Form 8717-A User Fee for Employee Plan Opinion Letter Request

Form

8717-A

(Rev. September 2018)
Department of the Treasury
Internal Revenue Service
1 Name of plan provider

User Fee for Employee Plan Opinion
Letter Request
▶

For
IRS
Use
Only

▶ Attach to applicable Form 4461, 4461-A, or 4461-B.
Go to www.irs.gov/Form8717A for the latest information.

OMB No. 1545-1772

Amount paid

2 Provider’s employer identification number

3 Plan number

4 Plan name

Applications
5

User fees for pre-approved plans
(1a) Mass or non-mass submitter—per basic plan document with one adoption agreement

.

.

(1a) $

(1b) Mass or non-mass submitter—per each additional adoption agreement

.

.

(1b) $

Mass or non-mass submitter single document plan (no adoption agreements)—per each
single document plan . . . . . . . . . . . . . . . . . . . . . . .

.

(2)

$

Provider’s identical adoption of mass submitter basic plan document—per adoption
agreement or single document plan . . . . . . . . . . . . . . . . .

.

.

(3)

$

Provider’s minor modification of mass submitter basic plan document—per adoption
agreement or single document plan . . . . . . . . . . . . . . . . .

.

.

(4)

$

(5)

Assumption of sponsorship of a pre-approved plan—per basic plan document .

.

.

.

(5)

$

(6)

Change in name and/or address of provider of a pre-approved plan—per basic plan
document . . . . . . . . . . . . . . . . . . . . . . . . . .

.

.

(6)

$

(2)

(3)

(4)

Attach Check or Money Order Here

User Fee

Cat. No. 60826Q

.

.

.

.

.

.

Form 8717-A (Rev. 9-2018)

Page 2

Form 8717-A (Rev. 9-2018)

General Instructions
Section references are to the Internal Revenue
Code.

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/Form8717A.

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.

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

Specific Instructions
Line 5. User fee. To determine the
appropriate user fee to enter on line 5, go to
the schedule for user fees in Rev. Proc.
2018-4, 2018-1 I.R.B. 146, available at
www.irs.gov/irb/2018-01_IRB#RP-2018-4 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 letter
application for Forms 4461, 4461-A, and
4461-B.
If you have multiple plans, submit a
separate opinion 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 6-403, Group 7521
Cincinnati, OH 45201-2508
If sent via Express Mail or Private
Delivery Service,
Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
550 Main Street
Room 6-403, 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 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 send your
comments to the Internal Revenue Service,
Tax Forms and Publications Division, 1111
Constitution Ave. NW, IR-6526, Washington,
DC 20224.
Do not send this form to this address.
Instead, see Where To File, earlier.