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

Form

4461-A

(Rev. March 2013)
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 and Attachment 1-A. (See Rev. Proc. 2011-49, 2011-44 I.R.B. 608.)
See instructions before completing this form.
1
2a

3a

Enter amount of user fee submitted
$
Approval requested:
Initial application
Amendment—Enter file folder number or letter
serial number and date of last letter issued ▶

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

2c Date of last letter issued

3b Employer identification number
of applicant

Name of applicant
Address (number, street, room or suite no.) (If a P.O. box, see instructions)
City

State

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

ZIP code

3c Applicant’s telephone no.

Volume submitter practitioner
Volume submitter mass submitter
4b Telephone number

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

Does the plan provide for permitted disparity in accordance with section 401(l)?
Filing status of plan:
Standardized plan
Nonstandardized plan
Volume submitter governmental plan (i.e., described in section 414(d))
Volume submitter nongovernmental 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 ▶

Date ▶

Title ▶

For Privacy Act and Paperwork Reduction Act Notice, see the instructions.

Cat. No. 11416U

Form

4461-A (Rev. 3-2013)

Form 4461-A (Rev. 3-2013)

Page

9

Procedural requirements:
a Have the following been submitted as required by instructions—
(1) Adoption agreement? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Copy of plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(3) Copy of trust indenture or custodial agreement? . . . . . . . . . . . . . . . . . . .
(4) Copy of Certification of Interim Amendments? . . . . . . . . . . . . . . . . . . . .
b 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

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, is there a procedure in place for the
adoption and distribution of the amendments? . . . . . . . . . . . . . . . . . . . . .

d 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.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e

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)
(3)

f

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:
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? . . . . .

Mass submitter request (M&P mass submitter complete (1), (2), and (3); VS mass submitter complete (4)):
(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)
(3)

(4)

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:
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? . . . . . . . . . . . . . .
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? . . . . . . . . . . . . .

Note: This application is designed to be used in conjunction with Rev. Proc. 2011-49. A List of Required Modifications (LRMs) is also
recommended for use and may be obtained from the IRS website at www.irs.gov/ep.
Form

4461-A (Rev. 3-2013)

Form 4461-A (Rev. 3-2013)

General Instructions
Purpose of Form
Use Form 4461-A to apply for approval
of a Master or Prototype (M&P) or
Volume Submitter (VS) defined benefit
plan.
Be sure to submit a complete and
accurate application, including Form
4461-A and Attachment 1-A (see
www.irs.gov/pub/irs-tege/form4461A_attachment.pdf). Complete every
applicable line on the application. If an
item on the Attachment 1-A does not
apply, check the “N/A” box or enter
“N/A” on the line where indicated as an
option. If your application is not
complete, we will return it without
processing it. The first page must be
typed. Unless otherwise noted, the
questions on Form 4461-A and
Attachment 1-A apply to both M&P and
VS defined benefit plans.
Request for additional information. If a
letter requesting additional information
or changes to plan documents is sent to
the sponsor, VS practitioner, or an
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 that
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
and mass submitters (see Definitions,
later).
Volume submitter plans. Practitioners
and mass submitters (see Definitions,
later).

What To File
One copy of Form 4461-A and
Attachment 1-A for each separate
adoption agreement or for each separate
specimen plan where no adoption
agreement is utilized.

Page

For approval, file this application and
each applicable document listed in line
9a.
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 (a
standardized plan with permitted
disparity, a standardized plan without
permitted disparity, a nonstandardized
plan with permitted disparity, and a
nonstandardized plan without permitted
disparity). A separate adoption
agreement and completed application
must be provided for each such defined
benefit plan. In the case of a
simultaneous submission using the same
basic plan document, 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). One
basic plan document may not be used
for both defined benefit and defined
contribution plans.
A VS practitioner is permitted to
submit a defined benefit specimen plan
which allows for an employer to select
either a benefit formula with or without
permitted disparity. You may not use
the same specimen 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)).

Where To File
Send applications for opinion and
advisory letters to:
Internal Revenue Service
P.O. Box 2508; Room 5106
Cincinnati, OH 45201
Add “Attn: Pre-approved Plans
Coordinator.”
For both types of applications, send a
request shipped by Express Mail or a
delivery service to the attention of the
Pre-approved Plans Coordinator to:
Internal Revenue Service
550 Main Street
Room 5106
Cincinnati, OH 45202
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.

3

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 (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.
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. 2011-49.
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. 3-2013)

Mass submitter. In Rev. Proc. 2011-49,
any entity that submits applications on
behalf of at least 30 unaffiliated sponsors
each of which is sponsoring, on a wordfor-word identical basis, the same basic
plan document and one or more of the
adoption agreements associated 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 for each specimen plan
for which the 30-unaffiliatedpractitioners requirement is separately
met.
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 wordfor-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. For purposes
of determining whether 30 (or 10, if
applicable) unaffiliated sponsors or
practitioners sponsor on a word-forword identical basis the same basic plan
document or the same specimen plan,
the mass submitter is treated as an
unaffiliated sponsor or practitioner.
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

Page

4.01 of Rev. Proc. 2011-49) 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.
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 agreement, 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.
M&P standardized plan. A plan which
meets the specific requirements of
Attachment 1-A, line 11. (See
www.irs.gov/pub/irs-tege/form4461A_attachment.pdf or Rev. Proc. 2011-49,
2011-44 I.R.B. 615.)

4

M&P nonstandardized plan. A plan
which meets the specific requirements of
Attachment 1-A, line 12. (See
www.irs.gov/pub/irs-tege/form4461A_attachment.pdf or Rev. Proc. 2011-49,
2011-44 I.R.B. 615.)
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
plan that is substantially similar to the
VS practitioner’s specimen plan. A VS
practitioner may submit any number of
specimen plans for advisory letters
provided that the 30 employer-clients
requirement is separately satisfied with
respect to each specimen plan. For this
purpose, where an adoption format is
used, each adoption agreement is
treated as one specimen plan.
Notwithstanding the above, any person
that has an established place of
business in the United States where it is
accessible during every business day
may sponsor a specimen plan as a
word-for-word identical adopter of a
specimen plan of a VS mass submitter,
regardless of the number of employers
that are expected to adopt the 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 submitted must
be accompanied by the appropriate user
fee and Form 8717-A, User Fee for
Employee Plan Opinion or Advisory
Letter Request, as determined from the
schedule set forth in Rev. Proc. 2013-8,
2013-8 I.R.B. 237, (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 applicant has a P.O. box number,
show the P.O. box number instead of the
street address.
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, earlier.

Form 4461-A (Rev. 3-2013)

Page

Line 4c. The applicant should include an
email address in order for the Service to
send an email of preliminary approval
notifying the applicant that review of the
applicable plan has been completed,
subject to final approval by opinion or
advisory letter.

Line 7. Indicate if this plan provides for
permitted disparity in accordance with
sections 401(a)(5) and 401(l).

Line 5a. 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.

In the case of a VS plan, submit a
separate application for each type of
plan.

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 or specimen
plan should be given a different threedigit number beginning with “001.” For
example, if the 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 or specimen plans (that are
not word-for-word identical to a
previously submitted basic plan
document) should be similarly
numbered beginning with “001.”

Line 9. Procedural requirements. A
separate application must be submitted
for each different plan/adoption
agreement combination.

Line 9d. 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
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 9f. 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/practitioners, and
submit Form 8717-A.

5

Privacy Act and 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:M:S, 1111 Constitution
Ave., NW, IR-6526, Washington, DC
20224. Do not send this form to this
address. Instead, see Where To File,
earlier.