Form 5306 Application for Approval of Prototype or Employer Sponso

Form

5306

(Rev. August 2013)
Department of the Treasury
Internal Revenue Service

Application for Approval of Prototype or Employer
Sponsored Individual Retirement Arrangement (IRA)

OMB No. 1545-0390

(Under section 408(a), (b), (c), or (p) or section 408A of the Internal Revenue Code)
▶ Information about Form 5306 and its instructions is at www.irs.gov/form5306.

For IRS Use Only
1

Enter amount of user fee submitted (see Specific Instructions) ▶ $

Part I
2
a

Approval requested for:
Type of individual retirement arrangement—
Prototype traditional IRA under section 408(a) or 408(b)
(1)
Prototype dual-purpose IRA
(3)
(5)
Roth or traditional IRA established by employer or
employee association under section 408(c)

b
c

3a

File folder number

Identifying Information (see instructions before completing this part)

Initial application
Amendment—Enter ▶

(2)
(4)

(1) Latest letter serial number

Prototype Roth IRA under section 408A
Prototype SIMPLE IRA under section 408(p)

(2) Date letter issued

(3) File folder number

3b Employer identification
number of applicant

Name of applicant

Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
4a

Name of person to be contacted

4c

Email address

5a

4b Telephone number

4d If a power of attorney is attached, check box . . . . . ▶
Type of sponsoring organization (if you are applying for a ruling under section 408(c), do not complete this item):
(1)
Insurance company
(5)
Regulated investment company
Trade or professional association
Federally insured credit union
(2)
(6)
(3)
(7)
Savings and loan association that qualifies as a bank
Approved non-bank trustee (attach copy of approval
letter)
(4)
Bank

b Type of submission (check one box):
(1)
Not a mass submitter
(3)
Identical adoption of a mass submitter
6
Name of trustee or custodian

(2)
(4)

Mass submitter
Minor modification of a mass submitter

Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
7
a
b

Type of funding entity:
Trust
Custodial account

Insurance company
Annuity contract or endorsement number (see instructions) ▶

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 of officer

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

Date

▲

▲

Please
Sign
Here

c

Cat. No. 11830C

Title
Form 5306 (Rev. 8-2013)

Form 5306 (Rev. 8-2013)

Part II

Page

2

Plan Information

Attach a copy of the plan documents and indicate the article or section reference and the page number
where the following provisions appear. If an item does not apply, enter “N/A.” Sample language, or a listing
of required modifications (LRMs), is available on the IRS website at IRS.gov. Type “LRM” in the search box.
Sponsors are encouraged to use LRM language.

8a Does the IRA provide that the trust is created for the exclusive benefit of the participant
or his or her beneficiaries, or that the annuity contract must be owned only by the
annuitant? . . . . . . . . . . . . . . . . . . . . . . . . .
b Does the IRA describe the type of allowable contributions (that is, only cash except
for rollovers) and maximum limitation? . . . . . . . . . . . . . . . .
c

Does the IRA prohibit the investment of trust assets in collectibles, or contain a
statement informing individuals that an investment in collectibles, except for
investments in certain coins and precious metals, will be treated as a taxable
distribution? . . . . . . . . . . . . . . . . . . . . . . . . .

d
e
f
g
h
i

Does the IRA prohibit investment in life insurance contracts? . . . . . . . . .
Does the IRA provide the rules on required distributions commencing before death? .
Does the IRA provide the rules on required distributions commencing after death?
.
Does the IRA provide that the account is nonforfeitable? . . . . . . . . . .
Does the IRA provide that the contract is nontransferable? . . . . . . . . .
Does the IRA provide for application of premium refund (other than refunds attributable
to excess contributions) before the end of the calendar year following the year of the
refund toward the payment of future premiums or the purchase of additional benefits?

j
k
l

Does the IRA prohibit commingling assets of trusts?
. . . . . . . . . . .
Does the IRA provide that annuity contracts must have flexible premiums? . . . .
Does the IRA provide for a separate accounting for the interest of each employee or
member of the association? . . . . . . . . . . . . . . . . . . . .

m Does the IRA provide for annual calendar-year reports by trustees or issuers? . . .
n Does the IRA require substitution of non-bank trustee or custodian when notified by
the Commissioner of the Internal Revenue Service? . . . . . . . . . . . .
o Does the IRA define compensation? .

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Article or
Section
Reference

Page
Number

For IRS
Use
Only

1/13
2/14

3
4
5/15
6/16
7/17
18

19
8
20
9
10/21
11
12/22
Form 5306 (Rev. 8-2013)

Form 5306 (Rev. 8-2013)

General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
Future developments. For the latest
information about developments related
to Form 5306 and its instructions, such
as legislation enacted after this form and
instructions were published, go to
www.irs.gov/form5306.
Purpose of form. Sponsoring
organizations, employers, or employee
associations, use Form 5306 to request
a ruling as to:
• Whether a trust or custodial account
agreement meets the requirements of
section 408(a), 408(c), 408(p), or 408A,
or
• Whether an individual annuity meets
the requirements of section 408(b),
408(p), or 408A.

Who May File
Opinion letters on prototype IRAs.
Form 5306 may be filed by a sponsoring
organization that is:
• A bank (including savings and loan
associations that qualify as banks and
federally insured credit unions),
• Any person who has IRS approval to
act as a trustee or custodian,
• An insurance company,
• A regulated investment company, or
• A trade or professional society or
association (other than employee
associations).
Rulings under section 408(c).
Employers or employee associations
who want a ruling under section 408(c)
for a trust which will be used for
individual retirement accounts may file
this form. The term “employee
association” means any organization
composed of two or more employees,
including, but not limited to, an
employee association described in
section 501(c)(4).
Who does not need to file. Sponsors of
programs that use any of the Form 5305
series of model forms should not submit
their programs to the Internal Revenue
Service. These model forms, issued by
the Service, contain language that, if
followed, will satisfy the applicable
statutory requirements.
What to file. File Form 5306 and a copy
of the trust, custodial account, or
annuity contract and all other applicable
documents. If you are requesting an
opinion letter for an annuity where all the
Internal Revenue Code requirements are
set forth in a separate endorsement that
supersedes any conflicting language in
any contract to which it may be
attached, submit the endorsement and
not the contract.

Page

Where to file. File Form 5306 with the
Internal Revenue Service, Attention: EP
Opinion Letters, P.O. Box 27063,
McPherson Station, Washington, DC
20038.
Address. Include the suite, room, or
other unit number after the street
number. If the Post Office does not
deliver mail to the street address and
you have a P.O. box, show the box
number instead of the street address.
Signature. An officer who is authorized
to sign or another person authorized
under a power of attorney must sign this
application. Send the power of attorney
with this application when you file it.

Specific Instructions
User fee. All applications must be
accompanied by the appropriate user
fee. Applications submitted without the
proper user fee will not be processed
and will be returned to the applicant.
To find the proper user fee, see Rev.
Proc. 2013-8, 2013-1 I.R.B. 237,
available at
www.irs.gov/irb/2013-01_IRB/ar13.html
or the current superseding revenue
procedure.
Line 2c. If you are amending your plan,
enter the file folder number, letter serial
number, and date from the latest opinion
letter you received for your plan.
Line 7c. Identify the endorsement,
contract, or both for which you are
requesting an opinion letter.

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. We need it to ensure
that you are complying with these laws
and to allow us to figure and collect the
right amount of tax. This information is
needed to process your application and
to determine whether your individual
retirement account or individual
retirement annuity meets the
requirements of section 408(a), 408(b),
408(c), 408(p), or 408A. You are not
required to apply for approval; however,
if you want to receive a ruling from the
IRS regarding your prototype or
employee sponsored individual
retirement arrangement, you are required
to provide the information requested on
this form. Section 6109 requires you to
provide the requested identification
numbers. Failure to provide the
information may delay or prevent
processing your application; providing
any false information may subject you to
penalties.

3

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 contents
may become material in the
administration of any Internal Revenue
law.
Generally, tax returns and return
information are confidential, as stated in
section 6103. However, section 6103
allows or requires the Internal Revenue
Service to disclose or give such
information to the Department of Justice
for civil and criminal litigation, and to
cities, states, the District of Columbia,
U.S. commonwealths and possessions
for use in administering their tax laws.
We may also disclose this information to
other countries under a tax treaty, to
federal and state agencies to enforce
federal nontax criminal laws, or to
federal law enforcement and intelligence
agencies to combat terrorism.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping .

.

.

11 hr., 43 min.

Learning about the
law or the form . .

.

.

Preparing and sending
the form to the IRS . .

.

53 min.

1 hr., 7 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 send us comments
from www.irs.gov/formspubs/. Click on
"More Information" and then on
"Comment on Tax Forms and
Publications." Or you can send your
comments to Internal Revenue Service,
Tax Forms and Publications Division,
1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send the
form to this address. Instead, see Where
to file.