Form 4461-B Application for Approval of Standardized or Nonstandardi

4461-B

Form
(Rev. November 2018)

Application for Approval of
Standardized or Nonstandardized Pre-Approved Plans

Department of the Treasury
Internal Revenue Service

▶

OMB No. 1545-0169

Mass Submitter Adopting Provider
Go to www.irs.gov/Form4461B for the latest information.

This Form Is Open to Public Inspection

For IRS Use Only

File This Form With the Internal Revenue Service
Section references are to the Internal Revenue Code unless otherwise noted.
Complete every applicable item on this form.
1

Enter amount of user fee submitted

2a

Name of applicant

$

2b Employer identification number
of applicant

Address (number, street, room or suite no.) (If a P.O. box, see instructions.)
2c Applicant’s telephone no.
City
3a

State

ZIP code
3b Email address

Name of person to be contacted

3c Telephone number

3d If a power of attorney is attached, check the box ▶
4a

Basic plan document or single document plan number

b Adoption agreement number, if applicable

5

This plan is:

6

Name of mass submitter

7

Enter the following information for the mass submitter’s plan on which this plan is based (if this application is submitted
simultaneously with the mass submitter’s application, see instructions).

Word-for-word identical to a pre-approved plan
A minor modification to a pre-approved plan only (see instructions to
line 5 for specific requirements)

File folder number
Letter serial number
Date of letter
8

9

Type of plan (select all that apply):
Money purchase
Target benefit
Profit-sharing
Defined benefit

Profit-sharing/401(k)
ESOP

Governmental
Nonelecting church

Filing status of plan (see General Instructions)
Standardized plan
Nonstandardized plan

Under penalties of perjury, I declare that the provider has adopted a pre-approved plan that is word-for-word identical to, or a minor modification of, the mass submitter
plan indicated in lines 6 and 7 above.

(Provider)
Signature ▶

Title ▶

Date ▶

(Mass Submitter)
Signature ▶

Title ▶

Date ▶

For Paperwork Reduction Act Notice, see the instructions.

Cat. No. 10235P

Form 4461-B (Rev. 11-2018)

Form 4461-B (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/Form4461B.

Purpose of Form
Use Form 4461-B to apply for approval
of a plan submitted by a mass submitter
on behalf of an adopting provider, which
is based on a plan submitted by the
mass submitter.

Completing Form 4461-B
Be sure to submit a complete and
accurate application. Complete every
applicable line on the application. If your
application isn’t complete, we will return
it without processing it. The application
must be typed.
User fee. All applications must be
accompanied by the appropriate user
fee from the schedule set forth in Rev.
Proc. 2018-4, 2018-1 I.R.B. 146 (or the
most recent version, updated annually);
and Form 8717-A, User Fee for
Employee Plan Opinion Letter Request.
Applications submitted without the
proper user fee will not be processed
and will be returned to the applicant.
Don’t submit a copy of the plan,
except as provided under the
instructions to line 5 later.

Who May File
Only mass submitters may file this form.

Where To File
Send Form 4461-B 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 the mass submitter and
provider. If a power of attorney
authorizes the mass submitter to sign
the form on behalf of the provider, attach
the power of attorney to Form 4461-B.

Page

Disclosure requested by taxpayer. A
taxpayer may request the IRS to
disclose and discuss the return or return
information with any person or persons
whom 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,
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 Signature
above).
As an alternative to providing the
above statement, Form 2848, Power of
Attorney and Declaration of
Representative, may be submitted.

Definitions
Mass submitter. As set forth in Rev.
Proc. 2017-41, 2017-29 I.R.B. 92, 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-unaffiliatedprovider 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.
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.

2

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.

Specific Instructions
Line 2a. 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 box number instead of the street
address.
Line 3a. The person to contact must be
an employee or an authorized
representative of the mass submitter. 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 4a. 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.
Line 4b. Enter the three-digit number
you have assigned to the adoption
agreement, if applicable, 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 mass submitter should
submit four separate Forms 4461-B.
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.”

Form 4461-B (Rev. 11-2018)

Line 5. In the case of a provider
adopting a plan (including a flexible plan)
that is word-for-word identical to a plan
of the mass submitter, a copy of the plan
doesn’t have to be submitted. If the plan
is a minor modification, the mass
submitter should submit Form 4461-B as
a “placeholder.” When the mass
submitter receives notification from the
IRS that the IRS has determined that the
lead plan appears to be in full
compliance with the applicable
qualification requirements, it must
submit a copy of the mass submitter
plan with minor modifications underlined
in red, or otherwise highlighted, as well
as a statement indicating the location
and effect of each change.
Line 7. If this application is
simultaneously filed with the mass
submitter’s application or filed before the
information under line 7 is available,
enter on the “File folder number” line the
basic plan document number and
adoption agreement number or the
single document plan number of the
mass submitter’s plan on which this plan
is based. Don’t complete the rest of
line 7.

Page

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
any Internal Revenue law. Generally, tax
return and return information are
confidential, as required by section 6103.

3

The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping .

.

.

. 5 hr., 58 min.

Learning about the
law or the form . .

.

.

Preparing the form

.

. 1 hr., 56 min.

.

Copying, assembling, and
sending the form to the IRS

. 52 min.

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