Form 5300, Application for Determination for Employee Benefit Plan, Schedule Q (Form 5300), Elective Determination Requests

Instructions for Form 5300
(Rev. January 2017)

Department of the Treasury
Internal Revenue Service

Application for Determination for Employee Benefit Plan
Section references are to the Internal Revenue
Code unless otherwise noted.

Future Developments

For the latest information about
developments related to Form 5300 and
its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form5300.

What's New
Revised form. The form and
instructions have undergone major
revisions in format and information
required.
Note. Filers permitted to submit from
2/1/16 to 1/31/17 (Cycle A3 filers)
should use the prior version of Form
5300 (Rev. December 2013).
Many of the revisions reflect the
changes affecting individually designed
plans described in Rev. Proc. 2016-37,
2016-29 I.R.B. 136, available at
www.irs.gov/irb/2016-29_IRB/ar10.html,
including (1) eliminating 5-year remedial
amendment cycles, and (2) generally
limiting determination letter (DL)
requests to initial plan qualification and
qualification on plan termination,
effective January 1, 2017. In addition,
sponsors may submit requests for
determinations on partial termination
regardless of their ability to request DLs
on their plan document. Many other
changes are intended to reduce
burdens on filers.
Note. The DL program is administered
under Rev. Proc. 2016-6, 2016-1 I.R.B.
200, available at www.irs.gov/irb/
2016-01_IRB/ar12.html (updated
annually), and Rev. Proc. 2016-37.
Review these documents before
completing the application.
Defined benefit plan. New information
is requested for defined benefit plans in
connection with Notice 2015-49,
2015-30 I.R.B. 79. See item 7 under
What To File and include the
information in your submission.
Multiple employer plans. A DL
applicant for a multiple employer plan
must request a letter for the plan in the
name of the controlling member. An
applicant requesting a letter for the plan

Dec 13, 2016

submits one Form 5300 application for
the plan in the name of the controlling
member. Any application for an
employer wishing to receive its own
determination letter must be submitted
with the application of the controlling
member.
Disclosure request by taxpayer. A
taxpayer can authorize the IRS to
disclose and discuss the taxpayer's
return and/or return information with any
person(s) the taxpayer designates in a
written request. Use Form 2848, Power
of Attorney and Declaration of
Representative, or Form 8821, Tax
Information Authorization, for this
purpose. See Pub. 947, Practice Before
the IRS and Power of Attorney, for more
information.
Public inspection. Form 5300 is open
to public inspection if there are more
than 25 plan participants. The total
number of participants must be shown
on line 3e. See the instructions for
line 3e for a definition of “participant.”

General Instructions
Purpose of Form

File Form 5300 to request a DL from the
IRS for the qualification of a defined
benefit (DB) or a defined contribution
(DC) plan and the exempt status of any
related trust.

Type of Plan

A DC plan is a plan that provides an
individual account for each participant
and for benefits based only on:
1. The amount contributed to the
participant's account; and
2. Any income, expenses, gains and
losses, and any forfeiture of accounts of
other participants that may be allocated
to the participant's account.
A DB plan is any plan that isn’t a DC
plan.
Note. A DB plan can’t be amended to
become a DC plan. If a sponsor of a DB
plan attempts to amend the plan to
become a DC plan, or if the merger of a
DB plan with a DC plan results solely in

Cat. No. 10932P

a DC plan, the DB plan is considered
terminated.
Terminating plan. If the plan is a
terminating plan, file Form 5310,
Application for Determination for
Terminating Plan. If benefit accruals or
contributions have ceased, the plan and
trust won’t be considered terminated
until formal action has been taken to
terminate the plan.

Who May File

This form may be filed by:
Individually Designed Plans. This
form may be filed by the employer,
(including a sole proprietor, partnership,
or corporation) or plan administrator to
request a DL for an individually
designed plan that:
1. Has never received a DL,
regardless of when the plan was
adopted;
2. Has previously received a DL and
is specifically authorized to apply for a
new DL under current IRS guidance.
Volume Submitter and Master &
Prototype Plans. An application for a
DL for a volume submitter (VS) plan or
master & prototype (M&P) plan may be
filed on Form 5300 by an employer or
plan administrator, if otherwise
permissible under Rev. Proc. 2016-37,
during the period announced in IRS
guidance.
If this is a VS plan that has made
limited modifications to an approved
specimen plan (that doesn’t convert the
plan into an individually designed plan),
file Form 5307, Application for
Determination for Adopters of Modified
Volume Submitter (VS) Plans, instead of
Form 5300. The plan will be reviewed
on the basis of the Cumulative List that
was considered in issuing the advisory
letter for the VS plan.
Note. If no changes have been made
by an adopting employer other than to
select among options in the adoption
agreement or make other permitted
changes as specified in section 19.03 of
Rev. Proc. 2015-36, 2015-27 I.R.B. 20,
available at www.irs.gov/irb/
2015-27_IRB/ar08.html, the adopting
employer must rely on the opinion or
advisory letter for the M&P or VS plan.

Where To File

File Form 5300 at the address indicated
below.
Internal Revenue Service
P.O. Box 12192
Covington, KY 41012-0192

Private delivery services. The
organization can use only the
IRS-designated private delivery
services below to meet the “timely
mailing as timely filing/paying” rule for
tax returns and payments. These private
delivery services include only the
following.
DHL Express 9:00, DHL Express
10:30, DHL Express 12:00, DHL
Express Worldwide, DHL Express
Envelope, DHL Import Express 10:30,
DHL Import Express 12:00, and DHL
Import Express Worldwide.
Federal Express (FedEx): FedEx First
Overnight, FedEx Priority Overnight,
FedEx Standard Overnight, FedEx
2Day, FedEx International Next Flight
Out, FedEx International Priority, FedEx
International First, and FedEx
International Economy.
United Parcel Service (UPS): UPS
Next Day Air Early AM, UPS Next Day
Air, UPS Next Day Air Saver, UPS 2nd
Day Air, UPS 2nd Day Air AM, UPS
Worldwide Express Plus, and UPS
Worldwide Express.
For private delivery services, deliver
the return to:
Internal Revenue Service
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011
The private delivery service can tell
you how to get written proof of the
mailing date.
Private delivery services can’t
deliver items to P.O. boxes. You
CAUTION must use the U.S. Postal
Service to mail any item to an IRS P.O.
box.

!

How To Complete the
Application

The application must be completed and
signed by the employer, plan
administrator, or authorized
representative.
Note. Stamped signatures aren’t
acceptable. It is important that an
appropriate response be entered for
each line item (unless instructed

otherwise). When completing the
application, use the following
guidelines.
N/A (not applicable) is accepted as a
response only if an N/A block is
provided.
If a number is requested, a number
must be entered.
If an item provides a choice of boxes
to mark, mark only one box unless
instructed otherwise.
If an item provides a box to mark,
written responses aren’t permitted.
The application has formatted fields
that will limit the number of characters
entered per field.
All responses should be entered in
Courier 10 point font.
Alpha characters should be entered
in capital letters.
Enter a space between each word.
Spaces count as characters.
All date fields are entered as an
eight-digit field (MM/DD/YYYY).
Any required attachment should refer
to the form and the line item.
The IRS may require additional
information.

What To File

See the instructions under line 4a for
Partial Termination Request.
All applications (including
applications for M&P or VS plans,
unless otherwise noted) must contain an
original signature and be accompanied
by the following.
1. A completed Form 5300,
including the procedural requirements
checklist.
2. A Form 8717, User Fee for
Employee Plan Determination Letter
Request, and a check for the
appropriate user fee (unless payment
was made through www.pay.gov).
Submit a separate check for each
application. Make checks payable to
“United States Treasury.”
Note. If the user fee is paid using
www.pay.gov, a copy of the payment
confirmation must be submitted along
with the paper Form 8717.
3. Form 8905, Certification of Intent
To Adopt a Pre-Approved Plan, if
applicable.
4. A copy of the current plan
document and prior plan document(s), if
the plan has been restated.
5. Copies of all signed and dated
plan amendments. If the plan was
amended, include a copy of the last
favorable DL and any amendments
since the last favorable DL. The plan
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should be updated based on the
Required Amendments List that was
issued during the second calendar year
preceding the submission of the DL
application (and prior Required
Amendments List). However, plans
submitted for initial qualification during
the 2017 calendar year will be reviewed
based on the 2015 Cumulative List. See
Rev. Proc. 2016-37.
6. A copy of any Voluntary
Correction Program compliance
statement or Audit Closing Agreement
Program closing agreement regarding
the plan.
7. For a DB plan, include one of the
following paragraphs in the cover letter
to your application indicating whether
the plan provides for lump-sum risk
transfers, as described in Notice
2015-49, 2015-30 I.R.B. 79.
a. If not provided in the plan, add
the following paragraph: “The plan
doesn’t provide for lump-sum risk
transfers, as described in Notice
2015-49.”
b. If provided in the plan, add the
following paragraph: “The plan provides
for lump-sum risk transfers, as
described in section II of Notice
2015-49. This provision (satisfies)
(doesn’t satisfy) one of the four
conditions for Pre-Notice Acceleration
described in section IV of Notice
2015-49.” (If you state that the plan
"satisfies" one of the four conditions for
Pre-Notice Acceleration, describe in
detail how the plan complies with the
conditions.)
8. For an adopting employer of a
M&P or VS plan, attach a statement
explaining why the 5300 is being filed,
and include a copy of the opinion or
advisory letter for the plan. Do not
include any interim amendments
adopted by the employer, except in the
case of a VS plan that doesn’t authorize
the practitioner with respect to a M&P or
VS plan to amend the plan on behalf of
adopting employers. The plan will be
reviewed on the basis of the Cumulative
List that was considered in issuing the
opinion or advisory letter for the M&P or
VS plan. See section 20 of Rev. Proc.
2016-37.
9. For an employee stock ownership
plan (ESOP), attach:
a. Form 5309, Application for
Determination of Employee Stock
Ownership Plan;
b. A statement indicating whether
the employer is a C corporation or an S
corporation; and

Instructions for Form 5300

c. An explanation if the employer’s
corporate status changed after the
ESOP was originally adopted.
Note. Do not use staples (except to
attach the check to the Form 8717),
paper clips, binders, or sticky notes. Do
not punch holes in the documents.
Note. See the Procedural
Requirements Checklist to ensure that
the application package is complete
before submitting it. Incomplete
applications may be closed if required
items aren’t included in the submission.
If the application package is closed as
incomplete, the application won’t be
returned and any user fee paid with the
application won’t be refunded. (See
Rev. Proc. 2016-6.)

Specific Instructions
Line 1. Enter the name, address, and
telephone and fax numbers of the plan
sponsor/employer.
A plan sponsor means:
1. In the case of a plan that covers
the employees of one employer, the
employer;
2. In the case of a plan sponsored
by two or more entities required to be
combined under section 414(b), (c), or
(m), one of the members participating in
the plan; or
3. In the case of a plan that covers
the employees and/or partner(s) of a
partnership, the partnership.
Note. The name of the plan sponsor/
employer should be the same name that
is used when the Form 5500, Annual
Return/Report of Employee Benefit
Plan, series annual return/report is filed
for the plan. Line 1a is limited to 70
characters.
Line 1f. Enter the nine-digit employer
identification number (EIN) assigned to
the plan sponsor/employer. This should
be the same EIN that is used when the
Form 5500 series annual return/report is
filed for the plan.
The plan of a group of entities
combined under section 414(b), (c), or
(m), whose sponsor is more than one of
the combined entities, should only enter
the EIN of one of the sponsoring
members.
This EIN must be used in all
subsequent filings of DL requests for the
plan, and annual returns/reports for the
plan, unless there is a change of
sponsor.

Instructions for Form 5300

!

Do not use a social security
number or the EIN of the trust.

CAUTION

The plan sponsor/employer must
have an EIN. A plan sponsor/employer
without an EIN can apply for one.
Online—Generally, a plan sponsor/
employer can receive an EIN by Internet
and use it immediately to file a return.
Go to the IRS website at www.irs.gov/
businesses/small and click on Employer
ID Numbers (EINs).
By mail or fax—Send in a completed
Form SS-4, Application for Employer
Identification Number, to apply for an
EIN.
Lines 1g and 1h. Enter the telephone
and fax numbers of the plan sponsor.
Line 1i. Enter the two digits
representing the month the plan
sponsor/employer's tax year ends.
Lines 1j through 1m. If a foreign
entity, follow the country's practice for
entering the name of the city or town,
province/country, and the postal code.
Line 2. If Form 2848 or Form 8821 is
attached, check the box only. If not
attached, enter a contact person. The
contact person listed on line 2 will
receive copies of all correspondence.
Lines 2h through 2k. If a foreign
contact, follow the country's practice for
entering the name of the city or town,
province/country, and the postal code.
Line 3a. This field is limited to 70
characters, including spaces. Fill in the
plan name as it should appear on the
DL. If the plan name contains more than
70 characters, abbreviations should be
used.
Line 3b. Enter the three-digit plan
number, beginning with "001" and
continuing in numerical order for each
plan you adopt (001–499). The
numbering will differentiate your plans.
The number assigned to a plan must not
be changed or used for any other plan.
This should be the same number that is
used on the Form 5500 series annual
return/report for the plan.
Line 3c. Plan month means the month
in which the plan year ends. Enter the
two-digit month (MM).
Line 3d. Enter the plan's original
effective date.
Line 3e. Enter the total number of
participants. A participant is:
1. Any employee participating in the
plan, including employees under a
section 401(k) qualified cash or deferred
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arrangement who are eligible but don’t
make elective deferrals;
2. Retirees and other former
employees who have a nonforfeitable
right to benefits under the plan; and
3. The beneficiary of a deceased
employee who is receiving or will in the
future receive benefits under the plan.
Include one beneficiary for each
deceased employee regardless of the
number of individuals receiving benefits.
Example. Payment of a deceased
employee's benefit to three children is
considered a payment to one
beneficiary.
Lines 3f and 3g. See Notice 2011-86,
2011-45 I.R.B. 698 (or later guidance)
for further details, including how to
determine compensation.
Line 4a. Enter the number that
corresponds to the request being made
(enter one number only).
Enter 1 if the plan is a new plan
that's being submitted within its initial
remedial amendment period described
under Regulations section 1.401(b)-1(d)
(1) or as extended in other guidance.
See Rev. Proc. 2016-37.
Enter 2 if this plan is an existing plan
that has never received a favorable DL.
Enter 3 if neither 1 nor 2 apply and
the plan is specifically authorized to
apply for a DL under applicable IRS
guidance. Include an attachment that
cites the applicable IRS guidance and
explain how the plan meets the criteria
for a DL submission.
Partial termination request. Enter 3 if
requesting a determination with respect
to a partial termination. Employers and
plan administrators that request a
determination on a potential partial
termination may not request a DL on
their entire plan unless the plan is
otherwise eligible for a DL. Indicate in
the cover letter if a partial termination
may have occurred or might occur as a
result of proposed actions. If the
submission is only for a partial
termination request, only complete lines
1–5 and submit the Form 8717 with the
user fee. DO NOT submit the other
items under What To File.
Provide detailed information
regarding the partial termination,
including data specified on the Partial
Termination Worksheet in these
instructions.
1. Using the format in the Partial
Termination Worksheet, submit a
schedule of information for the plan year
in which the partial (or potential partial)

termination began along with the
following plan year, and for the 2 prior
plan years, to the extent information is
available.
2. If the plan has more than one
benefit computation formula, provide a
schedule of information in the same
format as lines 1a through 1f of the
worksheet for each benefit computation
formula.
3. Include an explanation of how the
plan meets the requirements of section
411(d)(3).
Special ruling requests. See Rev.
Proc. 2016-37 and successors to Rev.
Proc. 2016-6 for other types of issues
for which a Form 5300 may be filed.
Line 4b. If line 4a is “1,” enter the date
the plan was originally adopted. If the
initial plan is a proposed plan document,
enter “09/09/9999.”
Line 5. A “pension equity plan” (PEP) is
a DB plan which, rather than or in
addition to expressing the accrued
benefit as a life annuity commencing at
normal retirement age, defines benefits
for each employee as an amount equal
to an accumulated percentage of final
pay. Benefits are generally described as
a percentage of final average pay, with
the percentage determined as the
accumulation of percentage points or
lump-sum credits received for each year
of service. Generally, the accumulated
percentage points or lump-sum credits
are multiplied by final average or career
average compensation to determine the
lump-sum amount.
A “cash balance” plan is a DB plan
which, rather than or in addition to
expressing the accrued benefit as a life
annuity commencing at normal
retirement age, defines benefits for
each employee in terms more common
to a DC plan, that is, as a single-sum
amount equal to the employee’s
hypothetical account balance. Benefits
consist of accumulated hypothetical
allocation credits in an account plus
accumulated hypothetical interest
credits for the account.
Note. If this is only a request for a
partial termination, DO NOT complete
the rest of the application.
Line 6. Check “Yes” if the plan is a
governmental plan under section
414(d).
Line 7. Check “Yes” if the plan is a
church plan under section 414(e) that
hasn’t made a section 410(d) election.
Line 8. Check “Yes” if the plan benefits
any collectively bargained employees

Partial Termination Worksheet
1

Year

Year

Year of partial termination

Year

Participants employed:
a Number at beginning of plan year
b Number added during the plan year
c Total, add lines a and b
d Number dropped during the plan year
e Number at end of plan year, subtract d
from c
f Total number of participants in this plan
separated from service without full
vesting

2

Present value (as of month
during the year of

/

day)

a Plan assets
b Accrued benefits
c Vested benefits
3

Submit a description of the actions that may have resulted (or might result) in a partial
termination. Include an explanation of how the plan meets the requirements of section 411(d)
(3).

under Regulations section 1.410(b)-6(d)
(2).
Line 9. Check “Yes” if the plan is an
insurance contract plan under section
412(e)(3).
Line 10. Check “Yes” if the plan is a
multiemployer collectively bargained
plan under section 414(f).
Line 11. Check “Yes” if the plan is a
multiple employer plan under section
413(c).
Line 12. Section 3001 of the Employee
Retirement Income Security Act of 1974
requires that applicants subject to
section 410 provide evidence that each
employee who qualifies as an interested
party has been notified of the filing of
the application. If “Yes” is marked, it
means that each employee has been
notified as required by Regulations
section 1.7476-1. If this is a one-person
plan or if this plan isn’t subject to section
410, a copy of the notice isn’t required
to be attached to this application. If “No”
is marked or this line is blank, the
application will be returned. Rules
defining “interested parties” and the
form of notification are in Regulations
section 1.7476-1. See Part II of Rev.
Proc. 2016-6.
Line 13. If “Yes,” attach a statement
identifying the plan sections that satisfy
the safe harbor (including, if applicable,
permitted disparity requirements) and
specify which of the following
regulations is intended to be satisfied.
1.401(a)(4)-2(b)(2) DC plan with
uniform allocation formula.
-4-

1.401(a)(4)-3(b)(3) unit credit DB
plan.
1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit
DB fractional rule plan.
1.401(a)(4)-3(b)(4)(i)(C)(2) flat
benefit DB plan.
1.401(a)(4)-3(b)(5) insurance
contract plan.
Line 14. Check “Yes” if the plan utilizes
the permitted disparity rules of 401(l).
Line 15. If “Yes,” attach a statement
providing the plan name, EIN of the plan
sponsor/employer, plan type of the
other plan, and a copy of pertinent
provisions from the other plan regarding
the offset.
Line 16. If this is a request for an
individually designed plan that consists
of a DB plan and a qualified cash or
deferred arrangement, submit two
Forms 5300 and two applicable user
fees and provide an attachment with the
plan sponsor/employer EIN and plan
number of the other plan.
Line 17. Attach a statement that
provides the following.
1. Name of plans involved.
2. Type of plan.
3. Date of merger, consolidation,
spinoff, or transfer of plan assets or
liabilities.
4. Verification that each plan
involved was qualified at the time of the
merger, consolidation, spinoff, or
transfer of plan assets or liabilities.
If the plan previously obtained a DL,
only provide information on a
Instructions for Form 5300

transaction that occurred after the most
recent DL was issued.
Note. Verification includes (1) a copy of
a prior DL, opinion or advisory letter; (2)
plan document and/or adoption
agreement; and (3) interim and
discretionary amendments.
Note. For individually designed plans,
interim amendments only apply if the
adoption deadline is before January 1,
2017. See Rev. Proc. 2016-37.
If applicable, file Form 5310-A,
Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or
Liabilities; Notice of Qualified Separate
Lines of Business, 30 days prior to the
merger, consolidation, or transfer of
assets or liabilities.
Line 18. If the plan has been restated
to change the type of plan under
Regulations section 1.401-1, check
“Yes” and attach a statement explaining
the change.

1. The Internal Revenue Service
(including the Voluntary Compliance
Program),
2. The Department of Labor,
3. The Pension Benefit Guaranty
Corporation (PBGC), or
4. Any court (including bankruptcy
court).
The attachment should include a
contact person's name and telephone
number and agency or court.

How To Get Tax Help

If you have questions about a tax issue,
need help preparing your tax return, or
want to download free publications,
forms, or instructions, go to IRS.gov and
find resources that can help you right
away.
Getting answers to your tax
law questions. On IRS.gov get
answers to your tax questions
anytime, anywhere.
Go to IRS.gov/help or IRS.gov/
letushelp pages for a variety of tools that

Line 19. Check “Yes” and attach an
explanation if the plan has any matter
pending before:

will help you get answers to some of the
most common tax questions.
Go to IRS.gov/ita for the Interactive
Tax Assistant, a tool that will ask you
questions on a number of tax law topics
and provide answers. You can print the
entire interview.
You may also be able to access tax
law information in your electronic filing
software.
Getting tax forms and publications.
Go to IRS.gov/forms to view, download,
or print all of the forms and publications
you may need. You can also download
and view popular tax publications and
instructions (including the 1040
instructions) on mobile devices as an
eBook at no charge. Or, you can go to
IRS.gov/orderforms to place an order
and have forms mailed to you within 10
business days.
By phone. For questions regarding this
form, call the Employee Plans Customer
Service toll free at 1-877-829-5500.

Privacy Act and Paperwork Reduction Act Notice. We ask for information on this form to carry out the Internal Revenue
laws of the United States. We use this information to determine whether the plan complies with these laws. You aren’t required
to request a determination letter; however, if you do so, sections 6001, 6011, 6058(a), and 6109 require you to provide the
information requested. Failure to provide this information in a timely manner, or providing false or fraudulent information, may
subject you to penalties.
You aren’t 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 contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103. However, section 6104(b) makes certain information contained in this
form publicly available. We may also give it to the Department of Labor or the Pension Benefit Guaranty Corporation (PBGC)
for administration of ERISA, the Department of Justice for civil and criminal litigation, and cities, states, the District of Columbia,
and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to
other countries under a treaty, to federal and state agencies to enforce federal non-tax criminal laws, and to federal law
enforcement and intelligence agencies to combat terrorism.
is:

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time

Form 5300

Recordkeeping

Learning about the law or the form

Preparing the form

Copying, assembling, and sending the form

33 hr., 57 min.

10 hr., 7 min.

17 hr., 38 min.

1 hr., 52 min.

We welcome your comments about this publication and your suggestions for future editions. You can send us comments
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Or you can write to:
Internal Revenue Service
Tax Forms and Publications
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send any of these forms or schedules to this address. Instead, see Where To File, earlier.

Instructions for Form 5300

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