Instructions for Form 8955-SSA - Main Contents


Specific Instructions

PART I

Enter the calendar or fiscal year beginning and ending dates of the plan year (not to exceed 12 months in length) for which you are reporting information. Express the dates in numerical month, day, and year in the following order (“MMDDYYYY”).

For a plan year of less than 12 months (short plan year), insert the short plan year beginning and ending dates on the line provided at the top of the form. For purposes of this form, the short plan year ends on the date of the change in accounting period or the complete distribution of the plan's assets.

Line A.   Check this box if you are electing to file this form voluntarily. The plan administrators of plans, such as governmental plans and non-electing church plans, not subject to the vesting standards of section 203 of ERISA are not required to file this form but may elect to do so. If such a plan administrator so elects, the plan administrator is encouraged to provide as much information as possible, but no specific requirements are imposed.

Note.

Only the plan administrators of plans subject to the vesting standards of section 203 of ERISA must file the Form 8955-SSA.

Line B.   Check this box if this Form 8955-SSA amends a previously filed Schedule SSA (Form 5500) or Form 8955-SSA.

Line C.   Check the appropriate box if an extension of time has been filed using Form 5558, or if an automatic or special extension has been granted. If a special extension has been granted, enter the description of the special extension exactly as it is listed in the announcement. See Other Extensions of Time To File for additional information regarding special extensions.

PART II

Please verify that the employer identification number (EIN) and plan number (PN) being used on this Form 8955-SSA are correct for this plan.

Line 1a.   Enter the formal name of the plan or enough information to identify the plan. Abbreviate if necessary.

Line 1b.   Enter the three-digit number that the employer or plan administrator assigned to the plan and uses to file the plan's Form 5500 series return/report.

Line 2a.   Enter the name of the plan sponsor. The term “plan sponsor” means:
  • the employer, for a plan that a single employer established or maintains;

  • the employee organization in the case of a plan of an employee organization; or

  • the association, committee, joint board of trustees, or other similar group or representatives of the parties who established or maintain the plan (in the case of a plan established or maintained jointly by one or more employers and one or more employee organizations, or by two or more employers).

Note.

In the case of a multiple-employer plan, if an association or similar entity is not the sponsor, enter the name of a participating employer as sponsor. The plan administrator of a plan maintained by a controlled group of corporations should enter the name of the member of the controlled group that is entered on the Form 5500 series return/report as the plan sponsor. The same name must be used in all subsequent filings of the Form 8955-SSA for the multiple-employer plan or controlled group (see instructions for line 5 about changes in sponsorship).

Line 2b.   Enter the sponsor's nine-digit EIN. Do not use a social security number (SSN). Sponsors without an EIN must apply for one as soon as possible.

  EINs are issued by the IRS. To apply for an EIN:
  • Mail or fax Form SS-4, Application for Employer Identification Number, obtained by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS website at IRS.gov.

  • Call 1-800-829-4933 to receive your EIN by telephone.

  • Select the Online EIN Application link at IRS.gov. The EIN is issued immediately once the application information is validated. (The online application process is not yet available for corporations with addresses in foreign countries.)

  A multiple-employer plan or plan of a controlled group of corporations should use the EIN of the sponsor identified in line 2a. The EIN must be used in all subsequent filings of the Form 8955-SSA. (See instructions for line 5 about changes in EIN.)

  If the plan sponsor is a group of individuals, get a single EIN for the group (providing the group name).

Line 2c.   Enter the plan sponsor's trade name if that trade name is different from the plan sponsor's name entered on line 2a.

Line 2e.   If you want a third party to receive mail for the plan, enter “C/O” followed by the third party's name and complete the applicable mailing address in lines 2f through 2l.

Line 2f.   Enter the sponsor's street address. A post office box may be entered if the Post Office does not deliver mail to the sponsor's street address.

Line 2g.   Enter the name of the city.

Line 2h.   Enter the two-character abbreviation for the U.S. state or possession.

Line 2j.   Enter the foreign province or state, if applicable.

Line 2k.   Enter the foreign country, if applicable.

Line 2l.   Enter the foreign postal code, if applicable. Leave the U.S. state and ZIP code blank if completing line 2k or line 2l.

Line 3a.   Enter the plan administrator's name. Enter “Same” if the plan administrator identified on line 3a is the same as the plan sponsor identified on line 2a and leave lines 3b through 3k blank.

  Plan administrator for this purpose means:
  • The person or group of persons specified as the administrator by the instrument under which the plan is operated,

  • The plan sponsor/employer if an administrator is not so designated, or

  • Any other person prescribed by regulations if an administrator is not designated and a plan sponsor cannot be identified.

Note.

Employees of the plan sponsor who perform administrative functions for the plan are generally not the plan administrator unless specifically designated in the plan document. If an employee of the plan sponsor is designated as the plan administrator, that employee must obtain an EIN.

Line 3b.   Enter the plan administrator's nine-digit EIN. Plan administrators who do not have an EIN, must apply for one as described in the instructions for line 2b.

Line 3c.   If you want a third party to receive mail for the plan administrator, enter “C/O” followed by the third party's name and complete the applicable mailing address in lines 3e through 3k.

Line 3e.   Enter the plan administrator's street address. A post office box may be entered if the Post Office does not deliver mail to the sponsor's street address.

Line 3f.   Enter the name of the city.

Line 3g.   Enter the two-character abbreviation for the U.S. state or possession.

Line 3i.   Enter the foreign province or state, if applicable.

Line 3j.   Enter the foreign country, if applicable.

Line 3k.   Enter the foreign postal code, if applicable. Leave the U.S. state and ZIP code blank if completing line 3j or line 3k.

Line 4.   If the plan administrator's name and/or EIN have changed since the most recent Schedule SSA (Form 5500) or Form 8955-SSA was filed for this plan, enter the plan administrator's name and EIN as they appeared on the most recently filed Schedule SSA (Form 5500) or Form 8955-SSA.

  
Failure to indicate on line 4 that a plan administrator was previously identified by a different name or EIN could result in correspondence from the IRS.

Line 5.   If the plan sponsor's name and/or EIN have changed since the most recently filed Schedule SSA (Form 5500) or Form 8955-SSA for this plan, enter the plan sponsor's name, EIN, and the three-digit plan number as they appeared on the most recently filed Schedule SSA (Form 5500) or Form 8955-SSA.

  
Failure to indicate on line 5 that a plan sponsor was previously identified by a different name or EIN could result in correspondence from the IRS.

Line 6a.   For a plan to which only one employer contributes, provide the total number of participants entitled to a deferred vested benefit who separated from service in the 2012 plan year and who were not previously reported. For a plan to which more than one employer contributes, provide the total number of participants entitled to a deferred vested benefit who completed the second of two consecutive one-year breaks in service in the 2013 plan year and who were not previously reported.

Line 6b.   For a plan to which only one employer contributes, provide the total number of participants entitled to a deferred vested benefit who separated from service under the plan in the 2013 plan year and who are reported in Part III of this form. For a plan to which more than one employer contributes, provide the total number of participants entitled to a deferred vested benefit who separated from service under the plan in 2013 or who completed the first one-year break in service in the 2013 plan year, and who are reported in Part III of this form. See When To Report a Separated Participant.

  
Do not include any participants on line 6a or 6b who were previously reported on a Form 8955-SSA or a Schedule SSA (Form 5500). Accordingly, only those participants who are listed with an Entry Code A on page 2 should be included on line 6a or 6b.

  

Line 7.   The sum of lines 6a and 6b should equal the number on line 7.

Line 8.   Check the appropriate box as to whether the plan administrator provided the individual statement to each participant required to receive one. See Penalties.

Signature.   The Form 8955-SSA must be signed and dated by the plan sponsor and by the plan administrator. If the plan administrator and the plan sponsor are the same person, include only the signature as plan administrator on the form. If more than one page 2 of the form is filed for one plan, only one page 1 of the Form 8955-SSA should be signed and filed with the pages 2 for the plan.

PART III

Enter the name of the plan, the plan number, and the plan sponsor's EIN at the top of each page 2.

Line 9, column (a).   Enter the appropriate code from the following list:

Code A Use this code for a participant not previously reported. Also complete columns (b) through (g).
Code B Use this code for a participant previously reported under the plan number shown on this form to modify some of the previously reported information. Enter all the current information for columns (b) through (g). You do not need to report a change in the value of a participant's account since that is likely to change. However, you may report such a change if you want.
Code C Use this code for a participant previously reported under the plan of a different plan sponsor and who will now be receiving a future benefit from the plan reported on this form. Also complete columns (b), (c), (h), and (i).
Code D Use this code for a participant previously reported under the plan number shown on this form who is no longer entitled to those deferred vested benefits. This includes a participant who has begun receiving benefits, has received a lump-sum payout, or has been transferred to another plan (for example, in the case of a plan termination). Also complete columns (b) and (c). Participants should not be reported under Code D merely because they return to the service of the plan sponsor.
Line 9, column (b).   Enter the exact SSN of each participant listed. If the participant is a foreign national employed outside the United States who does not have an SSN, enter the word “FOREIGN.

Line 9, column (c).   Enter each participant's name exactly as it appears on the participant's social security card. Do not enter periods; however, initials, if on the social security card, are permitted.

   After the last name column, there is a check mark column. Check the box for each participant whose information is based on incomplete records. Information for a participant may be based on incomplete records where more than one employer contributes to the plan and the records at the end of the plan year are incomplete regarding the participant's service. Check the box next to a participant's name if:
  1. The amount of the participant's vested benefit is based on records which are incomplete as to the participant's covered service (or other relevant service) or

  2. The plan administrator is unable to determine from the records of the participant's service if the participant is vested in any deferred retirement benefit but there is a significant likelihood that the participant is vested in such a benefit. See Regulations section 1.6057-1(b)(3).

Line 9, column (d).   From the following list, select the code that describes the type of annuity that will be provided for the participant. Enter the code that describes the type of annuity that normally accrues under the plan at the time of the participant's separation from service covered by the plan (or, for a plan to which more than one employer contributes, at the time the participant incurs the second consecutive one-year break in service under the plan).

Type of Annuity Code   

A A single sum

B Annuity payable over fixed number of years

C Life annuity

D Life annuity with period certain

E Cash refund life annuity

F Modified cash refund life annuity

G Joint and last survivor life annuity

M Other

Line 9, column (e).   From the following list, select the code that describes the benefit payment frequency during a 12-month period.

Type of Payment Code   

A Lump sum

B Annually

C Semiannually

D Quarterly

E Monthly

M Other

Line 9, column (f).   For a defined benefit plan, enter the amount (in whole dollars) of the periodic payment that a participant is entitled to receive.

  In general, a deferred vested benefit under a defined benefit plan would be reported under line 9(f) as the periodic payment that the participant is entitled to receive. The plan administrator may, however, report a different form of benefit if the plan administrator considers it more appropriate. The plan administrator of a cash balance plan may report a participant's benefit as the participant's hypothetical account balance. In that case, the plan administrator may enter Code A (a single sum) in column 9(d) and Code A (a lump sum) in column 9(e).

  For a multiemployer plan, if the amount of the periodic payment cannot be accurately determined because the plan administrator does not maintain complete records of covered service, enter an estimated amount.

Line 9, column (g).   For defined contribution plans, enter the value (in whole dollars) of the participant's account.

Line 9, columns (h) and (i).   Show the EIN and plan number of the plan under which the participant was previously reported.

Privacy Act and Paperwork Reduction Act Notice.

We ask for the information on this form to carry out the Internal Revenue laws. Sections 6057 and 6109 require you to provide the information requested on this form. We need it to determine whether the plan properly accounts for the deferred vested retirement benefits of separated participants. Failure to provide this information, or providing false or fraudulent information, may subject you to penalties.

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 and records relating to a form or its instructions must be retained as long as their contents may become material in the administration of the Internal Revenue Code. Generally, tax returns and return information are confidential, as required by section 6103.

However, section 6103 authorizes disclosure of the information to others. Pursuant to section 6057(d), we will disclose this information to the Social Security Administration for use in administering the Social Security Act. This information may also be disclosed to the Department of Justice for civil or criminal litigation, to the Department of Labor or the Pension Benefit Guarantee Corporation for use in administering ERISA, and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. It may also be disclosed to other countries under a tax treaty, 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 49 minutes.

If you have suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from www.irs.gov/formspubs. Click on “More Information” and then on “Comment on Tax Forms and Publications.” You can also send your comments to the Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send the form to this address. Instead, see Where To File, earlier.


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