Form 4461-A Application for Approval of Standardized or Nonstandardi

Form

4461-A

(Rev. November 2019)
Department of the Treasury
Internal Revenue Service

Application for Approval of Standardized or
Nonstandardized Pre-Approved Defined
Benefit Plan
▶

OMB No. 1545-0169

This Form Is Open to Public Inspection

Go to www.irs.gov/Form4461A 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-A. (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
$
2b File folder number
Approval requested:
Initial application
Amendment—Enter file folder number in line 2b
and date of last letter issued in line 2c . . ▶

2c Date of last letter issued

3b Employer identification number
(EIN) of applicant

Name 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 number

4b Telephone number

4c Fax number

4d Email address
4e If a power of attorney is attached, check box
5b Adoption agreement number, if applicable

5a

Basic plan document or single document plan number

6

Form of plan:
Adoption agreement plan
Single document plan
Type of plan (select all that apply):
Without permitted disparity
With permitted disparity
Nonelecting church
Without cash balance features
Filing status of plan:
Standardized plan
Nonstandardized plan

7

8

.

.

▶

Governmental
With cash balance features

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 ▶

Date ▶

Title ▶

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

Cat. No. 11416U

Form

4461-A (Rev. 11-2019)

Form 4461-A (Rev. 11-2019)

Page

9

Procedural requirements:
a 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? . . . . . . . . . . . . . . . . . . . .
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.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

2

No

d Provider (non-mass submitter) request.
(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? (If you don’t have more than one
pre-approved plan, skip this question.) . . . . . . . . . . . . . . . . . . . . . .
e Mass submitter request.
(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)
(3)

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:
Is this a flexible plan? If “Yes,” answer (a) and (b). If “No,” skip (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/lrms.
Form

4461-A (Rev. 11-2019)

Form 4461-A (Rev. 11-2019)

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-A,
such as legislation enacted after the
form was published, go to
www.irs.gov/Form4461A.

Purpose of Form
Form 4461-A is used to apply for
approval of standardized or
nonstandardized pre-approved defined
benefit plans.
Be sure to submit a complete and
accurate application, including Form
4461-A and Attachment 1-A (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 the Attachment 1-A 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-A and Attachment 1-A apply to
both standardized and nonstandardized
pre-approved defined benefit 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 be granted only
for good cause.
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.

Who May File
A provider or mass submitter of a preapproved defined benefit plan may file a
Form 4461-A. See Definitions, later.

What To File
Submit one copy of Form 4461-A and
Attachment 1-A for each separate
adoption agreement or for each single
document plan where no adoption
agreement is used.

Page

For approval, file this application and
each applicable document listed on line
9a. A mass submitter should also file
Form(s) 4461-B, Application for Approval
of Standardized or Nonstandardized PreApproved Plans, as needed.
Multiple adoption agreement plans. A
provider may use one basic plan
document for several plans. A provider
may, for example, use one basic plan
document with a standardized plan with
or without permitted disparity as well as
a nonstandardized plan with or without
permitted disparity. Submit a separate
adoption agreement and completed
application for each such defined benefit
plan. See section 9.06 of Rev. Proc.
2017-41 for more details, including the
special rules for governmental and
nonelecting church plans. In the case of
simultaneous submissions 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 pre-approved 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. See section 9.07 of Rev.
Proc. 2017-41 for more details, including
the special rules for governmental and
nonelecting church plans.

Where To File
Send Form 4461-A to:
Internal Revenue Service
Attn: Pre-Approved Plans
Coordinator
Room 6-403, Group 7521
P.O. Box 2508
Cincinnati, OH 45201-2508
If using Express Mail or a private
delivery service, use this address:
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 following.
• The taxpayer’s name, address, EIN,
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. An adoption
agreement is 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. A basic plan
document is 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-A (Rev. 11-2019)

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Flexible plan. A flexible plan is 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 that 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.

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.

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 is a mass
submitter. A mass submitter is treated as
a mass submitter with respect to all of its
plans, provided the 30-unaffiliatedprovider requirement is met with respect
to at least one plan.

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.

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.
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 preapproved 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.

Standardized plan. A standardized plan
is a pre-approved plan (other than a
statutory hybrid plan) that meets the
requirements set forth in section 5.16 of
Rev. Proc. 2017-41.

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). Section 6.03
of Rev. Proc. 2017-41 (as revised by
Rev. Proc. 2018-21, 2018-14 I.R.B. 467)
provides a list of areas not covered by
opinion letters. This list includes
statutory hybrid plans with certain
features, such as a statutory hybrid
benefit formula that isn’t a cash balance
formula. See section 6.03 of Rev. Proc.
2017-41 for the complete list.

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. 2019-4, 2019-1 I.R.B. 146 (or the
latest annual update). 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.

4

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.
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 sponsor
has four different adoption agreements,
they should be numbered “001” through
“004,” and the provider should submit
four separate Forms 4461-A. 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 that includes the following.
• The name and file folder number of the
plan, including the name and EIN of the
provider.
• A list of all plans written by the plan
drafter that 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.
• 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-A, the mass submitter should use
Form 4461-B, when submitting
applications on behalf of its adopting
providers, and submit Form 8717-A.

Form 4461-A (Rev. 11-2019)

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. You
are required to give us this information.
We need it to determine whether you
meet the legal requirements for plan
approval.
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

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any Internal Revenue law. Generally, tax
returns and return information are
confidential, as required by Code section
6103.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping

.

.

. 42 hr., 5 min.

Learning about the law
or the form . . . . . 5 hr., 55 min.
Preparing the form .

. 7 hr., 48 min.

Copying, assembling, and
sending the form to the IRS . 16 min.

5

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-A to this address.
Instead, see Where To File, earlier.