Form 8717

(Rev. February 2013)

Department of the Treasury 

Internal Revenue Service

User Fee for Employee Plan Determination 

Letter Request

▶ Attach to determination letter application. 

▶ 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 (employer if single-employer plan)

2 Sponsor’s employer identification number 3 Plan number 4 Plan name

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 B of line 5.

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 7528(b)(2)(B) of the Internal Revenue Code.

Sign Here ▶ Date ▶

Type or print name and title ▶

Form Submitted

Fee Schedule

A B 

no Demo 5 and 

no Demo 6:

Attach Check or Money Order Here

5a Form 5300: $ 2,500

b Form 5307: $ 300

c Form 5310: $ 2,000

d

e Multiple employer plans (Form 5300):

(1) 2 to 10 Forms 5300 submitted . . . . . . . . . . . . . . (1) $ 3,000

(2) 11 to 99 Forms 5300 submitted . . . . . . . . . . . . . (2) $ 3,000

(3) 100 to 499 Forms 5300 submitted . . . . . . . . . . . . . (3) $ 15,000

(4) Over 499 Forms 5300 submitted . . . . . . . . . . . . . (4) $ 15,000

f Multiple employer plans (Form 5310):

(1) 2 to 10 employers maintaining the plan . . . . . . . . . . . (1) $ 3,000

(2) 11 to 99 employers maintaining the plan . . . . . . . . . . (2) $ 3,000

(3) 100 to 499 employers maintaining the plan . . . . . . . . . . (3) $ 15,000

(4) Over 499 employers maintaining the plan . . . . . . . . . . (4) $ 15,000

g Reserved

(1a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Reserved

(1a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(4a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(4b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Form 5316 (Group trusts) . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000

Cat. No. 64727O Form 8717 (Rev. 2-2013)
Form 8717 (Rev. 2-2013) Page 2

What’s New

The user fees were updated by Rev. Proc. 

2013-8, 2013-1 I.R.B. 237. Form 8717 has 

been updated to reflect modifications to the 

determination letter program which were 

described in Announcement 2011-82, 

2011-52 I.R.B. 1052 and set forth in Rev. 

Proc. 2013-6, 2013-1 I.R.B. 198. The 

determination letter program was modified to 

eliminate the option of plan sponsors to 

request a determination relating to minimum 

participation, coverage, and nondiscrimination 

requirements of the Code, effective for 

applications filed on or after February 1, 2012 

in the case of plans under a 5-year remedial 

amendment cycle (other than terminating 

plans) and May 1, 2012, in the case of 

terminating plans and plans under a 6-year 

remedial amendment cycle. Column A (with 

Demo 5 and/or Demo 6) of the Fee Schedule 

has been deleted from Form 8717. The 

determination letter program was also 

modified to limit the ability to file a Form 5307, 

Application for Determination of Adopters of 

Modified Volume Submitter (VS) Plans, to 

adopters of certain Volume Submitter plans 

who modify the terms of an approved 

specimen plan, effective for applications filed 

on or after May 1, 2012.

Form 8717 has been renamed, User Fee for 

Employee Plan Determination Letter Request. 

Information previously on Form 8717 relating 

to opinion or advisory letter requests for 

Volume Submitter and Master or Prototype 

plans has been deleted. This information may 

now be found on new Form 8717-A, User Fee 

for Employee Plan Opinion or Advisory Letter 

Request.

Note. Please do not use any of the form that 

is grayed out. Those portions of the form are 

no longer functional on this form.

Instructions

(Section references are to the Internal 

Revenue Code unless otherwise noted.)

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. 2013-6, 2013-1 

I.R.B. 198. 

Effective Date

The user fee schedule in Form 8717 is 

effective for determination letter applications 

postmarked after January 31, 2011. Use of 

this revision of Form 8717 is mandatory 

beginning August 1, 2013.

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 5 

plan years or, if later, the end of any remedial 

amendment period with respect to the plan 

that begins within the first 5 plan years. 

A determination letter application that is 

filed by an eligible employer meets the 

requirements for exemption if:

(1) the application is filed no later than the last 

day of the submission period for the plan's 

current remedial amendment cycle under Rev. 

Proc. 2007-44, and

Where To File (Include Form 8717 and user fee with your request or 

application.)

IF you have this type of 

request or application . . .

THEN use this address if you send it by:

US mail Express Mail or 

private delivery service

Determination letter 

(Form 5307, 5300, 5310, 5310-A, 

and group trust applications)

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

(2) the plan was first in effect no earlier than 

January 1 of the tenth calendar year 

immediately before the year in which the 

submission period for the plan's current 

remedial amendment cycle begins. (If the plan 

was first in effect before this date, but the 

application is still filed within a remedial 

amendment period that began within the first 

5 plan years and you are an eligible employer, 

complete only the Certification and attach an 

explanation of how your application qualifies 

for exemption under section 7528(b)(2)(B).)

Example. An employer maintains an 

individually designed plan first effective on 

July 1, 2001. Assume that the plan's 5 year 

remedial amendment cycle is Cycle A. 

Therefore, the submission period for the 

plan's current cycle ends on January 31, 

2012. Assume that the employer files a 

determination letter application for the plan on 

January 31, 2012. If the employer is an 

eligible employer, the application is exempt 

from the user fee requirement because the 

application is filed by the last day of the 

submission period for the plan's current 

remedial amendment cycle and the date the 

plan was first in effect (July 1, 2001) is not 

before January 1, 2001 (i.e., January 1 of the 

tenth calendar year immediately before 2011, 

the year in which the submission period for 

the plan's current remedial amendment cycle 

begins). 

A determination letter application that is 

filed by an eligible employer for a defined 

benefit plan eligible for the 6-year remedial 

amendment cycle ending on April 30, 2012, 

also meets the requirements for exemption if: 

(1) the application is filed before May 1, 2012, 

and 

(2) the plan was first in effect no earlier than 

January 3, 1996. 

See Notice 2002-1, 2002-1 C.B. 283 as 

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

and Notice 2011-86, 2011-45 I.R.B. 698.

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.

The determination of whether an employer 

is an eligible employer 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.

Payment of User Fee

If you do not meet the conditions for 

exemption discussed above, a user fee is due.

Check the appropriate box in Column B of 

line 5 and attach to the left side of the form 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.

If you have multiple plans, submit a 

separate determination letter application and 

Form 8717 for each plan.

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 are not 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 . . . . 8 hr., 07 min.

Learning about the law 

or the form . . . . . . . . 35 min.

Preparing, copying, assembling, 

and sending the form to the IRS . 45 min.

If you have comments about 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:M:S, 1111 

Constitution Ave. NW, IR-6526, Washington, 

DC 20224. Do not send this form to this 

address. Instead, see Where To File above.