Form 8717

(Rev. November 2011)

Department of the Treasury 

Internal Revenue Service

User Fee for Employee Plan Determination, 

Opinion, and Advisory 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 A or 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 

with Demo 5 

and/or Demo 6:

B 

no Demo 5 and 

no Demo 6:

Attach Check or Money Order Here

5a Form 5300: $ 4,500 $ 2,500

b Form 5307: $ 1,800 $ 300

c Form 5310: $ 4,000 $ 2,000

d

e Multiple employer plans (Form 5300):

(1) 2 to 10 Forms 5300 submitted . . . . . . . . . . . . . . (1) $ 5,000 (1) $ 3,000

(2) 11 to 99 Forms 5300 submitted . . . . . . . . . . . . . (2) $ 5,000 (2) $ 3,000

(3) 100 to 499 Forms 5300 submitted . . . . . . . . . . . . . (3) $ 25,000 (3) $ 15,000

(4) Over 499 Forms 5300 submitted . . . . . . . . . . . . . (4) $ 25,000 (4) $ 15,000

f Multiple employer plans (Form 5310):

(1) 2 to 10 employers maintaining the plan . . . . . . . . . . . (1) $ 5,000 (1) $ 3,000

(2) 11 to 99 employers maintaining the plan . . . . . . . . . . (2) $ 5,000 (2) $ 3,000

(3) 100 to 499 employers maintaining the plan . . . . . . . . . . (3) $ 25,000 (3) $ 15,000

(4) Over 499 employers maintaining the plan . . . . . . . . . . (4) $ 25,000 (4) $ 15,000

g Volume submitter:

(1a) Specimen plan (nonmass) with no/one adoption agreement . . . . . . . . . . . (1a) $ 12,000

(1b) Specimen plan (nonmass) - per each additional adoption agreement . . . . . . . . (1b) $ 9,500

(2a) Mass submitter specimen plan with no/one adoption agreement . . . . . . . . . (2a) $ 12,000

(2b) Mass submitter - per each additional adoption agreement . . . . . . . . . . . . (2b) $ 1,000

(3) Specimen plan identical to mass submitter specimen plan . . . . . . . . . . . (3) $ 300

(4) Assumption of sponsorship of an approved specimen plan - per basic plan document . . (4) $ 300

h Master & Prototype (M&P):

(1a) Mass submitter - per basic plan document with one adoption agreement . . . . . . . (1a) $ 12,000

(1b) Mass submitter - per each additional adoption agreement . . . . . . . . . . . . (1b) $ 1,000

(2) Sponsor’s identical adoption of mass submitter basic plan document - per adoption agreement . . (2) $ 300

(3) Sponsor’s minor modification of mass submitter basic plan document - per adoption agreement . . (3) $ 1,000

(4a) Nonmass submitter - per basic plan document with one adoption agreement . . . . . (4a) $ 12,000

(4b) Nonmass submitter - per each additional adoption agreement . . . . . . . . . . (4b) $ 9,500

(5) Opinion letter for additional optional provisions - per mass submitter basic plan document . (5) $ 1,000

(6) Assumption of sponsorship of an approved M&P plan - per basic plan document . . . . (6) $ 300

(7) Mass submitter/non-mass submitter sponsor - per trust document in excess of 10 . . . (7) $ 1,000

i Group trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000

Cat. No. 64727O Form 8717 (Rev. 11-2011)
Form 8717 (Rev. 11-2011) Page 2

What’s New

The user fees were updated by Rev. Proc. 

2011-8, 2011-1 I.R.B. 237, corrected by 

Announcement 2011-8, 2011-5 I.R.B. 446.

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. 2011-6, 2011-1 

I.R.B. 195. 

Effective Date

The user fee schedule in Form 8717 is 

effective for opinion, advisory, and 

determination letter applications postmarked 

after January 31, 2011.

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 after January 31, 

2011, 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

(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: 

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

Volume submitter plan or 

Master or Prototype plan 

(Forms 4461, 4461-A, or 4461-B)

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

(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 A of 

line 5 if (a) you use the average benefit test to 

satisfy minimum coverage requirements and/

or the general test to show nondiscrimination 

in the amount of contributions or benefits, and 

(b) you are requesting a determination letter 

that covers these issues (i.e., your application 

includes Schedule Q (Form 5300), Elective 

Determination Requests and a demonstration 

labeled Demo 5 and/or Demo 6).

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 (i.e., 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 nondesignbased safe harbor plan.

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.

If you have multiple plans, submit a 

separate determination letter application and 

Form 8717 for each plan.

Privacy Act and 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; section 

6109 requires you to provide your identifying 

number.

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. 

However, section 6103 allows or requires us 

to disclose this information to the Department 

of Justice and to other federal agencies as 

provided by law. We may also give it to cities, 

states, the District of Columbia, and U.S. 

commonwealths or possessions to carry out 

their tax laws. We may give it to certain 

foreign countries under tax treaties, to federal 

and state agencies to enforce federal nontax 

criminal laws, or to federal law enforcement 

and intelligence agencies to combat terrorism.

The time needed to complete and file this 

form will vary depending on individual 

circumstances. The estimated average time is:

Recordkeeping . . . . 8 hrs., 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.