Form 4461-A Application for Approval or Master or Prototype or Volum

Form

4461-A

(Rev. March 2008 )
Department of the Treasury
Internal Revenue Service

Application for Approval of Master or
Prototype or Volume Submitter Defined
Benefit Plan

OMB No. 1545-0169

This Form Is Open to Public Inspection

For IRS Use Only

File This Form With Internal Revenue Service
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.
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)
City

State

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
Note: A master plan has only one trust or custodial account for all adopting employers.

7

Does the plan provide for permitted disparity in accordance with section 401(l)?

8

Filing status of plan:
Standardized plan
Nonstandardized plan
Volume submitter plan

Yes

©

No

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.
Signature

©

Title

©

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

Date
Cat. No. 11416U

©

Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

9

Page

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:
(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?

Yes

2

No

(3) 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)):
(1) 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)
(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) 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?
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)):
(1) Are applications on behalf of the requisite number of sponsors who are adopting the same basic plan

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
sponsoring organizations 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 1, 2007)
Form

4461-A

(Rev. 3-2008)

Page

Form 4461-A (Rev. 3-2008)

3

Note: This application is designed to be used in conjunction with Rev. Proc. 2005-16. A list of required modifications (LRM’s) is also
recommended for use and may be obtained from the IRS website at www.irs.gov/ep.
In items 10 through 12 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

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?

For
IRS
Use
Only

(1)
(2)

(3) Hour of service under Department of Labor Regulations, including service
with all employers aggregated under section 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)?
(4) Elapsed time?
(5) Plan year?
(6) Compensation as defined in section 414(s) or limited by section 401(a)(17)?
(7) Average annual compensation?
(8) Earned income as defined in section 401(c)(2)?
(9) Employee as described in section 414(b), (c), (m), (n), or (o)?
(10) Leased employee as described in section 414(n) or (o)?
(11) Highly compensated employee as defined in section 414(q)?
(12) Owner-employee?
(13) Self-employed individual?
(14) Normal retirement age?
(15) Straight life annuity?

(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)

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

(16)

(2) 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?

(17)

(3) 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?

(18)

(4) 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?
(5) 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)?
(6) Will an employee otherwise eligible, who is in an ineligible class of employees,
immediately participate on becoming a member of an eligible class?

(19)
(20) (21)
(22)

c Accrual of benefits:
(1) Does the benefit formula provide for wear-away and fresh-start rules?
(2) Does the plan provide for the determination of a participant’s frozen
accrued benefit?
(3) Does the plan provide for adjustments to frozen accrued benefits?
(4) Does the current benefit formula provide for no permitted disparity and
does it use the fractional accrual rule?
(5) Does the current benefit formula provide for permitted disparity?
(6) Does the plan define covered compensation, final average compensation,
and taxable wage base?
(7) Does the plan provide adjustments for benefits beginning at a time other
than normal retirement age?

(23)
(24)
(25)
(26)
(27)
(27A)
(27B)
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

10

Provisions applicable to all plans (continued):
c Accrual of benefits (continued):
(8) If the plan provides for permitted disparity, must mandatory employee
contributions be allocated to a separate account?
(9) If fully insured, does the plan provide for permitted disparity with respect
to employer-provided benefits?
(10) If the plan is integrated, is the employer-provided benefit limited in
accordance with section 401(a)(5)(d)?
(11) If the plan has permitted disparity under an offset benefit formula, do
retroactive amendments comply with the Social Security Act of 1983?

Page

N/A

Article or
Section and
Page Number

Change

For
IRS
Use
Only

(27C)
(27D)
(27E)
(27F)

d Benefits increases:
For a fully insured plan, or a plan that provides an insured death benefit, is
there a provision for purchasing additional contracts due to increases in
compensation?
e

4

(28)
(29)
(30)

(1) Does the plan define an accrual computation period?
(2) Does the plan define a year of credited service?
(3) Does the rate of accrual under each benefit formula satisfy one of the
following tests at all times:
(a) 3 percent rule—section 411(b)(1)(A)?
(b) 1331⁄ 3 percent rule—section 411(b)(1)(B)?
(c) Fractional rule—section 411(b)(1)(C)?
(d) Fully insured plan rule—section 411(b)(1)(F)?
(4) Does the plan provide for pre-ERISA accruals?
(5) For purposes of determining accrued benefits, is the normal retirement
benefit equal to the greater of the early retirement benefit under the
plan or the benefit beginning at normal retirement age?
(6) Do plan participants continue to accrue benefits without reduction in the rate
of accruals solely on account of the attainment of any specified age?

(31)
(31)
(31)
(32)
(33)

(34)
(35)

f Employee contributions:
(1) If the plan permits employee contributions which are allocated to a
separate account, does the plan comply with section 401(m)?
(2) Does the plan provide a separate account for the portion of each
employee’s accrued benefit derived from voluntary employee
contributions?

(36)

(37)

(3) Are employee contributions (adjusted for investment experience)
nonforfeitable at all times?
(4) Does the plan require that deductible voluntary employee contributions will be
maintained in a separate account?

(38)
(39)

g Section 415 limitations:
(40)

Are annual benefits limited as required by section 415?
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

Page

N/A

10

Provisions applicable to all plans (continued):

Article or
Section and
Page Number

Change

h Distribution provisions:
(1) Does the plan state the normal form in which benefits will be paid (life
annuity, 10 years certain and life thereafter, etc.)?
(2) Does the plan specify the actuarial assumptions to be used in determining
actuarial equivalence which comply with Regulations section 1.417(e)-1?
(3) Are the optional forms of benefits stated in the plan?

5

For
IRS
Use
Only

(41)
(42)
(43)

(4) If the plan disregards service attributable to a distribution in computing the
employer-derived accrued benefit, does the plan contain provisions that
satisfy Regulations section 1.411(a)-7(d)(4)?

(44)

(5) If the present value of the accrued benefit 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
1.417(e)-1?

(45)

(6) (a) Does a married participant automatically receive a qualified joint and
survivor annuity (QJSA), and an unmarried participant the normal form
of life annuity?

(46)

(b) Is the participant given an opportunity to make a qualified election to
waive the automatic form of payment in a manner which satisfies section
417(a)(2) during the election period described in section 417(a)(6)(A)?

(46)

(7) (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)(1) in the
event of death before the annuity starting date?

(46)

(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 described in section 417(a)(6)(B)?

(46)

(8) 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?
(9) (a) Does the plan provide for a written explanation of the automatic form
of payment 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)?

(46)
(46)
(46)

(10) 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?

(47)

(11) 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?

(48)

(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) Are annuity contracts nontransferable when distributed?

(49)
(50)
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

Page

10

For
IRS
Use
Only

Provisions applicable to all plans (continued):
h Distribution provisions (continued):
(14) Does the plan require that, in accordance with section 401(a)(9):
(a) Distributions be made beginning not later than the required beginning date?
(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?

N/A

Article or
Section and
Page Number

Change

6

(51)

(51)

(c) Payment of the participant’s interest be made within 5 years of the
participant’s death, unless one of the exceptions in section
401(a)(9)(B)(iii) or (iv) applies, when payment of the participant’s interest
has not begun prior to death?

(51)

(d) Distributions, if not made in a single sum, will satisfy the minimum
distribution rules of section 401(a)(9) and the regulations there under,
including the minimum distribution incidental benefit requirement of
Regulations section 1.401(a)(9)-6 Q&A-2?
(15) Does the plan provide that any preretirement death benefits are incidental?
(16) Does the plan permit distributions only at normal retirement age, plan
termination, termination of employment, death, or disability?
(17) (a) Does the plan provide for the direct rollover of an eligible rollover
distribution to an eligible retirement plan?
(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 source
from which it will accept rollovers, such as the types of plans?

(51)
(52)
(53)
(54)

(18) If the plan provides for suspension of benefits upon reemployment with
the employer or continued employment beyond normal retirement age,
does this provision comply with Department of Labor regulations?
(19) Does the plan contain early termination provisions required by Regulations
section 1.401-4(c)?
(20) Does the plan contain pre-termination restrictions?

(55)
(56)
(57)

i 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
period which 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?

(58)
(59)
(60)

(4) Are vesting options 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)?
(5) If all years of service are not counted for vesting purposes, is the service
not counted excludable under section 411(a)(4)?
(6) Does the plan contain the vesting break in service one year holdout
provision?
(7) Does the plan contain the vesting break in service rule of parity?

(61)
(62)
(63)
(64)

(8) 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?
(9) Does the plan provide protection against cut back of vested rights or
rights to accrued benefits under sections 411(a)(10)(A) and 411(d)(6)?

(65)
(66)

(10) If participants may withdraw their contributions or earnings on them, may
the withdrawal be made without forfeiting vested benefits based on
employer contributions?
(11) 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?

(67)

(68)
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

10

Provisions applicable to all plans (continued):
j Top-heavy:
(1) If this plan does not fulfill the basic top-heavy plan requirements 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?

Page

N/A

Article or
Section and
Page Number

Change

(69)

(3) 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 lowest accrual rate permitted under section 411(b)(1)(C)?
(4) Does the plan provide an accrued benefit (determined without regard to
social security) which is at all times not less than 2% of the highest 5
consecutive years’ average compensation for each year of service (service
may be limited to service while the plan is top-heavy and to a maximum
of 10 years of service) for each nonkey employee participant who has
completed 1,000 hours of service including a nonkey employee who:
(a) fails to make mandatory contributions to the plan?
(b) is excluded from the plan because compensation is less than a
stated amount?
(c) is not employed on the last day of the accrual computation period?
(d) has his or her accrued benefit reduced in any way because of
permitted disparity?

(69)

(70)
(70)
(70)
(70)

(5) If the minimum accrued benefit in (4) is in a form other than a life annuity
at normal retirement age, is such minimum accrued benefit at least equal
to the actuarial equivalent of the required minimum accrued benefit?
(6) Are forfeitures of the minimum accrued benefit prohibited in the event a
participant:

(71)

(72)
(72)

(a) works beyond the normal retirement age?
(b) withdraws mandatory employee contributions?
(7) Does the plan provide for vesting not less favorable than the vesting
described in section 416(b)?

(73)

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

(3)

(4)

(5)

(6)

For
IRS
Use
Only

(69)
(69)
(69)
(69)
(69)
(69)
(69)
(69)

(2) 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?

(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 the rights of all affected employees to benefits accrued to the date of
such termination or partial termination, to the extent funded as of such
date, nonforfeitable?
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?

(72)

(73)

(74)
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

Page

N/A

Article or
Section and
Page Number

Change

8

For
IRS
Use
Only

(7) 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) the practitioner maintains recordkeeping and notice requirements?

(76)

(8) 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?
10 Provisions applicable to all plans (continued):
l 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 annuity requirements?
(3) Does the plan provide that corpus or income may not be diverted for purposes
other than the exclusive benefit of employees or their beneficiaries?
(4) Does the plan provide that if it does not attain or retain qualification, the
employer can no longer participate under the plan?
(5) If this is a master plan:
(a) Is only a single funding medium available for use by all adopting
employers?

(77)

(78)
(79)
(80)
(81)

(82)

(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?

(83)

(6) If the employer maintains a plan of a predecessor employer, does the
plan provide that service with the predecessor employer will be counted
as service with the employer?

(84)

(7) Does the plan provide that in the event of any conflict between provisions
of the plan and the terms of any policy or contract issued under the plan,
the provisions of the plan will control?
(8) If the plan provides for investment in insurance contracts, does it provide
for the disposition of dividends and other credits?

(86)
(87)

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

(88)

(10) Does the adoption 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?

(88)

(11) 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?
(12) Does the plan contain a provision that incorporates the requirements of
section 414(u) of the Code (USERRA) (see instructions)?
(13) Does the plan contain any sub-trusts for life insurance?

(88)
(89)
Form

4461-A

(Rev. 3-2008)

Page

Form 4461-A (Rev. 3-2008)

Part II
11

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 sections 414(b), (c), (m) or (o)
other than employees who may be excluded under section 410(a)(1) or (b)(3)?
b Are the eligibility requirements not more favorable for highly compensated
employees, as defined in section 414(q), than for other employees?
c 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)?

Part III
12

9

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

Article or
Section and
Page Number

Change

For
IRS
Use
Only

(90)
(91)

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

With respect to this nonstandardized plan:
a If the plan provides for mandatory contributions, does the adoption agreement
provide an election for the adopting employer to specify the level of these
contributions?

(92)

b Does the plan define the accrued benefit derived from employer contributions
as the total accrued benefit, less the accrued benefit derived from mandatory
employee contributions as provided in Regulations section 1.411(c)-1?
c Is the accrued benefit attributable to mandatory employee contributions
nonforfeitable at all times?
d Does the plan meet the minimum age and service requirements of section
410(a)(1)?
e Does the plan exclude categories of employees participation in addition to
those who may be excluded under section 410(a)(1) or section 410(b)(3)?
f Does the plan give the employer the option to satisfy one of the
nondiscrimination design-based safe harbors?

(93)
(94)
(95)
(96)
(97)

g 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?

(98)

h Does the plan give the employer the option to select total compensation?

(99)
Form

4461-A

(Rev. 3-2008)

Form 4461-A (Rev. 3-2008)

Page

General Instructions

What To File

Purpose of Form

One copy of Form 4461-A should be
submitted for each different adoption
agreement or for each separate adoption
agreement.
For initial approval, file this application
and each applicable document listed in
item 9a. For approval of an amendment,
file this application and a copy of each
applicable document listed in item 9b.
Different parts of this form must be
completed depending on the type of
plan for which you want approval.
Standardized plans. If you want to
receive an opinion letter on a
standardized plan, complete Parts
I and II.
Nonstandardized plans. If you want to
receive an opinion letter on a plan other
than a standardized, complete Parts I
and III.

Use Form 4461-A to apply for initial
approval of, or for approval of an
amendment to a master or prototype
(M&P) or Volume Submitter (VS) defined
benefit plan.
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
application is not complete, we will
return it without processing it. The first
page must be typed.
The questions are designed so that,
unless they are not applicable, the article
or section and page numbers indicating
the location in the plan of the provision
should be entered in the appropriate
column. The column marked “CHANGE”
is for IRS use only.
Unless otherwise noted, the questions
in Part I apply to both M&P and VS
defined contribution plans. Parts II and
III apply to M&P Plans. This form was
originally used only for M&P plans, and
many items, unless specifically referring
to VS plans, are based on a Listing of
Required Modifications (LRM’s)
containing sample language designed for
use in drafting M&P plans. VS
practitioners may also use this language
if appropriate, and should still complete
applicable parts of the Form, or explain
why a particular question is not
applicable.
Request for additional information. If a
letter requesting additional information or
changes to plan documents is sent to
the sponsor, VS practitioner, or
authorized representative, such
information and/or changes must be
received no later than 30 days from the
date of the letter. Failure to respond
timely may result in the application being
considered withdrawn. An extension of
the 30-day time limit will only be granted
for good cause.
Inadequate submissions. The IRS will
return, without further action, plans
which are not in substantial compliance
with the qualification requirements or
plans that are so deficient that they
cannot be reviewed in a reasonable
amount of time.

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).

Multiple plans. A sponsor may utilize
one basic plan document for several
plans. A sponsor may, for example,
submit four applications for a given
defined benefit basic plan document (an
integrated standardized plan, a
nonintegrated standardized plan, an
integrated nonstandardized plan, and a
nonintegrated nonstandardized plan). A
separate adoption agreement and
completed application must be provided
for each such defined benefit plan. In
the case of a simultaneous submission,
only one basic plan document need be
submitted. If the request is not
simultaneous, separate basic plan
documents must be submitted (but the
number assigned to the basic plan
document of a master or prototype plan
remains the same).

Where To File
Master or prototype plan. Send
applications for opinions and advisory
letters to:
Internal Revenue Service
P.O. Box 2508; Room 5106
Cincinnati, OH 45201
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.
For both types of application, 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:
Internal Revenue Service
550 Main Street
Room 5106
Cincinnati, OH 45202

10

Signature. Form 4461-A 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
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:
● 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.
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 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.
Flexible plan. A plan submitted by a
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 that 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.

Form 4461-A (Rev. 3-2008)

Mass submitter. As set forth in Rev.
Proc. 2005-16, any entity that submits
applications on behalf of at least 30
unaffiliated sponsors 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 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.
Notwithstanding the above, any entity
that received a favorable GUST opinion
letter for a plan as a mass submitter 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
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. Affiliation
is determined under sections 414(b) and
(c) of the Code. Additionally, the
following will be considered to be
affiliated: any law, accounting, consulting
firm, etc. with its partners, members,
associates, etc.
Master plan. A form of plan that is
made available by a sponsor for
adoption by employers for which a
single funding medium (for example, a
trust or custodial account, see section
4.05 of Rev. Proc. 2005-16) is
established, as part of the plan, for the
joint use of all adopting employers. A
master plan consists of a basic plan
document, an adoption agreement, and,
unless included in the basic plan
document, a trust or custodial account
document.
National Sponsor. A sponsor which has
either: (a) 30 or more adopting
employers in each of 30 or more states,
or (b) 3,000 or more adopting employers
on any one date during the 12-month
period ending on April 18, 2005. For this
purpose, an adopting employer is any
employer that has adopted any plan of
the sponsor which has a GUST opinion
or notification letter.

Page

Prototype plan. A form of plan that is
made available by a sponsor for
adoption by employers under which a
separate funding medium is established
for each adopting employer. A prototype
plan consists of a basic plan document,
an adoption agreement, and unless the
basic plan document incorporates a
trust or custodial account agreement the
provisions of which are applicable to all
adopting employers, a trust or custodial
account document.
Specimen Plan. A specimen plan is a
sample plan, including the related trust
or custodial account, of a VS practitioner
(rather than the actual plan of an
employer). A specimen plan may include
an adoption agreement.
Sponsor. Any person that has an
established place of business in the
United States where it is accessible
during every business day and
represents to the Service that it has at
least 30 employer-clients each of which
is reasonably expected to adopt the
sponsor’s basic plan document and one
or more of the adoption agreements
associated with that basic plan
document. Once a person represents to
the Service that at least 30 employers
are reasonably expected to adopt its
basic plan document, it will be treated
as a sponsor with respect to all the
basic plan documents and associated
adoption agreements for which it
requests opinion letters, regardless of
the number of employers that are
expected to adopt such other plans.
Notwithstanding the above, any person
that has an established place of
business in the United States where it is
accessible during every business day
and is a word-for-word identical adopter
or minor modifier adopter of an M&P
plan of a mass submitter will be treated
as a sponsor with respect to such plan,
regardless of the number of employers
that are expected to adopt such plan.
Standardized plan. A plan that meets
the specific requirements of Part II of
this form.
VS Mass Submitter. Any person that
has an established place of business in
the United States where it is accessible
during every business day and submits
advisory letter application on behalf of at
least 30 unaffiliated practitioners each of
which is sponsoring, on a word-for-word
identical basis.
VS Practitioner. Any person that has an
established place of business in the
United States where it is accessible
during every business day and
represents to the Service that it has at
least 30 employer-clients each of which
is reasonably expected to timely adopt a

11

plan that is substantially similar to the
VS practitioner’s specimen plan.
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.

Specific Instructions
Line 1. All applications must be
accompanied by the appropriate user
fee from the schedule set forth in Rev.
Proc. 2007-8, I.R.B. 2007-1, 230 when
filing Form 4461-A. 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 box number instead of the
street address.
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.
Line 4c. The applicant should include an
email address in order for the IRS 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.
Line 5a. Enter the two-digit basic plan
document number you have assigned to
the specimen plan or 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.” The
first specimen plan should be numbered
“001,” the second “002,” etc.
Line 5b. Enter the three-digit number
you have assigned to the adoption
agreement for which this application is
submitted. Each different adoption
agreement designed to accompany a
single basic plan document should be
given a different three-digit number
beginning with “001.” For example, if the

Form 4461-A (Rev. 3-2008)

first basic plan document of a sponsor
has four different adoption agreements,
they should be numbered “001” through
“004,” and four different Forms 4461-A
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.”
Line 7. Indicate if this plan provides for
permitted disparity in accordance with
sections 401(a)(5) and 401(l).
Line 9. Procedural requirements. A
separate application must be submitted
for each different plan/adoption
agreement combination.
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
the amendment need not be submitted.
The Internal Revenue Service may, at its
discretion, require plan restatement any
time it deems necessary.
Line 9c. If you checked “Yes,” submit a
copy of such plan with language
differences highlighted. Attach a cover
letter which provides the name and file
folder number of the plan (including the

Page

name and EIN of the sponsor), a list of
all plans written by the plan drafter
which are substantially identical to the
lead plan (including the information
described above), a description of each
place where the plan for which the
application is being submitted is not
word-for-word identical to the language
of the lead plan (including an
explanation of the purpose and effect of
each difference), and a certification,
made under penalty of perjury by the
plan drafter, that the information
describing where the plan language is
not word-for-word identical is true and
complete.
Line 9e. The mass submitter should use
Form 4461-B, Application for Approval
of Master or Prototype or Volume
Submitter Plans, when submitting
applications on behalf of its adopting
sponsors/practitioners.
Line 10l. A plan sponsor 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.

12

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 this 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
returns and return information are
confidential, as required by Code section
6103.
The time needed to complete and file
this form will vary depending on the
individual circumstances. The estimated
average time is:
Recordkeeping
42 hr., 5 min.
Learning about the law
or the form
5 hr., 55 min.
Preparing the form
7 hr., 48 min.
Copying, assembling, and
sending the form to the IRS
16 min.
If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form
simpler, we would be happy to hear
from you. You can write to the Internal
Revenue Service, Tax Products
Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution
Ave., NW, IR-6526, Washington, DC
20224. Do not send this form to this
address. Instead, see Where To File on
page 10.