Form 4461 Application for Approval of Master or Prototype Defined

October 2011
Form

4461

(Rev. October 2006)
Department of the Treasury
Internal Revenue Service

Application for Approval of Master
or Prototype or Volume Submitter
Defined Contribution Plans

OMB No. 1545-0169

This Form Is Open to Public Inspection

For IRS Use Only

File This Form With the Internal Revenue Service

File folder number

Section references are to the Internal Revenue Code unless otherwise noted.

Complete every applicable item on this form. You may only answer “not applicable” (N/A) where an N/A answer is
indicated as one of your options.
and Attachment 1 (see Rev. Proc. 2011-49, XXXX-XX I.R.B. XXX).

Part I

All Filers Complete This Part. See instructions before completing this form.

1

Enter amount of user fee submitted
$
2a Approval requested:
Initial application
Amendment—Enter file folder number or letter serial
number and date of last letter issued ©
3a Name of applicant

2b M&P - File folder number or
VS - Letter serial number

2c Date of last
letter issued

3b Employer identification number
of applicant

Address (number, street, room or suite no.) (If a P.O. box, see instructions.)
State

City

ZIP code

3c Applicant’s telephone no.
(

3d Type of applicant (see Definitions in the instructions):
M&P sponsor
M&P mass submitter
M&P national sponsor
4a Name of person to be contacted

)

Volume submitter practitioner
Volume submitter mass submitter
Volume submitter national sponsor
4b Telephone number
(
)

4c Email address

©

4d If a power of attorney is attached, check box
5b Adoption agreement number

5a Basic plan document number
6

Form of plan:
Prototype plan
Master plan
Volume submitter plan
Note: A master plan has only one trust or custodial account for all adopting employers.
7

8

Type of plan:
Money purchase
Profit-sharing
Filing status of plan:
Standardized plan
Nonstandardized plan

Target benefit
Profit-sharing/401(k)
governmental
Volume submitter plan

(i.e., described in section 424(d))

[ ] Volume submitter nongovernmental plan

Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief it is true,
correct, and complete.

insert commas
Signature

©

Title

©

For Paperwork Reduction Act Notice, see page 12 of the instructions.

Date

Cat. No. 41676M

©

Form

4461
10-2011

(Rev. 10-2006)

(4) Copy of Certification of Interim Amendments?
10-2011
Form 4461 (Rev. 10-2006)

Page

Have

9 Procedural requirements:
a If this is an initial request, have the following been submitted as required by instructions—
(1) Adoption agreement?
(2) Copy of plan?
(3) Copy of trust indenture or custodial agreement?
b Amended or restated plans (see specific instructions):
(1) If the amendment is not incorporated into the plan document, have the following been submitted—
(a) A copy of the amendment?
(b) A description of the amendment and its effect on the plan?
(c) A working copy of the plan currently in effect?
(2) If the amendment is incorporated into the plan document, has a copy of the restated plan with
amendments highlighted been submitted?
(3)

b

Yes

2

No

For all M&P sponsors and those VS practitioners who are choosing to include a provision in their
specimen plans that allows them to amend on behalf of their adopting employers, will you advise those
employers who cannot or do not adopt the amended or restated plan providing for such authority, that
they may not continue to participate under the M&P plan or the VS plan?

c Is the plan and trust (or custodial agreement) patterned after and substantially the same as another plan and
trust (or custodial agreement) on which a favorable letter has been received? (If “Yes,” see specific
instructions.)
d Non-mass submitter request (M&P complete (1) and (2). VS complete (3))

d

(1)

e

(2)

Do you have at least 30 employer-clients which are reasonably expected to adopt this plan’s basic plan
document and one or more of the adoption agreements associated with this basic plan document? If
“No,” complete (2)
If “No” to (1), enter the file folder number of the basic plan document for which the requisite number
of adopting employer-clients requirement is met:

(3)

f

If you are a VS (non-mass submitter) practitioner, do you have at least 30 employer-clients reasonably
expected to adopt a plan that is substantially similar to the VS practitioner specimen plan (or 10
employer-clients reasonably expected to adopt a money purchase pension plan (MP), if you have a
specimen MP and at least one other type of specimen plan that satisfies the 30 employer-client
requirement)?
e Mass submitter or national sponsor request (M&P mass submitter complete (1), (2), and (3); VS mass submitter
complete (4); national sponsor complete (5)):
make bold
Are
applications
on
behalf
of
the
requisite
number
of
sponsors
who are adopting the same basic plan
(1)
)
document on a word-for-word identical basis included? If “No,” complete (2)
(2) If “No” to (1), enter the file folder number of the basic plan document for which the requisite number
of adopting sponsors requirement is met:
(3) If this is a flexible plan, answer (a) and (b):
(a) Have you bracketed and identified the optional provisions of the plan?
(b)

Have you included a copy of the written representation describing the choices available to sponsors
and the coordination of optional provisions?
(4) For a VS mass submitter, are applications on behalf of at least 30 unaffiliated practitioners sponsoring
the same specimen plan on a word-for-word identical basis included?
(5) If this is a national sponsor request, do you maintain a list of: (a) 30 or more adopting employers in
each of 30 or more states, or (b) 3,000 or more adopting employers that have adopted any master or
prototype plan of the sponsor or any VS specimen plan of the practitioner which has a GUST opinion
or advisory letter? (The determination as to whether there are 30 or more adopting employers or 3,000
or more adopting employers may be made on any one date during the 12-month period ending April
18, 2005.)
Note: This application is designed to be used in conjunction with Rev. Proc. 2005-16. A List of Required Modifications (LRMs) is
also recommended for use and may be obtained from the IRS website at www.irs.gov/ep.
2011-49

Form

c For all M&P sponsors and those VS practitioners who are choosing to include a provision in their specimen
plans that allows them to amend on behalf of their adopting employers, is there a procedure in place for the
adoption and distribution of the amendments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [

4461

(Rev. 10-2006)

10-2011
][

]

Form 4461 (Rev. 10-2006)

Delete line items 10 (Part I) through 13 (Part IV), pages 3-9. These pages will become a
worksheet (Attachment 1) available on the IRS website.

In items 10 through 13 indicate the article or section and page number of the plan or trust
where the following provisions are contained. All questions must be answered. If not applicable,
check “N/A” column; otherwise complete the “Article or Section and Page Number” column.

N/A

Article or
Section and
Page Number

Page
Change

10 Provisions applicable to all plans:
a Definitions:
Where does the plan define the following terms—
(1) Year of service?
(2) Break in service?

(1)
(2)

Hour of service under Department of Labor Regulations, including
service with all employers aggregated under sections 414(b), (c), (m), or
(o), and service of any individual considered an employee for purposes
of this plan under section 414(n) or (o)?
Elapsed time?
Plan year?
Compensation as defined in section 414(s) as limited by section 401(a)(17)?
Earned income as defined in section 401(c)(2)?
Disability?
Employee as described in sections 414(b), (c), (m), (n), or (o)?
Leased employee as described in section 414(n) or (o)?
Highly compensated employee as defined in section 414(q)?
Owner-employee?
Self-employed individual?
Normal retirement age?
Benefiting?
Straight life annuity?

(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)

b Minimum participation standards:
(1) Are the requirements for participation under the plan determined without
regard to maximum age?

(17)

(3)

(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)

(2)

(3)

(4)

(5)
(6)
(7)

(3)

Will a new employee, otherwise eligible, participate on the earlier of the
first day of the first plan year after meeting the minimum age and service
requirements of section 410(a)(1) or 6 months after satisfying such
requirements?

(18)

Does the initial eligibility computation period begin with the date on which
the employee first performs an hour of service, and do subsequent eligibility
computation periods: (1) begin with the anniversary of such date, or (2)
shift to the plan year in accordance with section 2530.202- 2(b) of the
Department of Labor regulations?

(19)

Is the computation period for determining a break in service the same as
is used to compute a year of service for eligibility after the initial
computation period?

(20)

If all years of service are not counted for participation purposes, is the
service not counted excludable under sections 410(a)(5)(B), (C), or (D)?
Does this plan include the one-year hold-out rule?
Will an employee otherwise eligible, who is in an ineligible class of
employees, immediately participate on becoming a member of an eligible
class?

(21)
(22)

(23)

c Employer contributions:
(1) If this is a money purchase plan, are contributions on behalf of each
participant determined under a definite, uniform formula?
(2) If this is a profit-sharing plan, are contributions allocated under a definite,
uniform formula?
(3)

(4)

3

For
IRS
Use
Only

(24)
(25)

If the plan contains a uniform points allocation formula, does the formula
meet the requirements of section 1.401(a)(4)-2(b)(3)(i)(A) of the
Regulations?
If this is a target benefit plan, answer (i) and (ii), below.
(i) Does the plan include a target benefit with permitted disparity?
(ii) Does the plan provide for the calculation of employer
contributions?

(25A)
(26), (27)
(28)
Form

4461

(Rev. 10-2006)

Form 4461 (Rev. 10-2006)

10c (continued)
(5) Does the contribution or allocation formula provide for permitted disparity
per section 401(l)?
(6)

(7)
(8)

Page
N/A

Article or
Section and
Page Number

Change

Does the plan continue to allocate contributions to participants without
reduction in the rate of allocations on account of the attainment of
any specified age?
Are annual additions limited as required by section 415?
Does the plan require separate accounting for each employee’s accrued
benefit?

(30)
(31)
(34)

(35)

(36)
(37)
(38)

(a) Does the plan meet the applicable requirements of section 408 and
408A of the Code and address every applicable point of the IRA
LRMs?
(b) Does the plan either provide for separate individual trusts, a single
trust separate from a trust maintained by the defined contribution
plan, or (if in a single trust that includes the defined contribution plan)
provide that the trustee must maintain a separate account for each
deemed IRA?

(38A)

(38A)

e Forfeiture provisions:
(1) Are forfeitures used either to reduce employer contributions or to increase
benefits according to a definite uniform formula?

(3)

For IRS
Use Only

(29)

d Employee contributions:
(1) If the plan permits:
(a) Does the plan comply with section 401(m)?
(b) Does the plan either provide for separate accounts for employer
contributions and nondeductible employee contributions, or identify
what portion of an account balance is attributable to
employer contributions and nondeductible employee contributions
according to section 411(c)(2)?
(c) Are all employee contributions and earnings thereon nonforfeitable at
all times?
(2) Does the plan prohibit deductible voluntary employee contributions for a
tax year beginning after 1986?
(3) If the plan permits deemed IRAs:

(2)

4

(39)

If participants may withdraw employee contributions or the earnings on
them, may the withdrawal be made without forfeiting vested benefits based
on employer contributions?
If benefits under the plan are forfeited when a participant or beneficiary
cannot be located, does the plan provide for a reinstatement of the benefit if
a claim is made?

(40)

(41)

f Distribution provisions:
(1)

(2)

(3)

(a) If this is not a profit-sharing plan described in (6) below, does a married
participant receive a qualified joint and survivor annuity (QJSA) and an
unmarried participant a life annuity?

(42)

(b) Is the participant given an opportunity to make a Qualified Election to
waive the QJSA in a manner which satisfies section 417(a)(2) during
an election period beginning no later than 90 days before the annuity
starting date?

(42)

(a) Does the plan provide that the spouse of a deceased participant will
receive a qualified preretirement survivor annuity (QPSA) that requires
payments not less than the amount specified in section 417(c)(2) in the
event of death before the annuity starting date?

(42)

(b) Is the participant given an opportunity to make a Qualified Election to
waive the QPSA in a manner which satisfies section 417(a)(2) during
the election period beginning on the first day of the plan year in which
the participant attains age 35 and ending on the date of the participant’s
death?
Does the plan designate or enable the employer to elect the percentage
(not less than 50% nor more than 100%) of the survivor annuity provided
under the QJSA?

(42)

(42)
Form

4461

(Rev. 10-2006)

Form 4461 (Rev. 10-2006)

10f (continued)
(4) Does the plan define annuity starting date in a manner that satisfies Q&A
10(b) of Regulations section 1.401(a)-20?
(5) (a) Does the plan provide for a written explanation of the QJSA in a manner
which satisfies section 417(a)(3)(A)?
(b) Does the plan provide for a written explanation of the QPSA in a manner
which satisfies section 417(a)(3)(B)?
(6) If this is a profit-sharing plan which does not offer a life annuity form
of payment, does the plan satisfy the conditions described in Q&A 3
of Regulations section 1.401(a)-20, including the requirement that the
value of the participant’s vested account balance on the date of death
be paid in full to the surviving spouse?
(7) If the plan permits distributions prior to 5 consecutive 1-year breaks in
service (upon termination of employment, hardship distributions, change to
an ineligible class, etc.), does the plan contain either (A) cashout, buy-back,
or (B) separate account provisions required under Regulations sections
1.411(a)-7(d)(4) and (5)?

Page
N/A

Article or
Section and
Page Number

Change

5

For IRS
Use Only

(42)
(42)
(42)

(42)

(43)

If the vested account balance is greater than $5,000, is consent of the
participant and spouse (if applicable) required when benefits are immediately
distributable within the meaning of Regulations section 1.411(a)-11?
(9) Do benefits under the plan begin, unless otherwise elected in writing, no later than
the 60th day after the latest of the close of the plan year in which: (i) the participant
attains the earlier of age 65 or the plan’s normal retirement age, (ii) the 10th
anniversary of the year in which the participant began participation under the plan
occurs, or (iii) the participant terminates his or her service with the employer?
(10) If the plan contains an early retirement provision which requires or could
require both a minimum age and service for eligibility, does a participant
who meets the service requirement but separates from service before
meeting the age requirement begin to receive benefits (unless otherwise
elected) upon meeting the age requirement?
(11) Are annuity contracts nontransferable when distributed?
(8)

(44)

(45)

(46)
(47)

(12) Does the plan provide that the terms of any annuity contract purchased
and distributed by the plan to a participant or spouse shall comply with
the requirements of the plan?
(13) Does the plan require, in accordance with section 401(a)(9) that:
(a) Distributions be made beginning not later than the required beginning
date?

(48)

(49)

(b) Payment of the participant’s interest be made at least as rapidly as
under the method used prior to death, when the participant dies after
distribution has started, using the participant’s remaining life
expectancy if there is no designated beneficiary and if there is a
designated beneficiary using the remaining life expectancy of either the
participant or the designated beneficiary, whichever is longer?

(49)

(c) Payment of the participant’s interest be made within 5 years of the
participant’s death or over the life expectancy method under either
sections 401(a)(9)(B)(iii) or (iv) when payment of the participant’s interest
has not begun prior to death?

(49)

(d) Distributions, if not made in a single sum, will satisfy minimum
distribution rules of section 401(a)(9) and the regulations thereunder,
including the minimum distribution incidental benefit requirement of
Regulations section 1.401(a)(9)-6 Q&A-2?
(14) Are optional forms of benefit:
(a) Stated in the plan?
(b) Made available to employees in a manner that does not discriminate in
favor of highly compensated employees?
(c) Not subject to employer discretion?
(15) (a) Does the plan provide for the direct rollover of an eligible rollover
distribution to an eligible retirement plan?

(49)
(50)
(50)
(50)
(51)

(b) Does the plan provide for the automatic rollover of a mandatory
distribution over $1,000 to an individual retirement plan, unless the
participant elects otherwise?
(c) If provided in the adoption agreement, does the plan specify the types
of plans that it will accept rollovers from?

(51)
(51)
Form

4461

(Rev. 10-2006)

Form 4461 (Rev. 10-2006)

10 (continued)
g Vesting provisions:
(1) Is a computation period for vesting purposes specified in the plan?
(2) Is the computation period for determining a break in service the same as
is used to compute a year of service for vesting?
(3) Does the plan provide that an employee will be fully vested on reaching
normal retirement age?
(4)

(5)
(6)
(7)

(8)

Page
N/A

Article or
Section and
Page Number

Change

(3)

(4)

(52)
(53)

If the plan contains vesting options, are they limited so that at all times
they will provide a percentage of nonforfeitable rights which is not less
than the percentage that would be provided under one of the options under
section 411(a)(2)?
If all years of service are not counted for vesting purposes, is the service
not counted excludable under section 411(a)(4)?
If the plan contains the vesting break in service rules, does the plan comply
with section 411(a)(6)(B), (C), or (D), as applicable?

(54)
(55)
(56,
57, 58)

Does a participant who has at least 3 years of service have a reasonable
period of time after the adoption of an amendment which directly or
indirectly affects the calculation of his or her nonforfeitable percentage
(including a change to or from a top-heavy vesting schedule) to elect to
have his or her nonforfeitable percentage computed without regard to the
amendment?
Does the plan provide protection against cutback of vested rights or rights
to accrued benefits under sections 411(a)(10)(A) and 411(d)(6)?

(59)
(60)

(61)
(61)
(61)
(61)
(61)
(61)
(61)
(61)

Does the adoption agreement provide a section for the employer to specify
the interest rate and mortality table used in determining the top-heavy
ratio because of the required aggregation of multiple plans?

(61)

Does the plan provide that for the purpose of determining the top-heavy
ratio, the accrual rate used will be that used to accrue benefits under all
defined benefit plans of the employer, or where there is no such uniform
rate, the slowest accrual rate permitted under section 411(b)(1)(C)?

(61)

Does the plan provide for a minimum contribution (determined without
regard to social security) for each nonkey-employee participant, who has
not separated from service at the end of the plan year, equal to the lesser
of: (a) 3% of compensation, or (b) the highest contribution rate applicable
to any key employee, including minimum contributions for nonkey
employees who:
(62)

(a) fail to complete 1,000 hours of service?
(b) fail to make mandatory contributions, or in the case of a cash or
deferred arrangement, elective contributions to the plan?
(5)

(6)

For IRS
Use Only

(52)

h Top-heavy:
(1) If this plan is not designed to operate as if it were top-heavy at all times,
does the plan define the following terms—
(a) Key employee?
(b) Top-heavy plan?
(c) Top-heavy ratio (as defined in section 416(g))?
(d) Permissive aggregation group?
(e) Required aggregation group?
(f) Determination date?
(g) Valuation date?
(h) Present value?
(2)

6

(62)

Does the plan prohibit forfeitures of required minimum contributions
because of withdrawal of mandatory contributions described in section
411(a)(3)(B) or 411(a)(3)(D)?
Does the plan provide for vesting not less favorable than the vesting
described in section 416(b)?

(63)
(64)
Form

4461

(Rev. 10-2006)

Page

Form 4461 (Rev. 10-2006)

10
i

(continued)
Death benefits:
(1) If life insurance is provided, are premiums properly limited?
(2)

(3)

N/A

Article or
Section and
Page Number

Change

If ordinary life insurance contracts are purchased, will such contracts be
either converted to cash or an annuity contract at or before retirement, or
distributed to the participant?
Are insurance contracts owned and held by the trustee or custodian, if
applicable, in accordance with the terms of the plan, including joint and
survivor annuity requirements, if any?

(66)

(67)

(68)
(68)
(69)

(70)

k Amendment and termination:
(1) Is there a provision for the sponsor or practitioner to amend the plan?

(3)

(4)

(5)
(6)
(7)

(8)

For IRS
Use Only

(65)

j Investment provisions:
(1) Trust or custodial accounts:
(a) Are assets valued at least annually, on a specified date, and at current
fair market value?
(b) Are trust earnings and losses allocated on the basis of account balances?
(2) If the plan provides for investment in insurance contracts, does it provide
for the disposition of dividends and other credits?
(3) If investments, including insurance contracts, may be earmarked, are such
investments subject to the employee’s consent or purchased ratably
where employee consent is not required?
(4) Does the plan contain any sub-trusts for life insurance?

(2)

7

(71)

For an M&P plan, is there a provision for the employer to amend the plan
to satisfy sections 415 and 416 because of the required aggregation of
multiple plans?
For an M&P plan, does the plan prohibit adopting employers from amending
other than elective provisions (except to the extent necessary to satisfy section
415 or 416 because of the required aggregation of multiple plans, or as
permitted by sections 5.06, 5.09 and 19.03 of Rev. Proc. 2005-16) unless the
employer wants to cease participation in the plan?

(72)

(72)

Is there a provision for the employer to amend the plan to add certain
model, sample or other required good faith amendments that specifically
provide that their adoption will not cause the plan to be treated as
individually designed?
Are amounts credited to participants’ accounts nonforfeitable
upon termination or partial termination of the plan?
Under a profit-sharing plan, are the employees’ rights under the plan
nonforfeitable upon complete discontinuance of contributions?

(72)
(73)
(74)

Does the plan provide that after merger or consolidation with, or transfer
of assets or liabilities to any other plan, benefits on a termination basis
will be no less than before the merger, consolidation, or transfer?
If a VS plan allows the practitioner to amend on behalf of adopting
employers, does the plan provide that:
(a) the practitioner will amend the plan on behalf of all adopting
employers?

(75)

(b) the practitioner will no longer have the authority to amend on behalf of

any adopting employer as of the date the Service requires the employer
to file Form 5300, Application for Determination for Employee Benefit
Plan, as an individually designed plan due to an employer amendment
to the plan to incorporate a type of plan not allowable in the VS program
or as of the date the plan is otherwise considered an individually
designed plan due to the nature and extent of the amendments?
(c) if the employer is required to obtain a determination letter to maintain

(9)

reliance on the advisory letter, the practitioner’s authority to amend on
behalf of the adopting employer is conditioned on the plan receiving a
favorable determination letter?
(d) the practitioner maintains recordkeeping and notice requirements?
Does the adoption agreement of the VS plan, if applicable, contain, in close
proximity to the employer’s signature line, the circumstances under which
the employer may not rely on the advisory letter?
Form

4461

(Rev. 10-2006)

Page

Form 4461 (Rev. 10-2006)

10
l

(continued)
Miscellaneous plan provisions:
(1) Does the plan prohibit the assignment or alienation of benefits except
as provided by sections 401(a)(13) and 414(p)?
(2) Do loans to plan participants satisfy the requirements of section 4975(d)(1)
and the joint and survivor requirements, if any?
(3)

(4)
(5)
(6)

(7)

(8)

(9)

N/A

Article or
Section and
Page Number

Change

11

For IRS
Use Only

(76)
(77)

Does the plan provide that corpus or income may not be diverted for
purposes other than the exclusive benefit of employees or their
beneficiaries?
If a nontrusteed plan, do insurance contracts provide for refunds or credits
for the exclusive benefit of the participants?
Does the plan provide that if the employer’s plan does not attain or retain
qualification, the employer can no longer participate under the plan?
If this is a master plan:
(a) Is only a single funding medium available for use by all adopting
employers?

(78)
(79)
(80)

(81)

(b) Does the plan provide that funds held in the master trust on behalf of
an adopting employer will be removed as soon as administratively
feasible if the employer’s plan does not attain or retain qualified
status?

(82)

Does the plan provide that if the employer maintains a plan of the
predecessor employer, service with the predecessor employer is counted
as service with the employer?

(83)

Does the adoption agreement contain the sponsor’s or representative’s
name, address, and telephone number for the purpose of answering
employer’s inquiries?

(85)

Does the adopting agreement contain a cautionary statement describing
the limitations on employer reliance on an opinion or advisory letter without
a determination letter and that the failure to properly fill out the adoption
agreement may result in disqualification of the plan?

(85)

(10) Does the adoption agreement contain a statement which provides that the
sponsor will inform the adopting employer of any amendments made to
the plan or of the discontinuance or abandonment of the plan?
(11) Does the adoption agreement contain an employer signature line?
(12) Does the plan contain a provision that incorporates the requirements of
section 414(u) of the Code (USERRA) (see instructions)?

Part II

8

(85)
(85)
(86)

(M&P only) Complete This Part If You Are Filing for a Standardized Plan

With respect to this standardized plan:

a Does the plan cover all employees (including individuals required to be
considered employees according to section 414(n) or (o) and employees of
other members of groups aggregated under section 414(b), (c), (m) or (o)) other
than employees who may be excluded under section 410(a)(1) or (b)(3)?

(87)

b Are the eligibility requirements not more favorable for highly compensated
employees as defined in section 414(q) than for other employees?

(88)

c Does the contribution formula satisfy the safe harbor requirements of
Regulations section 1.401(a)(4)-2(b)(2) or section 1.401(a)(4)-8(b)(3)?
d Does the adoption agreement contain, in close proximity to the employer’s
signature line, the circumstances under which the adopting employer may not
rely on the opinion letter (as set forth in section 19 of Rev. Proc. 2005-16),
including a statement that the employer, in order to obtain or retain reliance,
must obtain a determination letter if the employer ever has maintained any
other plan (including a welfare benefit plan)?

(89)

(90)
Form

4461

(Rev. 10-2006)

Form 4461 (Rev. 10-2006)

Part III

(M&P only) Complete This Part If You Are Filing for a Nonstandardized
Plan

Page

N/A

Article or
Section and
Page Number

Change

12 With respect to this nonstandardized plan:
a Does the plan meet the minimum age and service requirements of section
410(a)(1)?

For
IRS
Use
Only

(91)

b Does the adoption agreement contain, in close proximity to the employer’s
signature line, the circumstances under which adopting employers may not
rely on an opinion letter issued by EP Rulings and Agreements, with respect
to the qualification of this plan unless they apply to EP Determinations for a
determination letter?
c Does the plan give the employer the option to select total compensation?
d If the plan contains language that allows adopting employers to adopt an
allocation formula designed to be cross-tested for nondiscrimination on the
basis of equivalent benefits under section 1.401(a)(4)-8 of the regulations, does
the employer’s allocation formula meet the cross-testing rules?

Part IV

9

(92)
(93)

(94)

Complete This Part If You Are Filing for a Profit-Sharing/401(k) Plan

13 With respect to this section 401(k) plan Cash or Deferred Arrangement (CODA):
a Are contributions pursuant to an election permitted before the related
compensation is earned?
b Is an employee’s eligibility to make elective deferrals conditioned on no more
than one year of service or attainment of no more than age 21?
c Does the plan provide for a reasonable period during which participants may
once a year elect to commence elective deferrals?
d Are participants’ elective deferrals limited to the dollar limit in effect in section
402(g)?
e Will elective deferrals be distributed no later than April 15 to any participant
who has excess elective deferrals for the preceding tax year?
f Do the elective deferrals meet the nondiscrimination test of section 401(k)(3)?

(I)
(II)
(III)
(IV)
(V)
(VI)

g Does the plan provide for the distribution of excess contributions no later than
the 12 months after the plan year, if such excess contributions were allocated
to the previous plan year?
h May a participant recharacterize an excess contribution?
i Can the employer make matching contributions?
j Are matching contributions subject to section 411(a)(2)?
k Can the employer make qualified matching contributions?
l Do employee contributions and matching contributions meet the ACP test of
section 401(m)?
m Are the excess aggregrate contributions distributed or forfeited no later than
12 months after the plan year?
n May the employer make qualified non-elective contributions?

(XIII)
(XIV)

o Are the participant’s rights to his or her accrued benefit derived from employee
contributions, qualified non-elective contributions, qualified matching
contributions, and elective deferrals nonforfeitable?

(XV)

p Do distributions of elective deferrals, qualified non-elective contributions,
qualified matching contributions, and income allocable to each comply with
section 401(k)(2)(B)?
q Does the plan permit hardship distributions of elective deferrals?

(XVI)
(XVII)

r Does the plan provide that elective deferrals are not taken into account to satisfy
the minimum top-heavy contribution requirements?
s Does the plan permit 401(k) SIMPLE provisions?
t Does the plan permit 401(k) safe harbor provisions?

(XVIII)
(XIX)
(XX)

(VII)
(VIII)
(IX)
(X)
(XI)
(XII)

Form

4461

(Rev. 10-2006)

, including Form 4461 and Attachment 1 (see www.irs.gov/pub/irs-tege/form4461_attachment.pdf or Rev. Proc. 2011-49, XXXX-XX I.R.B. XXX).
Form 4461 (Rev. 10-2006)

10-2011

Submit one

and Attachment 1

Pre-approved Plans

General Instructions

What To File

Purpose of Form

One copy of Form 4461 should be
submitted for each separate adoption
agreement or for each separate
specimen plan where no adoption
agreement is utilized.
For initial approval, file this application
and each applicable document listed in
item 9(a). For approval of an
amendment, file this application and a
copy of each applicable document listed
in item 9(b).

Form 4461 is used to apply for initial
approval of or for approval of an
amendment to Master or Prototype
(M&P) or Volume Submitter (VS) defined
contribution plans.
on Attachment 1

Be sure to submit a complete and
accurate application. Complete every
applicable line on the application. If an
item does not apply, check the “N/A”
box or enter “N/A” on the line. If your
Different parts of this form must be
application is not complete, we will
completed depending on the type of
return it without processing it. The first
plan for which you want approval.
page must be typed. where indicated as an option.
M&P Standardized plans. If you want to
The questions are designed so that,
unless they are not applicable, the article receive an opinion letter on a
standardized plan, complete Parts I and II.
or section and page numbers indicating
the location in the plan of the provision
M&P nonstandardized plans. If you
should be entered in the appropriate
want to receive an opinion letter on a
column. The column marked "CHANGE"
plan other than a standardized plan,
is for IRS use only.
complete Parts I and III.
move
sentence up
Unless otherwise noted, the questions
VS plans. If you want to receive an
in Parts I and IV apply to both M&P and
advisory letter on a VS plan, complete
VS defined contribution plans. Parts II
Part I.
and III apply to M&P Plans. This Form
was originally used only for M&P plans,
Multiple plans. A sponsor may utilize
and many items, unless specifically
one basic plan document for several
referring to VS plans, are based on a
plans. A sponsor may, for example, use
Listing of Required Modifications (LRMs)
one basic plan document for a money
containing sample language designed for
purchase plan other than a target benefit
use in drafting M&P plans. VS
plan, a target benefit plan, and a
practitioners may also use this language
profit-sharing plan. A separate adoption
if appropriate, and should still complete
agreement and completed application
applicable parts of the Form, or explain
must be provided for each such defined
why a particular question is not
contribution plan. In the case of a
applicable.
copy of the
simultaneous submission, submit only
Requests for additional information. If
one basic plan document. If the request
a letter requesting additional information
is not simultaneous, separate basic plan
or changes to plan documents, is sent
documents must be submitted (but the
to the sponsor or VS practitioner or an
number assigned to the basic plan
authorized representative, such
document of a master or prototype plan
information and/or changes must be
remains the same).
received no later than 30 days from the
A VS practitioner may not combine
date of the letter. Failure to respond
different
categories in a single specimen
timely may result in the application being
plan or application, except that only one
considered withdrawn. An extension of
the 30-day time limit will only be granted specimen plan and application is
required for a VS profit-sharing plan,
for good cause.
with or without a 401(k) arrangement.
Inadequate submissions. We will
Where To File
return, without further action, plans that
are not in substantial compliance with
Send applications for opinion and
the qualification requirements or plans
advisory letters to:
that are so deficient that they cannot be
reviewed in a reasonable amount of
Internal Revenue Service
time.
P.O. Box 2508; Room 5106
Attn: Pre-approved
Cincinnati, OH 45201
Plans Coordinator

Who May File

Master or prototype plans. Sponsors,
mass submitters and national sponsors
(see Definitions later).
Volume submitter plans. Practitioners
(including national sponsors) and mass
submitters (see Definitions later).
In

addition, you may not use the same basic plan
document for governmental plans (i.e., plans
described in section 414(d) and nongovernmental
plans (i.e., plans not described in section 414(d)).

Add "Attn: M&P Coordinator" in the
case of an application for an opinion
letter, and "Attn: VS Coordinator" in the
case of an application for an advisory
letter.

Page

10 3

For both types of applications a
request shipped by Express Mail or a
delivery service should be sent to the
attention of the VS Coordinator or the
M&P Coordinator, whichever is
applicable, to:

, send

Internal Revenue Service
550 Main Street
P.O. Box 2508; Room 5106 on Form 4461
Cincinnati, OH 45202
and Attachment 1
Signature. The application must be
signed by a partner or officer of the
applicant who is authorized to sign, or
other person authorized by a power of
attorney. The power of attorney should
be filed with the application.
Disclosure requested by taxpayer. A
taxpayer may request the Service to IRS
disclose and discuss the return or return
information with any person(s) the
taxpayer designates in a written request.
If you want to designate a person(s) to
assist in an application for approval, you
must provide the IRS office of
jurisdiction with a written request that
contains:
of plans using the same basic plan document
● The taxpayer’s name, address,
employer identification number, and plan
number(s).
● The name, address, social security
number, and telephone number(s) of the
person or persons whom you are
authorizing to receive return information.
● A paragraph that clearly describes the
return or return information that you
authorize the IRS to disclose.
● An authorized signature (see above).
As an alternative to providing the above
statement, you may submit Form 2848,
Power of Attorney and Declaration of
Representative.

Definitions
Adoption agreement. The portion of the
plan containing all the options that the
adopting employer may select. The
adoption agreement may include blanks
or fill-in provisions for the employer to
complete if it also includes parameters
on these provisions that preclude an
employer from completing them in a
manner that could violate the
qualification requirements. Each
separate adoption agreement is treated
as a separate plan and will receive its
own opinion or advisory letter.
Basic plan document. The portion of
the plan containing all the nonelective
provisions applicable to all adopting
employers. No options (including blanks
to be completed) may be provided in the
basic plan document except for options
in flexible plans.

requests are not simultaneous, submit separate basic plan documents and include a cover
letter identifying the original submission. The number assigned to the basic plan document of
a master or prototype plan must remain the same as in the prior submission. One basic plan
document may not be used for both defined benefit and defined contribution plans.

10-2011
Form 4461 (Rev. 10-2006)

For purposes of determining whether 30 (or 10, if applicable) unaffiliated sponsors or
practitioners sponsor on a word-for-word identical basis the same plan document of the same
specimen plan, the mass submitter is treated as an unaffiliated sponsor or practitioner.

Volume Submitters without Adoption
Agreements. A VS specimen plan may
include blanks or fill-in provisions for the
employer to complete only if the plan
also includes parameters on these
provisions that preclude an employer
from completing them in a manner that
could violate the qualification
requirements.
2011-49
Flexible plan. A plan submitted by an
M&P mass submitter which contains
certain optional provisions as allowed by
section 12.03(1) of Rev. Proc. 2005-16,
2005-10 I.R.B. 674. Sponsors which
adopt a flexible plan may include or
delete any optional provision designated
as such in the mass submitter’s plan. A
flexible plan adopted by a sponsor
which differs from the mass submitter
plan only because of the deletion of
certain optional provisions will be treated
as a word-for-word identical plan to the
mass submitter plan.
2011-49

Mass submitter. As set forth in Rev.
Proc. 2005-16, any entity that submits
applications on behalf of at least 30
unaffiliated sponsors or practitioners
each of which is sponsoring, on a
word-for-word identical basis, the same
basic plan document and one or more of
the adoption agreements associated comma
with that basic plan document or in the
case of VS plans one or more of the
same lead specimen plans. For a mass
submitter of an M&P, once the mass
submitter has submitted applications on
behalf of 30 unaffiliated sponsors with
respect to any basic plan document, it
will be treated as a mass submitter with
respect to all the other basic plan
documents and associated adoption
agreements for which it requests opinion
letters, regardless of the number of
identical adopters of such other plans. A
mass submitter of a VS plan will be
treated as such with respect to each
hyphen
specimen plan for which the 30
unaffiliated practitioner requirement is
separately met.
s
Notwithstanding the above, for an
M&P plan, any entity that received a
favorable TRA ’86 opinion letter for a
plan as a mass submitter under Rev.
Proc. 89-9, 1989-1 C.B. 780, will
continue to be treated as a mass
submitter if it submits applications on
behalf of at least 10 sponsors
(regardless of affiliation) each of which is
sponsoring, on a word-for-word identical
basis, the same basic plan document
and one or more of the adoption
agreements associated with that basic
plan document. Once the mass
submitter has submitted applications on
behalf of 10 sponsors with respect to
any basic plan document, it will be
treated as a mass submitter with respect

Page

11

to all the other basic plan documents
or minor modifier adopter of an M&P
and associated adoption agreements for
plan of a mass submitter will be treated
which it requests opinion letters,
as a sponsor with respect to such plan,
regardless of the number of identical
regardless of the number of employers
adopters of such other plans. Affiliation
that are expected to adopt such plan.
is determined under sections 414(b) and break into two paragraphs
(c) of the Code. Additionally, the
Practitioner. Any person that has an
following will be considered to be
established place of business in the
affiliated: any law, accounting, consulting United States where it is accessible
firm, etc. with its partners, members,
during every business day and
associates, etc.
represents to the Service that it has at
least 30 employer-clients each of which
is reasonably expected to adopt a plan
Master plan. A form of plan that is made
that is substantially similar to the VS
available by a sponsor for adoption by
practitioner’s specimen plan.
employers for which a single funding
medium (for example, a trust or custodial
The required number of
account, see section 4.01 of Rev. Proc.
employer-clients is reduced to 10 for a
2005-16) is established, as part of the
money purchase pension specimen plan
plan, for the joint use of all adopting
in the case of a VS practitioner that has
employers. A master plan consists of a
specimen plans for two or more
basic plan document, an adoption
separate categories of plans (profit
agreement, and, unless included in the
sharing, money purchase, target benefit),
basic plan document, a trust or custodial
one of which is a money purchase plan,
account document.
and the 30 employer-clients requirement
has been satisfied with respect to the
Prototype plan. A form of plan that is
other specimen plan.
made available by a sponsor for
adoption by employers under which a
A VS practitioner may submit any
separate funding medium is established
number of specimen plans for advisory
for each adopting employer. A prototype
letters provided that the 30
plan consists of a basic plan document,
employer-clients requirement (or 10, if
an adoption agreement, and unless the
applicable) is separately satisfied with
basic plan document incorporates a
respect to each specimen plan.
trust or custodial account agreement the
Notwithstanding the above, any person
provisions of which are applicable to all
that has an established place of
adopting employers, a trust or custodial
business in the United States where it is
account document.
accessible during every business day
may sponsor a specimen plan as a
Specimen plan. A specimen plan is a
word-for-word identical adopter of a
sample plan, including the related trust
or custodial account, of a VS practitioner specimen plan of a VS mass submitter,
regardless of the number of employers
(rather than the actual plan of an
that are expected to adopt the plan.
employer). A specimen plan may include
an adoption agreement.
A VS practitioner is also a practitioner
that has either (a) 30 or more adopting
Sponsor. Any person that has an
employers in each of 30 or more states
established place of business in the
or (b) 3,000 or more adopting employers.
United States where it is accessible
The determination as to whether there
during every business day and
IRS
are 3,000 or more adopting employers
represents to the Service that it has at
or 30 or more adopting employers in
least 30 employer-clients each of which
each of 30 or more states may be made
is reasonably expected to adopt the
on any one date during the 12 month
sponsor’s basic plan document and one
period ending on April 18, 2005. For this
or more of the adoption agreements
purpose, an adopting employer is any
associated with that basic plan
employer that has adopted any plan of
document. Once a person represents to
the practitioner that has a GUST
the Service that at least 30 employers
advisory letter.
are reasonably expected to adopt its
basic plan document, it will be treated
M&P National Sponsor. A sponsor
as a sponsor with respect to all the
which has either: (a) 30 or more
basic plan documents and associated
adopting employers in each of 30 or
adoption agreements for which it
more states, or (b) 3,000 or more
requests opinion letters, regardless of
adopting employers on any one date
the number of employers that are
during the 12-month period ending on
expected to adopt such other plans.
April 18, 2005. For this purpose, an
Notwithstanding the above, any person
adopting employer is any employer that
that has an established place of
has adopted any plan of the sponsor
business in the United States where it is
which has a GUST opinion letter.
accessible during every business day
and is a word-for-word identical adopter For this purpose, where an adoption format is
used, each adoption agreement is treated as
one specimen plan.

4

2011-8, 2011-1 I.R.B. 237, as corrected by Announcement 2011-8, 2011-5, I.R.B. 446,
Form 4461 (Rev. 10-2006)

10-2011
the sponsor should submit

M&P Standardized plan. A plan which
meets the specific requirements of Part
II of this form.
insert space

Specific Instructions
Line 1. All applications submitted must
be accompanied by the appropriate user
fee and Form 8717, User Fee for
Employee Plan Determination, Opinion
and Advisory Letter Request, as
determined from the schedule in Rev.
Proc. 2006-8, 2006-1 I.R.B. 245 (or the
most recent version, updated annually).
Applications submitted without the
proper user fee will not be processed
and will be returned to the applicant.
Line 3a. Enter the name and address of
the applicant. If the Post Office does not
deliver mail to the street address and
the sponsor has a P.O. box number,
show the P.O. box number instead of
the street address.
applicant
Line 3d. Complete type of Applicant. If
Volume Submitter Practitioner is the type
that has either (a) 30 or more adopting
employers in each of 30 or more states
or (b) 3,000 or more adopting employers,
check the box next to Volume Submitter
National Sponsor.
Line 4a. If the person to be contacted is
other than an employee of the applicant,
please enclose an authorized power of
attorney. See Disclosure requested by
taxpayer on page 10.
earlier
Line 4c. The applicant should include an
email address in order for the Service to
send an interim email notifying the
applicant that review of the applicable
plan has been completed, subject to final
approval by opinion or advisory letter.

of preliminary approval

9(d)

Line 5a. Enter the two-digit basic plan
document number you have assigned to
the basic plan document designed to
accompany the adoption agreement for
which you are requesting approval. All
basic plan documents from one sponsor
which are the same (word-for-word)
should use the same two-digit number
on all applications. The first basic plan
document submitted should be
numbered “01,” the second, “02,” etc.

beginning with “001.” For example, if the
first basic plan document of a sponsor
has four separate adoption
agreements,they should be numbered
“001” through “004,” and four separate
Forms 4461 should be submitted.
Adoption agreements submitted with the
second or any subsequent basic plan
documents (that are not word-for-word
identical to a previously submitted basic
plan document) should be similarly
numbered beginning with “001.” Submit a
Line 9. Procedural requirements. A
separate application must be submitted
for each different plan/adoption
agreement combination.
submit
In the case of a VS plan, a separate
application must be submitted for each
type of plan, except that only one
specimen plan and application is
required for a VS profit-sharing plan,
either with or without a 401(k)
arrangement.
Line 9b. The applicant must submit,
along with this application, either: (a) a
copy of the amendment, a description of
the amendment and its effect on the
plan, and a working copy of the plan
currently in effect, or (b) a copy of the
amended plan in restated form with
areas of change highlighted (a restated
plan). If a restated plan is being
submitted with this application, a copy of
the amendment and a description of
such amendment need not be submitted.
The Internal Revenue Service may, at its
discretion, require plan restatement any
time it deems necessary.
In any event, a restated plan must be
submitted by the deadline for the
applicable remedial amendment cycle
described in Rev. Proc. 2005-66.

f

Page

12

5

Line 9e. The mass submitter should use
Form 4461-B, Application for Approval of
Master or Prototype or Volume Submitter
Plans, Mass Submitter Adopting Sponsor
or Practitioner, when submitting
applications on behalf of its adopting
sponsors, and submit Form 8717.
Line 10l. A plan sponsor or practitioner
will be treated as satisfying the
requirements of the Uniformed Services
Employment and Reemployment Rights
Act of 1994 (USERRA) and section
414(u) if the terms of the plan provide
that an employee reemployed after
qualified military service is not treated as
incurring a break in service, for purposes
of vesting and benefit accruals, solely
because of an absence due to qualified
military service.
Paperwork Reduction Act Notice. We
ask for the information on this form to
carry out the Internal Revenue laws of
the United States. You are required to
give us the information. We need it to
determine whether you meet the legal
requirements for plan approval.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records
relating to a form or its instructions must
be retained as long as their content may
become material in the administration of
any Internal Revenue law. Generally, tax
return and return information are
confidential, as required by Code section
6103.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:

Line 9c. If you checked “Yes,” submit a
8
22 min.
Recordkeeping
43 hr., 17
copy of such plan with language
differences highlighted. Attach a cover
Learning about the law
letter which provides the name and file
42
16 hr., 43
or the form
min.
folder number of the plan (including the
42
name and employee identification
48 hr., 39 min.
Preparing the form
number of the sponsor), a list of all plans
Copying, assembling, and
written by the plan drafter which are
48
sending the form to the IRS
16 min.
substantially identical to the lead plan
M
(including the information described
If you have comments concerning the
above), a description of each place
accuracy of these time estimates or
where the plan for which the application
suggestions for making this form simpler,
is being submitted is not word-for-word
Line 5b. Enter the three-digit number
identical to the language of the lead plan we would be happy to hear from you.
you have assigned to the adoption
You can write to the Internal Revenue
(including an explanation of the purpose
agreement for which this application is
Service, Tax Products Coordinating
and effect of each difference), and a
submitted. Each different adoption
Committee, SE:W:CAR:MP:T:T:SP,
certification, made under penalty of
agreement designed to accompany a
6526
1111 Constitution Ave. NW, IR-6406,
perjury by the plan drafter, that the
single basic plan document should be
Washington,
DC
20224.
Do
not
send
this
information describing where the plan
given a different three-digit number
form to this office. Instead, see Where To
language is not word-for-word identical
File on page 10.
is true and complete.
Enter the two-digit basic plan document number you have assigned to the specimen plan or basic plan document that accompanies (if
applicable) the adoption agreement for which you are requesting approval. All basic or specimen plan documents from one sponsor or
practitioner that are the same (word-for-word) should use the same two-digit number on all applications. The first basic plan document
submitted should be numbered "01," the second, "02,", etc. The first specimen plan document submitted should be numbered "01," the
second, "02," etc.