Form 8717

(Rev. September 2016)

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 and enter the user fee 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

User Fee

A B 

no Demo 5 and 

no Demo 6:

Attach Check or Money Order Here

5a Form 5300: $ 

b Form 5307: $

c Form 5310: $

d

e Multiple employer plans (Form 5300) . . . . . . . . . . . . . $

f Multiple employer plans (Form 5310) . . . . . . . . . . . . . $

g Reserved

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

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

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

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

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

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

h Reserved

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

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

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

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

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

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

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

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

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

i Form 5316 (Group trusts) . . . . . . . . . . . . . . . . . . . . . . . . $

Cat. No. 64727O Form 8717 (Rev. 9-2016)
Form 8717 (Rev. 9-2016) Page 2

Section references are to the Internal Revenue 

Code unless otherwise noted.

Future Developments

For the latest information about developments 

related to Form 8717 and its instructions, 

such as legislation enacted after they were 

published, go to www.irs.gov/form8717.

What’s New

Specific user fee amounts are no longer listed 

on Form 8717. You must now enter the 

appropriate user fee when completing line 5.

General Instructions

Purpose of Form

Generally, a user fee is required with each 

application for a determination letter. Use 

Form 8717 to submit the appropriate user fee.

Note: Don't use any part of the form that is 

shaded in gray. Those portions of the form are 

no longer functional.

Specific Instructions

Exemption from User Fee

The exemption from the user fee applies to 

all eligible employers (defined later) 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, 2007-28 I.R.B. 54, 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).)

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:

U.S. mail Express Mail or 

private delivery service

Determination letter 

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

and Form 5316, Group trust 

applications)

Internal Revenue Service 

Attn: EP/EO Determination 

Letters, Stop 31 

P.O. Box 12192 

Covington, KY 41012-0192

Internal Revenue Service 

Attn: EP/EO Determination 

Letters, Stop 31 

201 West Rivercenter Blvd. 

Covington, KY 41011

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, a submission period for the plan's 

cycle ended on January 31, 2012. Assume 

that the employer filed a determination letter 

application for the plan on January 31, 2012. 

If the employer is an eligible employer, the 

application was exempt from the user fee 

requirement because the application was 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 

(that is, 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 began). 

A determination letter application that was 

filed by an eligible employer for a defined 

benefit plan eligible for the 6-year remedial 

amendment cycle ending on April 30, 2012, 

also met the requirements for exemption if: 

(1) the application was 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. Don't 

complete any part of line 5.

Payment of User Fee

If you don't meet the conditions for exemption 

discussed earlier, a user fee is due.

Line 5. User fee. To determine the 

appropriate user fee to enter on line 5, go to 

www.irs.gov/Retirement-Plans/User-fees-forEmployee-Plans-Determination,-Opinion-andAdvisory-Letters. The schedule for user fees is 

also set forth in Rev. Proc. 2016-8, 2016-1 

I.R.B. 243, (available at www.irs.gov/

irb/2016-01_IRB/ar14.html) or the latest 

annual update.

Check the appropriate box and enter the 

user fee in Column B of line 5. 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 don't 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 aren't 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 . . . . . . . . 57 min.

Preparing, copying, assembling 2 hr., 04 min.

Sending the form to the IRS . . 16 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 send your 

comments to Internal Revenue Service, Tax 

Forms and Publications Division, Room 6526, 

1111 Constitution Ave. NW, Washington, DC 

20224. Do not send this form to this address. 

Instead, see Where To File.