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Specific Instructions

Table of Contents

    Line 1.   Enter the name, address, and telephone and fax numbers of the plan sponsor/employer.

      A plan sponsor means:
    1. In the case of a plan that covers the employees of one employer, the employer;

    2. In the case of a plan sponsored by two or more entities required to be combined under section 414(b), (c), or (m), one of the members participating in the plan; or

    3. In the case of a plan that covers the employees and/or partner(s) of a partnership, the partnership.


    The name of the plan sponsor/employer should be the same name that is used when the Form 5500, Annual Return/Report of Employee Benefit Plan, series annual return/report is filed for the plan. Line 1a is limited to 70 characters.

    Line 1f.   Enter the nine-digit employer identification number (EIN) assigned to the plan sponsor/employer. This should be the same EIN that is used when the Form 5500 series annual return/report is filed for the plan.

      The plan of a group of entities combined under section 414(b), (c), or (m), whose sponsor is more than one of the combined entities, should only enter the EIN of one of the sponsoring members.

      This EIN must be used in all subsequent filings of DL requests for the plan, and annual returns/reports for the plan, unless there is a change of sponsor.

    Do not use a social security number or the EIN of the trust.

      The plan sponsor/employer must have an EIN. A plan sponsor/employer without an EIN can apply for one.
    • Online—Generally, a plan sponsor/employer can receive an EIN by Internet and use it immediately to file a return. Go to the IRS website at and click on Employer ID Numbers (EINs).

    • By mail or fax—Send in a completed Form SS-4, Application for Employer Identification Number, to apply for an EIN.

    Lines 1g and 1h.   Enter the telephone and fax numbers of the plan sponsor.

    Line 1i.   Enter the two digits representing the month the plan sponsor/employer's tax year ends.

    Lines 1j through 1m.   If a foreign entity, follow the country's practice for entering the name of the city or town, province/country, and the postal code.

    Line 2.   If Form 2848 or Form 8821 is attached, check the box only. If not attached, enter a contact person. The contact person listed on line 2 will receive copies of all correspondence.

    Lines 2h through 2k.   If a foreign contact, follow the country's practice for entering the name of the city or town, province/country, and the postal code.

    Line 3a.   This field is limited to 70 characters, including spaces. Fill in the plan name as it should appear on the DL. If the plan name contains more than 70 characters, abbreviations should be used.

    Line 3b.   Enter the three-digit plan number, beginning with "001" and continuing in numerical order for each plan you adopt (001–499). The numbering will differentiate your plans. The number assigned to a plan must not be changed or used for any other plan. This should be the same number that is used on the Form 5500 series annual return/report for the plan.

    Line 3c.   Plan month means the month in which the plan year ends. Enter the two-digit month (MM).

    Line 3d.    Enter the plan's original effective date.

    Line 3e.   Enter the total number of participants. A participant is:
    1. Any employee participating in the plan, including employees under a section 401(k) qualified cash or deferred arrangement who are eligible but don’t make elective deferrals;

    2. Retirees and other former employees who have a nonforfeitable right to benefits under the plan; and

    3. The beneficiary of a deceased employee who is receiving or will in the future receive benefits under the plan. Include one beneficiary for each deceased employee regardless of the number of individuals receiving benefits.


    Payment of a deceased employee's benefit to three children is considered a payment to one beneficiary.

    Lines 3f and 3g.   See Notice 2011-86, 2011-45 I.R.B. 698 (or later guidance) for further details, including how to determine compensation.

    Line 4a.   Enter the number that corresponds to the request being made (enter one number only).

       Enter 1 if the plan is a new plan that's being submitted within its initial remedial amendment period described under Regulations section 1.401(b)-1(d)(1) or as extended in other guidance. See Rev. Proc. 2016-37.

       Enter 2 if this plan is an existing plan that has never received a favorable DL.

       Enter 3 if neither 1 nor 2 apply and the plan is specifically authorized to apply for a DL under applicable IRS guidance. Include an attachment that cites the applicable IRS guidance and explain how the plan meets the criteria for a DL submission.

    Partial termination request.   Enter 3 if requesting a determination with respect to a partial termination. Employers and plan administrators that request a determination on a potential partial termination may not request a DL on their entire plan unless the plan is otherwise eligible for a DL. Indicate in the cover letter if a partial termination may have occurred or might occur as a result of proposed actions. If the submission is only for a partial termination request, only complete lines 1–5 and submit the Form 8717 with the user fee. DO NOT submit the other items under What To File.

      Provide detailed information regarding the partial termination, including data specified on the Partial Termination Worksheet in these instructions.
    1. Using the format in the Partial Termination Worksheet, submit a schedule of information for the plan year in which the partial (or potential partial) termination began along with the following plan year, and for the 2 prior plan years, to the extent information is available.

    2. If the plan has more than one benefit computation formula, provide a schedule of information in the same format as lines 1a through 1f of the worksheet for each benefit computation formula.

    3. Include an explanation of how the plan meets the requirements of section 411(d)(3).

    Special ruling requests.

    See Rev. Proc. 2016-37 and successors to Rev. Proc. 2016-6 for other types of issues for which a Form 5300 may be filed.

    Line 4b.   If line 4a is “1,” enter the date the plan was originally adopted. If the initial plan is a proposed plan document, enter “09/09/9999.

        Partial Termination Worksheet Year Year Year of partial termination Year
      1 Participants employed:        
      a Number at beginning of plan year        
      b Number added during the plan year        
      c Total, add lines a and b        
      d Number dropped during the plan year        
      e Number at end of plan year, subtract d from c        
      f Total number of participants in this plan separated from service without full vesting        
      2 Present value (as of month / day) during the year of        
      a Plan assets        
      b Accrued benefits        
      c Vested benefits        
      3 Submit a description of the actions that may have resulted (or might result) in a partial termination. Include an explanation of how the plan meets the requirements of section 411(d)(3).
    Line 5.   A “pension equity plan” (PEP) is a DB plan which, rather than or in addition to expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee as an amount equal to an accumulated percentage of final pay. Benefits are generally described as a percentage of final average pay, with the percentage determined as the accumulation of percentage points or lump-sum credits received for each year of service. Generally, the accumulated percentage points or lump-sum credits are multiplied by final average or career average compensation to determine the lump-sum amount.

      A “cash balance” plan is a DB plan which, rather than or in addition to expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a DC plan, that is, as a single-sum amount equal to the employee’s hypothetical account balance. Benefits consist of accumulated hypothetical allocation credits in an account plus accumulated hypothetical interest credits for the account.

    Note.   If this is only a request for a partial termination, DO NOT complete the rest of the application.

    Line 6.   Check “Yes” if the plan is a governmental plan under section 414(d).

    Line 7.   Check “Yes” if the plan is a church plan under section 414(e) that hasn’t made a section 410(d) election.

    Line 8.   Check “Yes” if the plan benefits any collectively bargained employees under Regulations section 1.410(b)-6(d)(2).

    Line 9.   Check “Yes” if the plan is an insurance contract plan under section 412(e)(3).

    Line 10.   Check “Yes” if the plan is a multiemployer collectively bargained plan under section 414(f).

    Line 11.   Check “Yes” if the plan is a multiple employer plan under section 413(c).

    Line 12.   Section 3001 of the Employee Retirement Income Security Act of 1974 requires that applicants subject to section 410 provide evidence that each employee who qualifies as an interested party has been notified of the filing of the application. If “Yes” is marked, it means that each employee has been notified as required by Regulations section 1.7476-1. If this is a one-person plan or if this plan isn’t subject to section 410, a copy of the notice isn’t required to be attached to this application. If “No” is marked or this line is blank, the application will be returned. Rules defining “interested parties” and the form of notification are in Regulations section 1.7476-1. See Part II of Rev. Proc. 2016-6.

    Line 13.   If “Yes,” attach a statement identifying the plan sections that satisfy the safe harbor (including, if applicable, permitted disparity requirements) and specify which of the following regulations is intended to be satisfied.
    • 1.401(a)(4)-2(b)(2) DC plan with uniform allocation formula.

    • 1.401(a)(4)-3(b)(3) unit credit DB plan.

    • 1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit DB fractional rule plan.

    • 1.401(a)(4)-3(b)(4)(i)(C)(2) flat benefit DB plan.

    • 1.401(a)(4)-3(b)(5) insurance contract plan.

    Line 14.    Check “Yes” if the plan utilizes the permitted disparity rules of 401(l).

    Line 15.    If “Yes,” attach a statement providing the plan name, EIN of the plan sponsor/employer, plan type of the other plan, and a copy of pertinent provisions from the other plan regarding the offset.

    Line 16.   If this is a request for an individually designed plan that consists of a DB plan and a qualified cash or deferred arrangement, submit two Forms 5300 and two applicable user fees and provide an attachment with the plan sponsor/employer EIN and plan number of the other plan.

    Line 17.   Attach a statement that provides the following.
    1. Name of plans involved.

    2. Type of plan.

    3. Date of merger, consolidation, spinoff, or transfer of plan assets or liabilities.

    4. Verification that each plan involved was qualified at the time of the merger, consolidation, spinoff, or transfer of plan assets or liabilities.

      If the plan previously obtained a DL, only provide information on a transaction that occurred after the most recent DL was issued.


    Verification includes (1) a copy of a prior DL, opinion or advisory letter; (2) plan document and/or adoption agreement; and (3) interim and discretionary amendments.



    For individually designed plans, interim amendments only apply if the adoption deadline is before January 1, 2017. See Rev. Proc. 2016-37.

    If applicable, file Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities; Notice of Qualified Separate Lines of Business, 30 days prior to the merger, consolidation, or transfer of assets or liabilities.

    Line 18.   If the plan has been restated to change the type of plan under Regulations section 1.401-1, check “Yes” and attach a statement explaining the change.

    Line 19.   Check “Yes” and attach an explanation if the plan has any matter pending before:
    1. The Internal Revenue Service (including the Voluntary Compliance Program),

    2. The Department of Labor,

    3. The Pension Benefit Guaranty Corporation (PBGC), or

    4. Any court (including bankruptcy court).

      The attachment should include a contact person's name and telephone number and agency or court.

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