
(1)
(1)
2 to 10 employers maintaining the plan .
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$ 3,000
(2)
(2)
11 to 99 employers maintaining the plan
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$ 3,000
(3)
(3)
100 to 499 employers maintaining the plan .
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$ 15,000
(4)
Over 499 employers maintaining the plan
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(4)
$ 15,000
g Reserved
(1a)
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(1b)
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(2a)
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(2b)
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(3)
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h Reserved
(1a)
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(4a)
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(4b)
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(5)
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(6)
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(7)
i
Form 5316 (Group trusts)
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$ 1,000
8717
Form
(Rev. 2-2013)
Cat. No. 64727O
*64727O02201301*

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