Form 5306-A

(Rev. November 2019)

Department of the Treasury 

Internal Revenue Service 

Application for Approval of Prototype Simplified Employee 

Pension (SEP) or Savings Incentive Match Plan for 

Employees of Small Employers (SIMPLE IRA Plan)

(Under section 408(k) or (p) of the Internal Revenue Code) 

▶ Go to www.irs.gov/Form5306A for the latest information.

OMB No. 1545-0199

For IRS Use Only 

File folder number

1 Enter amount of user fee submitted. See Specific Instructions ▶ $ 

Part I Identifying Information (see instructions before completing this part) 

2 Approval requested for: 

a Type of plan— 

(1) Prototype simplified employee pension (SEP) under section 408(k) 

(2) Prototype savings incentive match plan for employees of small employers (SIMPLE IRA plan) under section 408(p) 

b Initial application 

c Amendment—Enter ▶ (1) Latest letter serial number (2) Date letter issued (3) File folder number 

3 If the SEP contains elective deferral provisions, check this box . . . . . . . . . . ▶

4a Name of applicant 4b Applicant’s employer identification number 

Number, street, and room or suite no. (if a P.O. box, see instructions) 

City or town, state, and ZIP code 

5a Name of person to be contacted 5b Telephone number

5c Email address 

5d If a power of attorney is attached, check box . . ▶

6 Type of submission (check one box): a Not a mass submitter b Mass submitter 

c Identical adoption of a mass submitter d Minor modification of a mass submitter 

7a If box 6c or 6d is checked, enter the mass submitter’s name:

b File folder number of the mass submitter’s SEP or SIMPLE IRA plan on which this submission is based: 

8 Type of sponsoring organization: 

a Insurance company 

b Trade or professional organization 

c Savings and loan association that qualifies as a bank 

d Bank 

e Regulated investment company 

f Federally insured credit union 

g Approved non-bank trustee (attach copy of approval 

letter) 

Part II SEP Information 

Attach a copy of the SEP documents and indicate the article or section and the page number where 

the following provisions appear. If any item does not apply, write “N/A.” Sample language, or a listing 

of required modifications (LRMs), is available at www.irs.gov/LRMS. Sponsors are encouraged to use 

LRM language. 

Plan Article or 

Section 

Reference 

Plan 

Page 

Number 

For 

IRS Use 

Only 

9a Does the SEP cover all employees who have attained age 21, performed service 

for the employer in 3 of the immediately preceding 5 years, and received at least 

$600* in compensation from the employer for the year, other than employees who 

may be excluded under section 410(b)(3)(A) or (C)? . . . . . . . . . . 1 

b Does the SEP provide that all eligible employees will share in an allocation? . . 2 

c Does the SEP contain a definite allocation formula that does not discriminate in 

favor of highly compensated employees? . . . . . . . . . . . . . 3 

d Does the SEP require that it be used only with pre-approved traditional IRAs? . 5 

e Does the SEP prohibit restrictions on withdrawals (other than restrictions 

permitted under section 408(d)(7)(A) in the case of a salary reduction SEP)? . . 6 

f Does the SEP define “compensation” in a manner that satisfies one of the safe 

harbor definitions under section 414(s) and limit compensation under section 

408(k)(3)(C)? . . . . . . . . . . . . . . . . . . . . . . . 7 

* This is the amount for 2019 and 2020. The amount may be increased in future years for cost-of-living adjustments. 

Sign 

Here 

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 Date ▲

Title 

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 32621R Form 5306-A (Rev. 11-2019) 
Form 5306-A (Rev. 11-2019) Page 2 

Part III SIMPLE IRA Plan Information 

Attach a copy of the SIMPLE IRA plan documents and indicate the article or section 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 at www.irs.gov/LRMS. Sponsors 

are encouraged to use LRM language. 

Plan Article or 

Section 

Reference 

Plan 

Page 

Number 

For 

IRS Use 

Only 

10a Does the plan define the term “employer” to include all members of such groups 

or entities required to be aggregated with the employer? . . . . . . . . 1 

b Does the plan limit adoption to employers that have 100 or fewer employees who 

earned $5,000 or more in compensation from the employer during the preceding 

calendar year? . . . . . . . . . . . . . . . . . . . . . . 2 

c Does the plan limit adoption to employers that do not maintain another qualified 

plan to which contributions are made or benefits accrued? . . . . . . . 3 

d Does the plan define the term “employee” to include leased employees and 

employees described in section 401(c)(1)? . . . . . . . . . . . . . 4 

e Does the plan cover all employees except those who may be excluded under 

section 408(p)(4)? . . . . . . . . . . . . . . . . . . . . . 5 

f Does the plan provide that each eligible employee may make or modify a salary 

reduction agreement during the 60-day period immediately preceding the 

calendar year after receiving proper notice? . . . . . . . . . . . . 6 

g Does the plan provide that salary reduction contributions may not exceed the 

statutory limits? . . . . . . . . . . . . . . . . . . . . . . 7 

h Under the plan, is an eligible employee permitted to terminate a salary reduction 

election at any time? . . . . . . . . . . . . . . . . . . . . 8 

i Is the interest of an eligible employee in the plan nonforfeitable at all times? . . 9 

j Does the plan provide that the employer will make matching contributions to each 

eligible employee’s SIMPLE IRA equal to the employee’s salary reduction 

contribution, up to a limit of 3% of the employee’s compensation for the calendar 

year? . . . . . . . . . . . . . . . . . . . . . . . . . 10 

k Does the plan provide that the employer will make a 2% nonelective contribution 

to each eligible employee’s SIMPLE IRA in lieu of matching contributions? . . 11 

l Does the plan require that the employer will make salary reduction contributions 

to eligible employees’ SIMPLE IRAs no later than 30 days after the month in which 

the amounts would otherwise have been payable to the employee in cash? . . 12 

m Unless the employer has chosen, does the plan allow each eligible employee to 

select the financial institution for their SIMPLE IRA? . . . . . . . . . . 13 

n If the employer has selected the financial institution, does the plan require the 

financial institution to meet the notification requirements of section 408(p)(7) and 

limited in accordance with section 408(p)(2)(B)? . . . . . . . . . . . 14 

o Does the plan define “compensation” as described in section 408(p)(6)(A)? . . 15 

p Does the plan require that it be used only with pre-approved SIMPLE IRAs? . . 16 

q Does the plan prohibit restrictions on withdrawals? . . . . . . . . . . 17 

r Does the plan provide that amendments will become effective only at the 

beginning of a calendar year and will conform to the content of the plan notice for 

the calendar year? . . . . . . . . . . . . . . . . . . . . . 18 

Form 5306-A (Rev. 11-2019) 
Form 5306-A (Rev. 11-2019) Page 3 

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-A 

and its instructions, such as legislation 

enacted after they were published, go to 

www.irs.gov/Form5306A.

Purpose of form. Form 5306-A is used 

by sponsors who want to get IRS 

approval of their prototype simplified 

employee pension (SEP) agreements or 

savings incentive match plans for 

employees of small employers (SIMPLE 

IRA plans). 

Who may file. Use Form 5306-A to 

request a favorable opinion letter if: 

• You are a bank, federally insured credit 

union, savings and loan association that 

qualifies as a bank, insurance company, 

regulated investment company, or trade 

or professional society or association 

(other than an employee association); 

and 

• You want to get a favorable opinion 

letter that a SEP agreement or SIMPLE 

IRA plan to be used by more than one 

employer is acceptable in form. 

Who does not need to file. Instead of 

designing their own SEP or SIMPLE IRA 

plan, sponsors may use one of the Form 

5304 or 5305 series of model forms to 

establish a SEP or a SIMPLE IRA plan. 

Sponsors who use one of these forms 

with individual retirement accounts or 

annuities for which the IRS has issued a 

favorable opinion or ruling letter, or with 

model individual retirement accounts 

issued by the IRS, are considered to 

have established a SEP or SIMPLE IRA 

plan that meets the requirements of 

section 408(k) or 408(p). Do not file 

Form 5306-A if you use a model form. 

Note: The IRS will not issue an opinion 

letter on a document submitted with 

Form 5306-A that is a combination of a 

prototype SEP or SIMPLE IRA plan and 

a prototype individual retirement account 

or annuity. 

What to file. File this application and 

one copy of all documents that make up 

the SEP agreement or SIMPLE IRA plan. 

If this is an amendment, include a 

copy of the amendment and an 

explanation of its effect on the SEP 

agreement or SIMPLE IRA plan. 

Where to file. File Form 5306-A at this 

address.

Internal Revenue Service 

Attn: EP Opinion Letters 

TE/GE Stop 31A Team 105 

P.O. Box 12192 

Covington, KY 41012-0192

Private delivery services (PDSs). PDSs 

can't deliver to the address shown 

above. If you choose to use a PDS, send 

Form 5306-A to this address.

Internal Revenue Service 

Attn: EP Opinion Letters 

7940 Kentucky Drive 

TE/GE Stop 31A Team 105 

Florence, KY 41042

Go to www.irs.gov/PDS for the current 

list of designated services.

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 determine the proper user fee, see 

Rev. Proc. 2019-4, 2019-1 I.R.B. 146, 

available at www.irs.gov/

irb/2019-01_IRB#RP-2019-04, or the 

latest annual update.

Line 2c. If you are amending your 

previously approved SEP or SIMPLE IRA 

plan, enter the letter serial number, date, 

and file folder number from the latest 

opinion letter you received for your SEP 

or SIMPLE IRA plan. 

Line 3. If the application is for a SEP 

that provides for elective deferrals 

intended to meet the requirements of 

section 408(k)(6), check the box. 

The Small Business Job Protection Act 

of 1996 (P.L. 104-188) repealed section 

408(k)(6), effective December 31, 1996, 

except with respect to a SEP of an 

employer if the terms of the SEP of such 

employer, as in effect on December 31, 

1996, provided for elective deferrals. 

Line 4a. 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. 

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 prototype 

SEP or SIMPLE IRA plan meets the 

requirements of section 408(k) or 408(p). 

You are not required to apply for 

approval; however, if you want to receive 

an opinion letter from the IRS regarding 

your prototype SEP or SIMPLE IRA plan, 

you are required to provide the 

information requested on this form. 

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. 

The time needed to complete and file 

this form will vary depending on 

individual circumstances. The estimated 

average time is: 

Recordkeeping . . . 15 hr., 46 min. 

Learning about the law 

or the form . . . . . 1 hr., 23 min. 

Preparing, copying, assembling, 

and sending the form 

to the IRS . . . . . . 1 hr., 42 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 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, earlier.