Form 8717 - User Fee For Employee Plan Determination, Opinion, And Advisory Letter Request
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1
28717
User Fee for Employee Plan Determination,
OMB No. 1545–1772
For
Opinion, and Advisory Letter Request
Form
IRS
(Rev. November 2011)
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 A or 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
A
B
Form Submitted
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6:
5a Form 5300:
$ 4,500
$ 2,500
b Form 5307:
$ 1,800
$
300
c Form 5310:
$ 4,000
$ 2,000
d
e Multiple employer plans (Form 5300):
(1) $ 5,000
(1)
(1)
2 to 10 Forms 5300 submitted .
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$ 3,000
(2) $ 5,000
(2)
(2)
11 to 99 Forms 5300 submitted
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$ 3,000
(3) $ 25,000
(3)
(3)
100 to 499 Forms 5300 submitted .
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$ 15,000
(4) $ 25,000
(4)
(4)
Over 499 Forms 5300 submitted .
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$ 15,000
f
Multiple employer plans (Form 5310):
(1) $ 5,000
(1)
(1)
2 to 10 employers maintaining the plan .
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$ 3,000
(2) $ 5,000
(2)
(2)
11 to 99 employers maintaining the plan
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$ 3,000
(3) $ 25,000
(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) $ 25,000
(4)
$ 15,000
g Volume submitter:
(1a) $ 12,000
(1a) Specimen plan (nonmass) with no/one adoption agreement
.
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(1b) $ 9,500
(1b) Specimen plan (nonmass) - per each additional adoption agreement
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(2a) $ 12,000
(2a) Mass submitter specimen plan with no/one adoption agreement
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(2b) $ 1,000
(2b) Mass submitter - per each additional adoption agreement .
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(3)
(3)
Specimen plan identical to mass submitter specimen plan
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$
300
(4)
Assumption of sponsorship of an approved specimen plan - per basic plan document
.
.
(4)
$
300
h Master & Prototype (M&P):
(1a) $ 12,000
(1a) Mass submitter - per basic plan document with one adoption agreement .
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(1b) $ 1,000
(1b) Mass submitter - per each additional adoption agreement .
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(2)
(2)
Sponsor’s identical adoption of mass submitter basic plan document - per adoption agreement .
.
$
300
(3)
(3)
Sponsor’s minor modification of mass submitter basic plan document - per adoption agreement .
.
$ 1,000
(4a) $ 12,000
(4a) Nonmass submitter - per basic plan document with one adoption agreement
.
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.
(4b) $ 9,500
(4b) Nonmass submitter - per each additional adoption agreement
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(5)
(5)
Opinion letter for additional optional provisions - per mass submitter basic plan document .
$ 1,000
(6)
(6)
Assumption of sponsorship of an approved M&P plan - per basic plan document .
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.
$
300
Mass submitter/non-mass submitter sponsor - per trust document in excess of 10
.
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.
(7)
(7)
$ 1,000
i
Group trust .
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$ 1,000
8717
Form
(Rev. 11-2011)
Cat. No. 64727O
*64727O11201101*
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