Form 8717 - User Fee For Employee Plan Determination Letter Request
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1
2D R A F T
For IRS Use Only
8717
User Fee for Employee Plan
Form
Control number
Determination Letter Request
(Rev. January 2002)
Department of the Treasury
Amount paid ______
Attach to determination letter application.
_
Internal Revenue Service
User fee screener
1 Sponsor’s name (employer if single-employer plan)
2 Sponsor’s employer identification number
|
3 Plan name
4 Plan number
Caution: If this is an application for a determination letter that meets the conditions for exemption from user fees described in section 620 of
the Economic Growth and Tax Relief Reconciliation Act of 2001, complete only the certification below. 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________________________ (name of the plan) meets the
conditions for exemption from user fees described in section 620 of the Economic Growth and Tax Relief Reconciliation Act of 2001.
Signature
Title _________________________
Date ___________________
FORM SUBMITTED
FEE SCHEDULE
A
B
5a. Form 5300:
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6
$1,250
$ 700
b. Form 5307:
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6
$1,000
$ 125
c. Form 5310:
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6
$ 375
$ 225
d. Form 6406:
Not applicable
$ 125
e. Multiple employer plans (Form 5300):
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6
(1) 1 to 10 Forms 5300 submitted
.
.
.
.
.
.
.
.
.
(1) $ 1,250
(1) $ 700
(2) 11 to 99 Forms 5300 submitted .
.
.
.
.
.
.
.
.
(2) $ 2,000
(2) $ 1,400
(3) 100 to 499 Forms 5300 submitted
.
.
.
.
.
.
.
.
(3) $ 3,500
(3) $ 2,800
(4) Over 499 Forms 5300 submitted .
.
.
.
.
.
.
.
.
(4) $ 6,500
(4) $ 5,600
f. Multiple employer plans (Form 5310):
with Demo 5
no Demo 5 and
and/or Demo 6:
no Demo 6
(1) 2 to 10 employers maintaining the plan .
.
.
.
.
.
.
(1) $ 375
(1) $ 225
(2) 11 to 99 employers maintaining the plan.
.
.
.
.
.
.
(2) $ 600
(2) $ 450
(3) 100 to 499 employers maintaining the plan .
.
.
.
.
.
(3) $ 1,000
(3) $ 900
(4) Over 499 employers maintaining the plan
.
.
.
.
.
.
(4) $ 2,000
(4) $ 1,800
g. Volume submitter:
(1) Specimen plan .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
(1) $ 1,500
(2) Lead specimen plan (see Rev. Proc. 2000-20)
.
.
.
.
.
.
.
.
.
.
(2) $ 3,000
(3) Specim en plan identical to lead specimen plan (see Rev. Proc. 2000-20)
.
.
.
(3) $ 100
h. Group trust
$ 750
Cat. No. 64727O
8717
Form
(Rev. 1-2002)
26
26
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