4461 Application for Approval of Standardized or Nonstandardi

Form

4461

(Rev. November 2018)
Department of the Treasury
Internal Revenue Service

Application for Approval of Standardized
or Nonstandardized Pre-Approved
Defined Contribution Plans
▶

OMB No. 1545-0169

This Form Is Open to Public Inspection

Go to www.irs.gov/Form4461 for the latest information.

For IRS Use Only

File This Form With the Internal Revenue Service

File folder number

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

Complete every applicable item on this form and Attachment 1 (see Rev. Proc. 2017-41, 2017-29 I.R.B. 92).

See instructions before completing this form.
1
2a

3a

Enter amount of user fee submitted
$
Approval requested:
Initial application
Amendment—Enter file folder number in 2b and date
of last letter issued in 2c.
Name of applicant

2b File folder number

2c Date of last
letter issued

3b Employer identification number
of applicant

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

State

ZIP code

3d Type of applicant (see Definitions in the instructions):
Provider
Mass submitter
4a Name of person to be contacted

3c Applicant’s telephone no.

4b Telephone number

4c Fax number

4d Email address
5a

Basic plan document or single document plan number

6

Form of plan:
Adoption agreement plan
Type of plan (select all that apply):
Money purchase
Profit-sharing
Filing status of plan:
Standardized plan

7

8

4e If a power of attorney is attached, check the box .
5b Adoption agreement number, if applicable

.

.

▶

Single document plan
Target benefit
Profit-sharing/401(k)

ESOP
Nonelecting church

Governmental

Nonstandardized plan

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 ▶

For Paperwork Reduction Act Notice, see the instructions.

Title ▶

Date ▶
Cat. No. 41676M

Form

4461 (Rev. 11-2018)

Form 4461 (Rev. 11-2018)

9
a

Procedural requirements:
Have the following been submitted as required by instructions—
(1) Adoption agreement, if applicable? . . . . . . . .
(2) Copy of plan? . . . . . . . . . . . . . . .
(3) Copy of Certification of Interim Amendments? . . . . .

Page

Yes

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

2

No

.
.
.

b Do you have a procedure in place for the adoption and distribution of interim amendments made on behalf of
adopting employers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c

Is the plan patterned after, and substantially the same as, another plan submitted? (If “Yes,” see specific
instructions.)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Provider (non-mass submitter) request. Complete (1) and (2).
(1) Do you have at least 15 employer-clients which are reasonably expected to adopt this plan’s basic plan
document and adoption agreement or single document plan? . . . . . . . . . . . . . . .
(2) If you have more than one pre-approved plan, do you have at least 30 employer-clients in the aggregate
which are reasonably expected to adopt at least one of the plans? . . . . . . . . . . . . .
e

Mass submitter request. Complete (1), (2), and (3).
(1) Are applications on behalf of the requisite number of providers who are adopting the same basic plan
document on a word-for-word identical basis included? If “No,” complete (2)
. . . . . . . . .
(2) If “No” to (1), enter the file folder number of the basic plan document for which the requisite number of
adopting providers requirement is met.
(3) 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 providers
and the coordination of optional provisions? . . . . . . . . . . . . . . . . . . .
Note: This application is designed to be used in conjunction with Rev. Proc. 2017-41. 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 (Rev. 11-2018)

Form 4461 (Rev. 11-2018)

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

Future Developments
For the latest information about
developments related to Form 4461,
such as legislation enacted after the
form was published, go to
www.irs.gov/Form4461.

Purpose of Form
Form 4461 is used to apply for approval
of standardized or nonstandardized
pre-approved defined contribution plans.
Be sure to submit a complete and
accurate application, including Form
4461 and Attachment 1 (see
www.irs.gov/retirement-plans/
preapproved-plan-submissionprocedures or Rev. Proc. 2017-41,
2017-29 I.R.B. 92). Complete every
applicable line on the application. If an
item on Attachment 1 doesn’t apply,
check the “N/A” box or enter “N/A” on
the line where indicated as an option. If
your application isn’t complete, we will
return it without processing it. The first
page must be typed. Unless otherwise
noted, the questions on Form 4461 and
Attachment 1 apply to both standardized
and nonstandardized pre-approved
defined contribution plans.
Requests for additional information. If
a letter requesting additional information
or changes to plan documents is sent to
the pre-approved plan provider 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.

Page

file Form(s) 4461-B, Application for
Approval of Standardized or
Nonstandardized Pre-Approved Plans,
as needed.
Multiple adoption agreement plans. A
provider may utilize one basic plan
document for several plans. A provider
may, for example, use one basic plan
document for a money purchase plan
other than a target benefit plan, a target
benefit plan, and a profit-sharing plan. A
separate adoption agreement and
completed application may need to be
provided for each such defined
contribution plan. See section 9.06 of
Rev. Proc. 2017-41 for more details,
including special rules for ESOP,
governmental, and nonelecting church
plans. In the case of a simultaneous
submission of plans using the same
basic plan document, submit only one
copy of the basic plan document. If the
requests aren’t simultaneous, submit
separate basic plan documents and
include a cover letter identifying the
original submission. The number
assigned to the basic plan document of
a standardized or nonstandardized preapproved plan must remain the same as
in the prior submission. One basic plan
document may not be used for both
defined benefit and defined contribution
plans.
Two or more single document plans. A
provider may not combine different
categories in a single document plan or
application, except that only one single
document plan and application is
required for a profit-sharing plan, with or
without a 401(k) arrangement and a
money purchase plan. See section 9.07
of Rev. Proc. 2017-41 for more details,
including special rules for ESOP,
governmental, and nonelecting church
plans.

Where To File

Inadequate submissions. We will
return, without further action, plans that
aren’t in substantial compliance with the
qualification requirements or plans that
are so deficient that they can’t be
reviewed in a reasonable amount of
time.

Send Form 4461 to:

Who May File

If using Express Mail or a private
delivery service, use this address:

A provider or mass submitter of a
pre-approved defined contribution plan
may file a Form 4461. See Definitions,
later.

What To File
Submit one copy of Form 4461 and
Attachment 1 for each separate adoption
agreement or for each single document
plan where no adoption agreement is
utilized. For approval, file this application
and each applicable document listed in
line 9(a). A mass submitter should also

Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
Room 6-403, Group 7521
P.O. Box 2508
Cincinnati, OH 45201-2508

Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
Room 6-403, Group 7521
550 Main Street
Cincinnati, OH 45202
Signature. The application 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 IRS 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 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.
Single document plan. A single
document plan may contain alternate
paragraphs and options that may be
selected by an adopting employer. A
single document 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.

Form 4461 (Rev. 11-2018)

Flexible plan. A plan submitted by a
mass submitter which contains certain
optional provisions as allowed by
section 10.03(1) of Rev. Proc. 2017-41.
Providers which 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 provider which differs from
the mass submitter plan only because of
the deletion of certain optional
provisions will be treated as a plan that
is word-for-word identical to the mass
submitter plan.
Mass submitter. As set forth in Rev.
Proc. 2017-41, any entity that submits
applications on behalf of at least 30
unaffiliated providers each of which is
sponsoring, on a word-for-word identical
basis, the same plan. A mass submitter
is treated as a mass submitter with
respect to all of its plans, provided the
30-unaffiliated-provider requirement is
met with respect to at least one plan.
Affiliation is determined under sections
414(b) and (c). Additionally, the following
will be considered to be affiliated: any
law firm, accounting firm, consulting
firm, etc., with its partners, members,
associates, etc. For purposes of
determining whether 30 unaffiliated
providers sponsor on a word-for-word
identical basis the same plan document,
the mass submitter is treated as an
unaffiliated provider.
Pre-approved plan. A pre-approved
plan is a plan (including a plan covering
self-employed individuals) that is made
available by a provider for adoption by
employers. The term pre-approved plan
includes both standardized and
nonstandardized plans. A pre-approved
plan may be an adoption agreement plan
or a single document plan. An adoption
agreement plan consists of a basic plan
document and an adoption agreement. A
single document plan consists of a
single plan document offered by a
provider without an adoption agreement.

Page

Provider. A provider is any person
(including a mass submitter, if
applicable) that (1) has an established
place of business in the United States
where it is accessible during every
business day; and (2) represents to the
IRS that it has at least 15 employerclients, each of which is reasonably
expected to adopt the same
pre-approved plan of the provider.
A provider may request an opinion
letter for more than one plan provided it
represents to the IRS that it has at least
30 employer-clients in the aggregate,
each of which is reasonably expected to
adopt at least one of the provider’s
plans.
A provider also includes any person
that has an established place of
business in the United States where it is
accessible during every business day
and offers a plan as a word-for-word
identical adopter or minor modifier
adopter of a plan of a mass submitter,
regardless of the number of employers
that are expected to adopt the plan.
Standardized plan. A standardized plan
is a pre-approved plan (other than an
ESOP or statutory hybrid plan) that
meets the requirements set forth in
section 5.16 of Rev. Proc. 2017-41.
Nonstandardized plan. A
nonstandardized plan is a pre-approved
plan that isn’t a standardized plan and
that satisfies section 5.15 of Rev. Proc.
2017-41.
ESOP. An ESOP is an employee stock
ownership plan within the meaning of
section 4975(e)(7).
Statutory hybrid plan. A statutory
hybrid plan is a defined benefit plan that
contains a statutory hybrid benefit
formula, as defined in Regulations
section 1.411(a)(13)-1(d)(4). See section
6.03 of Rev. Proc. 2017-41 which limits
the type of statutory hybrid plan to a
cash balance plan.

4

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 Letter Request,
as determined from the schedule in Rev.
Proc. 2018-4, 2018-1 I.R.B. 146 (or the
most recent version, updated annually).
Applications submitted without the
proper user fee won’t be processed and
will be returned to the applicant.
Line 3a. Enter the name and address of
the applicant. If the Post Office doesn’t
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.
Line 4c. Enter a fax number to receive
notice of preliminary approval of the
applicable plan, subject to final approval
by opinion letter.
Line 5a. Enter the two-digit number you
have assigned to your single document
plan or basic plan document that
accompanies the adoption agreement
for which you are requesting approval. If
multiple adoption agreements are linked
to the same basic plan document, the
same two-digit basic plan document
number should be used for all
applications.

Form 4461 (Rev. 11-2018)

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 should be
given a different three-digit number
beginning with “001.” For example, if the
first basic plan document of a provider
has four separate adoption agreements,
they should be numbered “001” through
“004,” and the provider should submit
four separate Forms 4461. Adoption
agreements submitted with the second
or any subsequent basic plan
documents (that aren’t word-for-word
identical to a previously submitted basic
plan document) should be similarly
numbered beginning with “001.”
Line 9. Procedural requirements.
Submit a separate application for each
different plan/adoption agreement
combination or single document plan.
Line 9c. 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 employer identification

Page

number of the provider), 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 isn’t 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 isn’t word-for-word identical is
true and complete.
Line 9e. In addition to filing Form 4461,
the mass submitter should use Form
4461-B when submitting applications on
behalf of its adopting providers, and
submit Form 8717-A.
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 the information. We need it to
determine whether you meet the legal
requirements for plan approval.

5

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 content may
become material in the administration of
any Internal Revenue law. Generally,
tax return 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., 22 min.

Learning about the law
or the form . . . . . 1 hr., 42 min.
Preparing the form

.

. 4 hr., 42 min.

Copying, assembling, and
sending the form to the IRS

. 48 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/FormComments. Or
you can write to the Internal Revenue
Service, Tax Forms and Publications
Division, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don’t
send Form 4461 to this address. Instead,
see Where To File, earlier.