Form 8717-A User Fee for Employee Plan Opinion or Advisory Letter Re

Form

8717-A

User Fee for Employee Plan Opinion
or Advisory Letter Request

For
IRS
Use
Only

(Rev. September 2016)
▶ Attach to applicable Form 4461, 4461-A, or 4461-B.
Department of the Treasury
▶ For the latest information about this form, go to www.IRS.gov/form8717.
Internal Revenue Service
1 Name of plan sponsor/practitioner

OMB No. 1545–1772

Amount paid

2 Sponsor’s/practitioner's employer identification number

3 Plan number

4 Plan name

Applications

Attach Check or Money Order Here

5a

Volume submitter
(1a) Specimen plan (nonmass) with no/one adoption agreement

User Fee
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(1a) $

(1b) Specimen plan (nonmass) – per each additional adoption agreement

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(1b) $

(2a) Mass submitter specimen plan with no/one adoption agreement

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(2a) $

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(2b) Mass submitter – per each additional adoption agreement .

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(2b) $

(3)

Specimen plan identical to mass submitter specimen plan .

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(3)

$

(4)

Assumption of sponsorship of an approved specimen plan – per basic plan document

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(4)

$

(5)

Change in name and/or address of practitioner of an approved specimen plan – per basic
plan document . . . . . . . . . . . . . . . . . . . . . . . . . .

(5)

$
$

(6) Mass submitter/nonmass submitter practitioner – per trust document in excess of 10 .
5b Master & Prototype (M&P):
(1a) Mass Submitter – per basic plan document with one adoption agreement . . . . .

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(6)

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(1a) $

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(1b) $

Sponsor’s identical adoption of mass submitter basic plan document – per adoption
agreement . . . . . . . . . . . . . . . . . . . . . . . . .

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(2)

$

Sponsor’s minor modification of mass submitter basic plan document – per adoption
agreement . . . . . . . . . . . . . . . . . . . . . . . . .

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(3)

$

(1b) Mass Submitter – per each additional adoption agreement
(2)

(3)

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(4a) Nonmass submitter – per basic plan document with one adoption agreement

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(4a) $

(4b) Nonmass submitter – per each additional adoption agreement

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(4b) $

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(5)

Opinion letter for additional optional provisions – per mass submitter basic plan document .

(5)

$

(6)

Assumption of sponsorship of an approved M&P plan – per basic plan document .

.

.

(6)

$

(7)

Change in name and/or address of sponsor of an approved M&P plan – per basic plan
document . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

(7)

$

Mass submitter/nonmass submitter sponsor – per trust document in excess of 10 .

.

(8)

$

(8)

Cat. No. 60826Q

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Form 8717-A (Rev. 9-2016)

Page 2

Form 8717-A (Rev. 9-2016)

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

Future Developments
For the latest information about developments
related to Form 8717-A 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-A. You must now enter the
appropriate user fee when completing line 5.

General Instructions
Purpose of Form
Generally, a user fee is required with each
application for an opinion or advisory letter.
Use Form 8717-A to submit the appropriate
fee for the opinion or advisory letter.

Specific Instructions
Line 5. User fee. To determine the
appropriate user fee to enter on line 5, go to
www.irs.gov/Retirement-Plans/User-fees-forEmployee-Plans-Determination,-Opinion-andAdvisory-Letters. The schedule for user fees is
also set forth in Rev. Proc. 2016-8, 2016-1
I.R.B. 243, (available at www.irs.gov/
irb/2016-01_IRB/ar14.html) or the latest
annual update.
Check the appropriate box on line 5 and
enter the user fee due. Attach a check or
money order payable to “United States
Treasury” for the full amount of the user fee to
Form 8717-A. If you don't include the full
amount, your application may be returned.
Attach Form 8717-A to the opinion or
advisory letter application for Forms 4461,
4461-A, and 4461-B.

If you have multiple plans, submit a
separate opinion or advisory letter application
and Form 8717-A for each plan.

Where To File
Include Form 8717-A and user fee with your
request or application.
Send your request or application to one
of the following:
If sent via U.S. mail,
Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
P.O. Box 2508
Room 5106, Group 7521
Cincinnati, OH 45201
If sent via Express Mail or Private
Delivery Service,
Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
550 Main Street
Room 5106, Group 7521
Cincinnati, OH 45202
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 . . . . 1 hr., 12 min.
Learning about the law
or the form . . . . . . . . 34 min.
Preparing, copying,
assembling, and sending
the form to the IRS . . . 1 hr., 48 min.
If you have comments concerning the
accuracy of this time estimate or suggestions
for making this form simpler, we would be
happy to hear from you. You can send your
comments to the Internal Revenue Service,
Tax Forms and Publications Division, Room
6526, 1111 Constitution Ave. NW,
Washington, DC 20224.
Do not send this form to this address.
Instead, see Where To File.