User Fee for Employee Plan Determination,

Opinion, and Advisory Letter Request

For

IRS

Use

Only

Form 8717

(Rev. June 2006)

Department of the Treasury Amount paid

Internal Revenue Service Attach to determination letter application.

2 Sponsor’s employer identification number

1 Name of plan sponsor (employer if single-employer plan)

4

3 Plan number

Caution. If you qualify for the exemption from user fees for small business employers, complete only the certification below (see

the instructions on page 2 for details). For all other applications, leave the certification blank and check the appropriate box in

column A or B of line 5.

Fee Schedule

5a Form 5300:

b Form 5307:

c

d

Form 5310:

e

g

(1) 2 to 10 Forms 5300 submitted

(2) 11 to 99 Forms 5300 submitted

(3) 100 to 499 Forms 5300 submitted

(4) Over 499 Forms 5300 submitted

Volume submitter:

Cat. No. 64727O Form 8717 (Rev. 6-2006)

f Multiple employer plans (Form 5310):

(1) 2 to 10 employers maintaining the plan

(2) 11 to 99 employers maintaining the plan

(3) 100 to 499 employers maintaining the plan

(4) Over 499 employers maintaining the plan

10,000

10,000

1,500

1,500

Specimen plan

Lead specimen plan (see Rev. Proc. 2005-16)

Specimen plan identical to lead specimen plan (see Rev. Proc. 2005-16)

(1)

(2)

(3)

i Group trust

Attach Check or Money Order Here

Certification

I certify that the application for a determination letter on the qualified status of the plan listed above meets the conditions for

exemption from user fees described in section 620 of the Economic Growth and Tax Relief Reconciliation Act of 2001.

Sign Here Date 

Form Submitted

Form 6406:

Multiple employer plans (Form 5300):

(1)

(2)

(3)

(4)

$

$

$

$

$ 1,000

no Demo 5 and

no Demo 6

$ 300

$ 1,000

A B

$ 300

15,000

15,000

2,300

(1) 2,300

(2)

(3)

(4)

$

$

$

$

$ 1,800

with Demo 5

and/or Demo 6:

$ 1,000

$ 1,800

10,000

10,000

1,500

(1) 1,500

(2)

(3)

(4)

$

$

$

15,000 $

15,000

2,300

(1) 2,300

(2)

(3)

(4)

$

$

$

$

200

9,000

(1) 9,000

(2)

(3)

$

$

$

$ 750

OMB No. 1545–1772

Plan name

Type or print name and title 

Not applicable

h Master & Prototype (M&P):

(1) Mass Submitter - per basic plan document with one adoption agreement

(2) Mass Submitter - per each additional adoption agreement

(3) Sponsor’s identical adoption of M&P Mass Submitter basic plan document - per adoption agreement

(4) Sponsor’s minor modification of M&P Mass Submitter basic plan document - per adoption agreement

650

200

650

(1) 9,000

(2)

(3)

(6)

$

$

$

$

(5) Nonmass submission by M&P sponsor - per adoption agreement

(6) Advisory letter for additional optional provisions - per Mass Submitter basic plan document

(7) Addition of new adoption agreement for approved plan - per Mass Submitter adoption agreement.

(8) Assumption of sponsorship of an approved M&P plan

(9) Mass Submitter/sponsor - per trust document in excess of 10

(4) $ 650

(5) $ 9,000

(7) $ 650

(8) $ 200

(9) $ 650

*64727O06200601*
Instructions

Generally, a user fee is required with

each application for a determination

letter. The user fees are shown on

page 1. For more information, see

Rev. Proc. 2006-8, 2006-1 I.R.B.

245, and Rev. Proc. 2005-16,

2005-10 I.R.B. 674.

If you do not meet the conditions for

exemption discussed above, a user

fee is due.

Attach a check or money order

payable to the “United States

Treasury” for the full amount of the

user fee to Form 8717, if applicable.

If you do not include the full amount,

your application may be returned.

Attach Form 8717 to your

determination letter application.

Form 8717 (Rev. 6-2006) Page 2

Check the appropriate box in

column B of line 5 if you do not

want to receive a determination

letter that covers the average benefit

test and/or the general test (that is,

the plan is not required to use these

tests or you do not want these

issues considered). A general test

plan is a plan that is other than a

design-based safe harbor or

nondesign-based safe harbor plan.

Printed on recycled paper

Where To File

Internal Revenue Service

P.O. Box 192

Covington, KY 41012-0192

● Send the determination letter

application and Form 8717 to:

If you have multiple plans (for

example, a profit-sharing plan and a

money purchase plan), submit a

separate determination letter

application and Form 8717 for each

plan.

Internal Revenue Service

P.O. Box 2508

Attn: Pre-Approved Plans Coordinator

Room 5106

Cincinnati, OH 45201

● Send a request for approval of a

volume submitter plan or master and

prototype plan to:

Exemption from User Fee

The exemption from the user fee

applies to all eligible employers

(defined below) who request a

determination letter within the first

five plan years or, if later, the end of

the remedial amendment period that

begins within the first five plan years

with respect to a plan. Under

section 620 of the Economic Growth

and Tax Relief Reconciliation Act of

2001 (EGTRRA), an application for a

defined contribution plan from an

eligible employer for a plan that was

first effective on or after January 2,

1997, will automatically meet this

requirement. An application for a

defined benefit plan from an eligible

employer for a plan that was first

effective on or after January 3, 1996,

will automatically meet this

requirement. See Notice 2002-1,

2002-1 C.B. 283 as amplified by

Notice 2003-49, 2003-2 C.B. 294.

An eligible employer as defined in

section 408(p)(2)(C)(i)(l) is an

employer which had no more than

100 employees who received at

least $5,000 of compensation from

the employer for the preceding year.

In addition, an eligible employer

must have at least one employee

who is not a highly compensated

employee (as defined in section

414(q)) and is participating in the

plan.

Payment of User Fee

(Section references are to the

Internal Revenue Code unless

otherwise noted. )

The determination of whether an

employer is an eligible employer

under this section is made as of the

date of the request described above.

Check the appropriate box in

column A of line 5 if (a) your plan

uses the average benefit test to

satisfy minimum coverage

requirements and/or the general test

to demonstrate nondiscrimination in

the amount of contributions or

benefits, and (b) you want to receive

a determination letter that covers

these issues (that is, your

application includes Schedule Q

(Form 5300), Elective Determination

Requests and a demonstration

labeled Demo 5 and/or Demo 6).

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.

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 section

6103.

The time needed to complete and

file this form will vary depending on

individual circumstances. The

estimated average time is 4 hours,

21 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, IR-6406,

Washington, DC 20224. Do not send

this form to this address. Instead,

see Where To File above.

Effective Date

The user fee schedule in Form 8717

is effective for opinion, advisory, and

determination letter applications

postmarked on or after July 1, 2006.

If your application meets these

requirements, complete only the

Certification. Do not complete any

part of line 5.