User Fee for Employee Plan Determination,

Opinion, and Advisory Letter Request

For

IRS

Use

Only

Form 8717

(Rev. May 2009)

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 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. 5-2009)

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

Multiple employer plans (Form 5300):

(1)

(2)

(3)

(4)

$

$

$

$

$ 1,000

no Demo 5 and

no Demo 6

$ 300

$ 1,000

A B

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 ©

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

*64727O05200901*

d
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. 2009-8; 2009-1

I.R.B. 229, Rev. Proc. 2005-16, 2005-10

I.R.B. 674, Rev. Proc. 2007-44, 2007-28

I.R.B. 54, and Rev. Proc. 2008-56, 2008-40

I.R.B. 826.

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. 5-2009) 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.

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.

● We deleted the user fee for Form 6406,

Short Form Application for Determination for

Minor Amendment of Employee Benefit Plan,

from line 5d because Form 6406 is no longer

accepted by the IRS.

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. If your application meets these

requirements, complete only the Certification.

Do not complete any part of line 5.

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-6526, 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.

What’s New

● Some of the filing addresses have

changed. See Where To File on this page.

Where To File

Include Form 8717 and user fee with your request or application.

IF you have this type of

request or application . . .

Determination 

letter

THEN use this address if you send it by:

US mail Express Mail or 

private delivery service

Internal Revenue Service 

P.O. Box 12192

Covington, KY 41012-0192

Internal Revenue Service 

201 West Rivercenter Blvd.

Attn. Extracting Stop 312

Covington, KY 41011

Volume submitter plan or

Master or Prototype plan

Internal Revenue Service 

P.O. Box 2508

Attn: Pre-Approved Plans

Coordinator

Room 5106

Cincinnati, OH 45201

Internal Revenue Service 

550 Main Street

Attn: Pre-Approved Plans

Coordinator

Room 5106

Cincinnati, OH 45202