OMB No. 1545-0212 Form 5558 Application for Extension of Time

To File Certain Employee Plan Returns (Rev. August 2004)

Department of the Treasury

Internal Revenue Service File With IRS Only  For Paperwork Reduction Act Notice, see instructions on back.

1 I request an extension of time until / / to file (check appropriate box(es)).

Form 5500 or 5500-EZ (no more than 21 a ⁄2 months).

Form 5330 (no more than 6 months). Enter Code section(s) imposing the tax . Payment amount

attached is $ (see instructions).

b

2

Plan year ending

Complete the following for the plan(s) covered by this application (see instructions):

Plan

number Month Day Year Plan name/filer

3a State in detail why you need the extension (if line 1b is checked)

Under penalties of perjury, I declare that to the best of my knowledge and belief the statements made on this form are true, correct, and complete, and that I am

authorized to prepare this application.

Signature  Date 

This application for extension to file Form 5330 IS approved to the date shown on line 1, if line 1b is checked. (You

must attach an approved copy of this form to each Form 5330 that was granted an extension.)

This application for an extension for Form 5330 is not approved, because

The application was not signed.

No reason was given on this application or the reason was not acceptable.

Other 

(Date) (Director)

 OR

Employer identification number (EIN). Filers checking box

1a must enter an EIN. All other filers, see Specific

Instructions.

By:

Form 5558 (Rev. 8-2004)

Filer’s Identifying Number—Check applicable box and enter

number (see instructions).

Cat. No. 12005T

Applicants for extension of Form 5330: Complete if you want this Form 5558 returned to an address other than the address shown above.

Name

Please

Print

or

Type

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

City or town, state, and ZIP code

A 10-day grace period is granted from the date shown below or the due date of the return, whichever is later.

(You must attach a copy of this form to each return you file that is granted a grace period.)

Notice to

Applicant

To Be

Completed

by the IRS

if Line 1b

Is

Checked

The date entered on line 1 is more than the 6-month maximum time allowed for Form 5330. This application is approved

to (You must attach an approved copy

of this form to each Form 5330 that was granted an extension.)

The application for an extension for Form 5330 is not approved, because it was filed after the normal due date of the

return. (A 10-day grace period is not granted.)

File before the

normal due

date of the

Form 5500,

5500-EZ, or

5330 (see

instructions)

The application is automatically approved to the date shown on line 1 (above) if: (1) box 1a is checked, (2) the Form 5558 is signed

and filed on or before the normal due date of Form 5500 or 5500-EZ for which this extension is requested, and (3) the date on line

1 is no more than 21⁄2 months after the normal due date.

To Be Completed by the IRS if line 1b is checked 

You must attach a copy of this Form 5558 to each Form 5500 and 5500-EZ filed after the due date for the plans listed below.

Type of plan (check)

Pension Welfare Fringe

Name of filer, plan administrator, or plan sponsor (see instructions)

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

City or town, state, and ZIP code Social security number (see Specific Instructions)



month day year

No reason was given on this application or the reason was not acceptable.

No payment was attached for the tax due on Form 5330.

b For excise taxes under section 4980 or 4980F of the Code, enter the reversion/amendment date.
Form 5558 (Rev. 8-2004) Page 2

Line 3 (complete only if box 1b is

checked)

The time needed to complete and file this form

will vary depending on individual circumstances. The

estimated average time: 33 minutes.

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 write to the Internal Revenue Service, Tax

Products Coordinating Committee,

SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave., NW,

Washington, DC 20224. Do not send the tax form to

this address. Instead, see Where To File above.

Filer’s Identifying Number

Purpose of Form

An extension of time to file a Form 5500 or Form

5500-EZ does not operate as an extension of time

to file the PBGC Form 1.

Lines 1a and 1b

How To File

If your application for an extension of time to file

a Form 5500 or Form 5500-EZ is filed on or before

the return/report’s normal due date on a properly

completed and signed Form 5558, you will

automatically be granted one extension of not more

than 21⁄2 months.

An extension of time to file does not extend the

time to pay the tax due. Any tax due must be paid

with this application.

Exception: Form 5500 and Form 5500-EZ filers are

automatically granted extensions of time to file until

the extended due date of the Federal income tax

return of the employer (and are not required to file

Form 5558) if all the following conditions are met: (1)

the plan year and the employer’s tax year are the

same; (2) the employer has been granted an

extension of time to file its Federal income tax return

to a date later than the normal due date for filing the

Form 5500 or Form 5500-EZ; and (3) a photocopy of

the IRS extension of time to file the Federal income

tax return is attached to the Form 5500 or Form

5500-EZ. An extension granted under this exception

CANNOT be extended further by filing a Form 5558

after the normal due date of the Form 5500 or Form

5500-EZ.

Signature

We ask for the information on this form to carry out

the Internal Revenue laws of the United States. We

need it to determine if you are entitled to an

extension of time to file your employee plan returns.

If you want an extension, you are required to give us

the information. Section 6109 requires you to

provide your taxpayer identification number (SSN or

EIN). If you fail to provide this information in a timely

manner, you may be liable for penalties and interest.

Routine uses of this information include giving it to

the Department of Justice for civil and criminal

litigation, and cities, states, and the District of

Columbia for use in administering their tax laws. We

may also disclose this information to federal and

state or local agencies to enforce federal nontax

criminal laws and to combat terrorism. The authority

to disclose information to combat terrorism expired

on December 31, 2003. Legislation is pending that

would reinstate this authority.

Use Form 5558 to apply for a one-time extension of

time to file Form 5500, Form 5500-EZ, or Form

5330. The following exception does NOT apply to

Form 5330.

In general, a separate Form 5558 is used for each

return for which you are requesting an extension.

However, if you are a single employer and all your

plan years end on the same date, file only one Form

5558 to request an extension of time to file more

than one Form 5500 or Form 5500-EZ.

If you are requesting an extension of time to file

Form 5500 or 5500-EZ only, file Form 5558 before

the return/report’s normal due date.

Enter your name and address in the heading if you

are a single employer requesting an extension of

time to file the Form 5500 or Form 5500-EZ. If you

are filing for other than a single employer, enter the

plan administrator’s or plan sponsor’s name and

address on the application. The plan sponsor listed

on this application should be the same as the plan

sponsor listed on the annual return/report filed for

the plan.

Include the suite, room, or other unit number after

the street address. 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. If you checked box 1(b) and want this form

returned to a different name and/or address, also

complete the name/address section at the bottom of

the form.

Employer Identification Number (EIN). Enter the

nine-digit EIN assigned to the employer for all

applications filed for Form 5500 or Form 5500-EZ.

Also enter the EIN for applications filed for Form

5330 (see Social Security Number (SSN) below for

exceptions).

Check the Form 5500 or Form 5500-EZ and/or Form

5330 box(es) to indicate the return(s) for which you

are requesting an extension.

The IRS will grant a reasonable extension of time

(not to exceed 6 months) for filing Form 5330 if you

file a timely application showing that you are unable

to file Form 5330 because of circumstances beyond

your control. Clearly describe these circumstances.

Generally, an application will be considered on the

basis of your own efforts to fulfill this filing

responsibility, rather than the convenience of anyone

providing help in preparing the return. However,

consideration will be given to any circumstances

that prevent your practitioner, for reasons beyond

his or her control, from filing the return by the

normal due date, and to circumstances in which you

are unable to get needed professional help in spite

of timely efforts to do so.

The form must be signed. The person who signs this

form may be an employer, plan sponsor, or plan

administrator filing a Form 5500, 5500-EZ, or 5330,

a disqualified person filing Form 5330, an attorney

or certified public accountant qualified to practice

before the IRS, a person enrolled to practice before

the IRS, or a person holding a power of attorney.

Caution: If we grant you an extension of time to file

Form 5330 and later find that the statements made

on this form are false or misleading, the extension

will be null and void. A late filing penalty associated

with the form for which you filed this extension will

be charged.

Interest is charged on taxes not paid by the due

date even if an extension of time to file is granted.

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 required by Code section 6103.

Where To File

General Instructions

If your application for extension of time to file

Form 5330 is approved, you may be granted an

extension of up to 6 months after the normal due

date of Form 5330. Also indicate the Code section(s)

for the excise tax you are requesting an extension.

Enter the amount of tax estimated to be due with

Form 5330 and attach your payment to this form.

Make the check payable to the United States

Treasury.

Applications for extension of time to file Form

5500 and Form 5500-EZ that are filed on or before

the return/report’s normal due date on a properly

completed and signed Form 5558 will be

automatically approved to the date that is not more

than 21⁄2 months after the return/report’s normal due

date. Approved copies of Form 5558 will not be

returned to the filer from the IRS. Attach a

photocopy of the completed and signed extension

request to your Form 5500 or Form 5500-EZ.

Applications for extension of time to file Form 5330

will continue to be returned to the applicant as

approved or not approved.

Specific Instructions

Name and Address

Privacy Act and Paperwork Reduction

Act Notice

When To File

File Form 5558 with the Internal Revenue Service

Center, Ogden, UT 84201-0027.

Private Delivery Services. You can use certain

private delivery services designated by the IRS to

meet the “timely mailing treated as timely

filing/paying” rule for tax returns and payments. If

you use a private delivery service designated by the

IRS (rather than the U.S. Postal Service) to send

your return, the postmark date generally is the date

the private delivery service records in its database

or marks on the mailing label. The private delivery

service can tell you how to get written proof of this

date.

The following are designated private delivery

services:

● Airborne Express (Airborne): Overnight Air Express

Service, Next Afternoon Service, Second Day

Service.

● DHL Worldwide Express (DHL): DHL “Same Day”

Service, DHL USA Overnight.

● Federal Express (FedEx): FedEx Priority Overnight,

FedEx Standard Overnight, FedEx 2Day, FedEx

International Priority and FedEx International First.

● United Parcel Service (UPS): UPS Next Day Air,

UPS Next Day Air Saver, UPS 2nd Day Air, UPS 2nd

Day Air A.M., UPS Worldwide Express Plus, and

UPS Worldwide Express.

File one Form 5558 to request an extension for

excise taxes with the same filing due date. For

specific information on excise tax due dates, see the

Instructions for Form 5330.

If you are requesting an extension of time to file

Form 5330, file Form 5558 in sufficient time for the

Internal Revenue Service to consider and act on it

before the return’s normal due date.

The normal due date is the date the Form 5500,

5500-EZ or 5330 would otherwise be due, without

extension.

Line 2

Complete line 2 to show the plan name, type of

plan, plan number, and the date the plan year ends.

If the employer does not have an EIN, it must

apply for one. An EIN can be applied for:

The online application process is not yet available

for corporations with addresses in foreign countries

or Puerto Rico.

● By telephone at 1-800-829-4933 from 7:30 a.m.

to 5:30 p.m. in the employer’s local time zone.

● Online by clicking the Employer ID Numbers

(EINs) link at www.irs.gov/business/small. The EIN is

issued immediately once the application information

is validated.

● Employers who do not have an EIN may apply for

one by attaching a completed Form SS-4 to this

form.

Social Security Number (SSN). If you made excess

contributions to a Code section 403(b)(7)(A)

custodial account or you are a disqualified person

other than an employer, enter your SSN.