Form 4461-B

(Rev. November 2018)

Department of the Treasury 

Internal Revenue Service 

Application for Approval of 

Standardized or Nonstandardized Pre-Approved Plans

Mass Submitter Adopting Provider

▶ Go to www.irs.gov/Form4461B for the latest information.

OMB No. 1545-0169 

This Form Is Open to Public Inspection 

File This Form With the Internal Revenue Service 

Section references are to the Internal Revenue Code unless otherwise noted. 

For IRS Use Only 

Complete every applicable item on this form. 

1 Enter amount of user fee submitted 

$ 

2 a Name of applicant 

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

City State ZIP code 

2 b Employer identification number 

of applicant 

2 c Applicant’s telephone no. 

3a Name of person to be contacted 3 b Email address 3 c Telephone number 

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

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

5 This plan is: 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) 

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). 

File folder number 

Letter serial number 

Date of letter 

8 Type of plan (select all that apply): 

Money purchase Target benefit Profit-sharing/401(k) Governmental

Profit-sharing Defined benefit ESOP Nonelecting church

9 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) Page 2 

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. 

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.

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) Page 3 

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. 

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.

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 . . . . . . 52 min.

Preparing the form . . 1 hr., 56 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-B to this address. 

Instead, see Where To File, earlier.