Table of Contents
- What's New
- Purpose of Form
- Telephone Assistance
- How To Get Forms and Publications
- Photographs of Missing Children
- General Instructions
- Who Must File
- When To File
- Extension of Time To File
- Amended Registration Statement
- Prior Year Statement
- When To Report a Separated Participant
- When Not To Report a Participant
- Transfer of a Participant's Benefit to the Plan of a New Employer
- Where To File
- How To File
- Penalties
The Social Security Administration (SSA) will no longer process nonstandard pages 2. If additional space is needed, use additional pages 2 of the 2012 Form 8955-SSA for separated participants. Do not add spreadsheets or other non-standard formats.
Form 8955-SSA, the designated successor to Schedule SSA (Form 5500), is used to satisfy the reporting requirements of section 6057(a) for plan years beginning after December 31, 2008. Form 8955-SSA is a stand-alone reporting form filed with the Internal Revenue Service (IRS). See Where To File. Do not file Form 8955-SSA with the Form 5500, Annual Return/Report of Employee Benefit Plan, or Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.
Use Form 8955-SSA to report information about separated participants with deferred vested benefits under the plan. Required information includes participants who have a deferred vested benefit under the plan and:
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separated from service covered by the plan;
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were reported as deferred vested participants on another plan's filing if their benefits were transferred (other than in a rollover) to the plan during the covered period;
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previously were reported under the plan but have been paid out or are no longer entitled to those deferred vested benefits; or
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previously were reported under the plan but whose information is being corrected.
The information reported on Forms 8955-SSA is generally given to the SSA. The SSA provides the reported information to separated participants when they file for social security benefits.
Note.
Report information about separated participants only on page 2 of Form 8955-SSA. If additional space is needed for separated participants, use additional pages 2 only. Do not add another page 1 of Form 8955-SSA, spreadsheets, or other nonstandard formats.
A Form 8955-SSA need not be filed for a year if no information is required to be provided for that year by these instructions.
The Form 8955-SSA may be filed electronically through the IRS Filing Information Returns Electronically (FIRE) system or on paper. For more information regarding electronic and paper filing, see How To File.
The IRS and SSA encourage all filers to file Form 8955-SSA electronically. Filing electronically saves time and effort and helps ensure accuracy.
If you have questions and need assistance completing this form, call the IRS Help Line at 1-877-829-5500 and follow the directions as prompted. This toll-free telephone service is available Monday through Friday.
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Download forms, instructions, and publications;
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Order IRS products online;
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Research your tax questions online;
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Search publications online by topic or keyword; and
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Sign up to receive local and national tax news by email.
The Internal Revenue Service is a proud partner with the National Center for Missing and Exploited Children. Photographs of missing children selected by the Center may appear in instructions on pages that would otherwise be blank. You can help bring these children home by looking at the photographs and calling 1-800-THE-LOST (1-800-843-5678) if you recognize a child.
Plan administrators of plans subject to the vesting standards of section 203 of ERISA must file Form 8955-SSA. For example, the plan administrator of a section 403(b) plan that is subject to the vesting standards of section 203 of ERISA must file a Form 8955-SSA for the plan's deferred vested participants. Sponsors and administrators of government, church, and other plans that are not subject to the vesting standards of section 203 of ERISA (including plans that cover only owners and their spouses) may elect to file the Form 8955-SSA voluntarily. See the instructions for Part I, line A.
Note.
If the 2012 Form 5500 annual return/report is the final return/report of the plan, the Form 8955-SSA filed for the 2012 plan year must report information on deferred vested participants, including reporting that previously reported deferred vested participants are no longer deferred vested participants.
In general, if a Form 8955-SSA must be filed for a plan year, it must be filed by the last day of the seventh month following the last day of that plan year (plus extensions). This due date may be extended under some circumstances. See Extension of Time To File.
If the filing due date falls on a Saturday, Sunday, or legal holiday, Form 8955-SSA may be filed on the next day that is not a Saturday, Sunday, or legal holiday.
If filing under an extension of time based on the filing of Form 5558, Application for Extension of Time To File Certain Employee Plan Returns, check the appropriate box on the Form 8955-SSA, Part I, line C. A one-time extension of time to file the Form 8955-SSA (up to 2½ months) may be obtained by filing Form 5558 on or before the normal due date (not including any extensions) of the Form 8955-SSA. See the instructions for Form 5558. You must file the Form 5558 with the Department of the Treasury, Internal Revenue Service Center, Ogden, UT 84201-0045. Because approved copies of the Form 5558 will not be returned to the filer, you should retain a copy of the Form 5558 that is filed.
An automatic extension of time to file Form 8955-SSA until the due date of the federal income tax return of the employer will be granted if both of the following conditions are met.
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The plan year and the employer's tax year are the same.
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The employer has been granted an extension of time to file its federal income tax return after the normal due date for filing the Form 8955-SSA.
An extension of time granted by using this automatic extension procedure CANNOT be extended further by filing a Form 5558. It also cannot be extended more than 9½ months beyond the close of the plan year.
The IRS may from time to time announce special extensions of time under certain circumstances, such as extensions for presidentially-declared disasters or for service in, or in support of, the Armed Forces of the United States in a combat zone. See IRS.gov for announcements of special extensions. If you are relying on a special extension, check the box on line C and enter the exact language describing the announcement in the space provided. For example, indicate “Disaster Relief Extension” or “Combat Zone Extension.”
File a 2012 Form 8955-SSA to correct errors and/or omissions in a previously filed statement for the 2012 plan year. Check the box for Part I, line B (“amended registration statement”). The amended Form 8955-SSA must conform to the requirements in the How To File section.
A full and complete Form 8955-SSA must be filed to correct any such errors and/or omissions. For example, a full and complete Form 8955-SSA must be filed if the plan administrator determines that incorrect information was provided for a single plan participant.
It is important to use a 2012 Form 8955-SSA to report revisions to a participant's information previously filed on a Form 8955-SSA or a Schedule SSA (Form 5500). Because SSA provides information that it has on file to individuals who file for benefits, if this information is not up-to-date, the individual may contact the plan administrator to resolve the difference.
A Schedule SSA (Form 5500) should not be filed after April 20, 2011. See Announcement 2011-21, 2011-12 I.R.B. 567. Form 8955-SSA should be filed after that date, even for plan years before 2009. If a paper 2012 Form 8955-SSA is used to satisfy filing obligations for plan years before 2009, complete Part I 'plan year beginning and plan year ending' dates for the appropriate plan year filed. Forms 8955-SSA for prior years should be sent to the same address as 2012 Form 8955-SSA. See Where To File.
In general, for a plan to which only one employer contributes, a participant must be reported on Form 8955-SSA if:
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The participant separates from service covered by the plan in a plan year, and
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The participant is entitled to a deferred vested benefit under the plan.
In general, information on the deferred vested retirement benefit of a plan participant must be filed no later than on the Form 8955-SSA filed for the plan year following the plan year in which the participant separates from service covered by the plan. However, you can report a deferred vested participant on the Form 8955-SSA filed for the plan year in which the participant separates from service under the plan if you want to report earlier. Do not report a participant more than once unless you are revising or updating information on a prior Form 8955-SSA or Schedule SSA (Form 5500). See the Specific Instructions for Part III, line 9, codes B, C, or D.
For purposes of determining when to report a separated participant, a single employer plan is a plan to which only one employer contributes. A single employer plan includes a plan maintained by a controlled group of corporations which are treated as a single employer under section 414(b), and a plan maintained by trades or businesses under common control which are treated as a single employer under section 414(c).
In general, for a plan to which more than one employer contributes, a participant must be reported on Form 8955-SSA if:
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The participant incurs two successive one-year breaks in service (as defined in the plan for vesting purposes), and
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The participant is (or may be) entitled to a deferred vested benefit under the plan.
For these purposes, a multiemployer plan and a multiple employer plan are treated as a plan to which more than one employer contributes.
In general, information about the deferred vested retirement benefit of a plan participant must be reported on the Form 8955-SSA filed for the plan year in which the participant completes the second of two consecutive one-year breaks in service. Consecutive one-year breaks in service are defined in the plan for vesting percentage purposes. The participant may be reported earlier on the Form 8955-SSA filed for the plan year in which the participant completed the first one-year break in service.
A participant is not required to be reported on Form 8955-SSA if, before the date the Form 8955-SSA is required to be filed (including any extension of time for filing), the participant:
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Is paid some or all of the deferred vested retirement benefit (see the Caution below),
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Returns to service covered by the plan and/or accrues additional retirement benefits under the plan, or
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Forfeits all the deferred vested retirement benefit.

When the benefit of a separated participant with deferred vested benefits is transferred from one plan to the plan of a new employer,
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The new plan administrator should complete a Form 8955-SSA using:
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Entry Code C for Part III, line 9, column (a), when the original plan information is available, or
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Entry Code A for Part III, line 9, column (a), when the original plan information is not available.
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The original plan administrator should complete a Form 8955-SSA using Entry Code D for Part III, line 9, column (a).
Send the completed Form 8955-SSA to:
Department of the Treasury
Internal Revenue Service Center
Ogden, UT 84201-0024
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DHL Express (DHL): DHL Same Day Service.
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Federal Express (FedEx): FedEx Priority Overnight, FedEx Standard Overnight, FedEx 2Day, FedEx International Priority, and FedEx International First.
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United Parcel Service (UPS): UPS Next Day Air, UPS Next Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air A.M., UPS Worldwide Express Plus, and UPS Worldwide Express.
Internal Revenue Service
1973 Rulon White Blvd.
Ogden, UT 84404
Follow the line-by-line instructions to complete the Form 8955-SSA. Answer all questions about the plan, unless otherwise specified.

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Use SSA-approved software to complete and electronically file a Form 8955-SSA. For more information, go to IRS.gov, search for and select “Form 8955-SSA Resources” and then select “Approved Software Vendors Form 8955-SSA”.
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Use a personal computer to complete the online fillable Form 8955-SSA on the IRS website at
www.irs.gov/formspubs/ before printing, signing, and mailing it to the IRS. A barcode capturing the data you entered on the form will appear on the completed pages when printed. A form partially completed online and partially completed (other than the signature) on printed paper will cause processing delays and may result in correspondence. -
Use a printed Form 8955-SSA ordered from the IRS by calling 1-800-TAX-FORM (1-800-829-3676). When completing the form, use as many pages 2 of the Form 8955-SSA as necessary and number them in sequential order.
Note.
Remember to use additional pages 2 of the 2012 Form 8955-SSA only if additional pages are needed to add separated participants. Do not use nonstandard pages 2.
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Sign and date the Form 8955-SSA.
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Check your information to avoid errors.
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Complete all applicable lines on the form unless otherwise specified.
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All information should be printed in the specific fields provided on the form.
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Do not mark on or near any barcode.
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Paper should be clean without glue or other sticky substances.
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Do not staple the form pages. Use binder clips or other fasteners that do not perforate the paper.
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Do not submit extraneous material or information, such as arrows used to indicate where to sign, notes between preparers of the report, or notations on the form.
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File the Form 8955-SSA using the address specified in the instructions under Where To File.
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Use only whole dollars. Round off cents to whole dollars. Drop any amount less than 50 cents and increase any amount from 50 to 99 cents to the next higher dollar.
The Internal Revenue Code imposes a penalty for failure to file a registration statement (including failure to include all required participants). The penalty is $1 for each participant not reported and for each day multiplied by the number of days the failure continues. The penalty, up to a maximum of $5,000, is imposed on the person failing to so file unless it is shown the failure is due to reasonable cause.
In the case of a failure to file a notification of a change in the status of the plan (such as a change in the plan name or a termination of the plan), or a change in the name or address of the plan administrator, the Code imposes a penalty of $1 for each day during which such failure occurs. The penalty, up to a maximum of $1,000, is imposed on the person failing to so file unless it is shown the failure is due to reasonable cause.
The Code requires that each plan administrator required to file a registration statement must, before the expiration of the time prescribed for the filing of the form, also furnish to each affected participant an individual statement setting forth the information required to be contained in the form. A penalty of $50 is imposed on the person required to furnish the statement to each affected participant for each willful failure to furnish the statement or a willful furnishing of a false statement.
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