Form 8717 User Fee for Employee Plan Determination Letter Request

Form

8717

User Fee for Employee Plan Determination
Letter Request

For
IRS
Use
Only

(Rev. September 2017)
▶ Attach to determination letter application.
Department of the Treasury
▶ Go to www.irs.gov/Form8717 for the latest information.
Internal Revenue Service
1 Name of plan sponsor (employer if single-employer plan)
2 Sponsor’s employer identification number

3 Plan number

OMB No. 1545-1772

Amount paid

4 Plan name

Caution: If you qualify for the exemption from user fees for small business employers, complete only the certification below. See the instructions on
page 2 for details. For all other applications, leave the certification blank and check the appropriate box and enter the user fee in column B of line 5.

Certification
I certify that the application for a determination letter on the qualified status of the plan listed above meets the conditions for
exemption from user fees described in section 7528(b)(2)(B) of the Internal Revenue Code.
Date ▶

Sign Here ▶
Type or print name and title ▶

User Fee
A

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$
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Cat. No. 64727O

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Multiple employer plans (Form 5300)
Multiple employer plans (Form 5310)
Reserved
(1a) . . . . . . . . . . .
(1b) . . . . . . . . . . .
(2a) . . . . . . . . . . .
(2b) . . . . . . . . . . .
(3)
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(4)
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Reserved
(1a) . . . . . . . . . . .
(1b) . . . . . . . . . . .
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(6)
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(7)
Form 5316: . . . . . . . . .

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Form 5300:
Form 5307:
Form 5310:

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5a
b
c
d
e
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Attach Check or Money Order Here

Form Submitted

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Form 8717 (Rev. 9-2017)

Page 2

Form 8717 (Rev. 9-2017)

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

Future Developments
For the latest information about developments
related to Form 8717 and its instructions,
such as legislation enacted after they were
published, go to www.irs.gov/Form8717.

What’s New
Specific user fee amounts are no longer listed
on Form 8717. You must now enter the
appropriate user fee when completing line 5.
Notice 2011-86 is obsoleted.
Note: www.pay.gov can be used to pay your
user fee. Be sure to include the payment
confirmation page along with Form 8717.

General Instructions
Purpose of Form
Generally, a user fee is required with each
application for a determination letter. Use
Form 8717 to submit the appropriate user fee.
Note: Don't use any part of the form that is
shaded in gray. Those portions of the form are
no longer functional.

Specific Instructions
Exemption From User Fee
The exemption from the user fee applies to all
eligible employers (defined later) who request
a determination letter within the first 5 plan
years or, if later, by the end of any remedial
amendment period with respect to the plan
that begins within the first 5 plan years
(“qualifying open remedial amendment
period”). The IRS will treat an application for a
determination letter as being filed within a
qualifying open remedial amendment period if
the plan was first in existence no earlier than
January 1 of the 10th calendar year preceding
the year in which the application is filed (the
“10-year rule”).
Example. If a determination letter
application for a plan that was first in
existence during 2007 is filed on
December 1, 2017, then the IRS will treat the
application as having been filed within a
qualifying open remedial amendment period.
If an application does not satisfy the 10year rule requirements, but the application
satisfies the user fee exemption requirements
under section 7528(b)(2)(B) (for example, in a
case in which a qualifying open remedial
amendment period ends more than 10 years
after the year in which the plan is first in
existence), then no user fee is required. The
applicant should complete only the
Certification and explain in a cover letter how
the application satisfies the user fee
exemption requirements under
section 7528(b)(2)(B).

Where To File (Include Form 8717 and user fee with your request or
application.)
IF you have this type of
request or application . . .

THEN use this address if you send it by:
U.S. mail

Express Mail or
private delivery service

Determination letter
Internal Revenue Service
Internal Revenue Service
(Form 5307, 5300, 5310, 5310-A, Attn: EP Determination
Attn: EP Determination
or 5316)
Letters, Stop 31
Letters, Stop 31
P.O. Box 12192
201 West Rivercenter Blvd.
Covington, KY 41012-0192
Covington, KY 41011
See Notice 2002-1, 2002-1 C.B. 283 as
amplified by Notice 2017-1, 2017-2 I.R.B.
367.
An eligible employer as defined in section
408(p)(2)(C)(i)(l) is an employer which had no
more than 100 employees who received at
least $5,000 of compensation from the
employer for the preceding year. In addition,
an eligible employer must have at least one
employee who is not a highly compensated
employee (as defined in section 414(q)) and is
participating in the plan.
The determination of whether an employer
is an eligible employer is made as of the date
of the request described above. If your
application meets these requirements for an
exemption, complete only the Certification.
Don't complete any part of line 5.

Payment of User Fee
If you don't meet the conditions for exemption
discussed earlier, a user fee is due.
Line 5. User fee. To determine the
appropriate user fee to enter on line 5, go to
www.irs.gov/Retirement-Plans/User-FeesFor-Employee-Plans-Determination-OpinionAnd-Advisory-Letters. The schedule for user
fees is also set forth in Rev. Proc. 2017-4,
2017-1 I.R.B. 146, available at www.irs.gov/
irb/2017-01_IRB/ar10.html, or the latest
annual update.
Check the appropriate box and enter the
user fee in column B of line 5. Attach to the
left side of the form a check or money order
payable to “United States Treasury” for the
full amount of the user fee to Form 8717, if
applicable. If payment was made through
www.pay.gov, a copy of the payment
confirmation must also be submitted. If you
don't include the full amount, your application
may be returned. Attach Form 8717 to your
determination letter application.

If you have multiple plans, submit a
separate determination letter application and
Form 8717 for each plan.
Paperwork Reduction Act Notice. We ask
for the information on this form to carry out
the Internal Revenue laws of the United
States. If you want to have your plan
approved by the IRS, you are required to give
us the information. We need it to determine
whether you meet the legal requirements for
plan approval. Section 7528 authorizes us to
charge a user fee.
You aren't required to provide the
information requested on a form 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.
The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is:
Recordkeeping . . . . .8 hr., 7 min.
Learning about the law
or the form . . . . . . . . 57 min.
Preparing, copying, assembling 2 hr., 4 min.
Sending the form to the IRS
. . 16 min.
If you have comments about the accuracy
of these time estimates or suggestions for
making this form simpler, we would be happy
to hear from you. You can send us comments
from www.irs.gov/FormsPubs. Click on “More
Information” and then on “Give us feedback.”
Or you can write to:
Internal Revenue Service
Tax Forms and Publications
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Don't send this form to this address.
Instead, see Where To File, earlier.