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

▶ Go to www.irs.gov/Form4461A for the latest information.

OMB No. 1545-0169 

This Form Is Open to Public Inspection 

File This Form With the Internal Revenue Service For IRS Use Only 

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 Enter amount of user fee submitted 

$ 

2 a Approval requested: 

Initial application 

Amendment—Enter file folder number in line 2b 

and date of last letter issued in line 2c . . ▶

2b File folder number 2c Date of last letter issued 

3 a Name of applicant 

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

City State ZIP code 

3b Employer identification number 

(EIN) of applicant 

3c Applicant’s telephone number 

3 d Type of applicant (see Definitions in the instructions): 

Provider Mass submitter

4a Name of person to be contacted 4b Telephone number 4c Fax number 

4 d Email address 

4e If a power of attorney is attached, check box . . ▶

5a Basic plan document or single document plan number 5b Adoption agreement number, if applicable

6 Form of plan: 

Adoption agreement plan Single document plan 

7 Type of plan (select all that apply):

Without permitted disparity With permitted disparity Governmental

Nonelecting church Without cash balance features With cash balance features

8 Filing status of plan: 

Standardized plan 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 ▶ Title ▶ Date ▶

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 2 

9 Procedural requirements: Yes No 

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.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) 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) 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) 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 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.

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. 

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) Page 4 

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. 

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.

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.

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 a 

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.

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.

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) Page 5 

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 

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. 

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.