Form 8717-A

(Rev. September 2016)

Department of the Treasury 

Internal Revenue Service

User Fee for Employee Plan Opinion 

or Advisory Letter Request

▶ Attach to applicable Form 4461, 4461-A, or 4461-B. 

▶ For the latest information about this form, go to www.IRS.gov/form8717.

For 

IRS 

Use 

Only

OMB No. 1545–1772

Amount paid

1 Name of plan sponsor/practitioner

2 Sponsor’s/practitioner's employer identification number 3 Plan number

4 Plan name

Applications User Fee 

Attach Check or Money Order Here

5a Volume submitter

(1a) Specimen plan (nonmass) with no/one adoption agreement . . . . . . . . . . . (1a) $

(1b) Specimen plan (nonmass) – per each additional adoption agreement . . . . . . . . (1b) $

(2a) Mass submitter specimen plan with no/one adoption agreement . . . . . . . . . (2a) $

(2b) Mass submitter – per each additional adoption agreement . . . . . . . . . . . . (2b) $

(3) Specimen plan identical to mass submitter specimen plan . . . . . . . . . . . . (3) $

(4) Assumption of sponsorship of an approved specimen plan – per basic plan document . . $

(5) Change in name and/or address of practitioner of an approved specimen plan – per basic 

plan document . . . . . . . . . . . . . . . . . . . . . . . . . . (5) $ 0

(6) Mass submitter/nonmass submitter practitioner – per trust document in excess of 10 . . . (6) $

5b Master & Prototype (M&P):

(1a) Mass Submitter – per basic plan document with one adoption agreement . . . . . . . (1a) $

(1b) Mass Submitter – per each additional adoption agreement . . . . . . . . . . . (1b) $

(2) Sponsor’s identical adoption of mass submitter basic plan document – per adoption 

agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . (2) $

(3) Sponsor’s minor modification of mass submitter basic plan document – per adoption 

agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . (3) $

(4a) Nonmass submitter – per basic plan document with one adoption agreement . . . . . (4a) $

(4b) Nonmass submitter – per each additional adoption agreement . . . . . . . . . . (4b) $

(5) Opinion letter for additional optional provisions – per mass submitter basic plan document . (5) $

(6) Assumption of sponsorship of an approved M&P plan – per basic plan document . . . . (6) $

(7) Change in name and/or address of sponsor of an approved M&P plan – per basic plan 

document . . . . . . . . . . . . . . . . . . . . . . . . . . . . (7) $ 0

(8) Mass submitter/nonmass submitter sponsor – per trust document in excess of 10 . . . . (8) $

Cat. No. 60826Q Form 8717-A (Rev. 9-2016)

(4)
Form 8717-A (Rev. 9-2016) Page 2

Instructions

(Section references are to the Internal 

Revenue Code unless otherwise noted.)

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/form8717.

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.

General Instructions

Purpose of Form

Generally, a user fee is required with each 

application for an opinion or advisory letter. 

Use Form 8717-A to submit the appropriate 

fee for the opinion or advisory letter.

Specific Instructions

Line 5. User fee. To determine the 

appropriate user fee to enter on line 5, go to 

www.irs.gov/Retirement-Plans/User-fees-forEmployee-Plans-Determination,-Opinion-andAdvisory-Letters. The schedule for user fees is 

also set forth in Rev. Proc. 2016-8, 2016-1 

I.R.B. 243, (available at www.irs.gov/

irb/2016-01_IRB/ar14.html) 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 or 

advisory letter application for Forms 4461, 

4461-A, and 4461-B.

If you have multiple plans, submit a 

separate opinion or advisory 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 5106, Group 7521 

Cincinnati, OH 45201

If sent via Express Mail or Private 

Delivery Service,

Internal Revenue Service 

Attn: Pre-Approved Plans Coordinator 

550 Main Street 

Room 5106, 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 this time estimate or suggestions 

for making this form simpler, we would be 

happy to hear from you. You can send your 

comments to the Internal Revenue Service, 

Tax Forms and Publications Division, Room 

6526, 1111 Constitution Ave. NW, 

Washington, DC 20224. 

Do not send this form to this address. 

Instead, see Where To File.