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Application for Approval of Prototype Simplified Employee
Form 5306-A
Pension (SEP) or Savings Incentive Match Plan for
(Rev. November 2019) OMB No. 1545-0199
Employees of Small Employers (SIMPLE IRA Plan)
Department of the Treasury (Under section 408(k) or (p) of the Internal Revenue Code)
Internal Revenue Service ▶ Go to www.irs.gov/Form5306A for the latest information.
For IRS Use Only
1 Enter amount of user fee submitted. See Specific Instructions ▶ $
Part I Identifying Information (see instructions before completing this part) File folder number
2 Approval requested for:
a Type of plan—
(1) Prototype simplified employee pension (SEP) under section 408(k)
(2) Prototype savings incentive match plan for employees of small employers (SIMPLE IRA plan) under section 408(p)
b Initial application
c Amendment—Enter ▶ (1) Latest letter serial number (2) Date letter issued (3) File folder number

3 If the SEP contains elective deferral provisions, check this box . . . . . . . . . . ▶
4a Name of applicant 4b Applicant’s employer identification number

Number, street, and room or suite no. (if a P.O. box, see instructions)

City or town, state, and ZIP code

5a Name of person to be contacted 5b Telephone number

5c Email address
5d If a power of attorney is attached, check box . . ▶
6 Type of submission (check one box): a Not a mass submitter b Mass submitter
c Identical adoption of a mass submitter d Minor modification of a mass submitter
7a If box 6c or 6d is checked, enter the mass submitter’s name:
b File folder number of the mass submitter’s SEP or SIMPLE IRA plan on which this submission is based:
8 Type of sponsoring organization:
a Insurance company e Regulated investment company
b Trade or professional organization f Federally insured credit union
c Savings and loan association that qualifies as a bank g Approved non-bank trustee (attach copy of approval
d Bank letter)
Part II SEP Information
Attach a copy of the SEP documents and indicate the article or section and the page number where Plan Article or Plan For
the following provisions appear. If any item does not apply, write “N/A.” Sample language, or a listing
of required modifications (LRMs), is available at www.irs.gov/LRMS. Sponsors are encouraged to use Section Page IRS Use
LRM language. Reference Number Only

9a Does the SEP cover all employees who have attained age 21, performed service
for the employer in 3 of the immediately preceding 5 years, and received at least
$600* in compensation from the employer for the year, other than employees who
may be excluded under section 410(b)(3)(A) or (C)? . . . . . . . . . . 1
b Does the SEP provide that all eligible employees will share in an allocation? . . 2
c Does the SEP contain a definite allocation formula that does not discriminate in
favor of highly compensated employees? . . . . . . . . . . . . . 3
d Does the SEP require that it be used only with pre-approved traditional IRAs? . 5
e Does the SEP prohibit restrictions on withdrawals (other than restrictions
permitted under section 408(d)(7)(A) in the case of a salary reduction SEP)? . . 6
f Does the SEP define “compensation” in a manner that satisfies one of the safe
harbor definitions under section 414(s) and limit compensation under section
408(k)(3)(C)? . . . . . . . . . . . . . . . . . . . . . . . 7
* This is the amount for 2019 and 2020. The amount may be increased in future years for cost-of-living adjustments.
Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and, to the best of my knowledge and belief, it
is true, correct, and complete.
Sign ▲ ▲
Here
Signature of officer Date Title
For Paperwork Reduction Act Notice, see the instructions. Cat. No. 32621R Form 5306-A (Rev. 11-2019)

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Form 5306-A (Rev. 11-2019)                                                                                                  Page  2 
Part III SIMPLE IRA Plan Information 
Attach a copy of the SIMPLE IRA plan documents and indicate the article or section and the page     Plan Article or  Plan   For   
number where the following provisions appear. If an item does not apply, enter “N/A.” Sample  
language, or a listing of required modifications (LRMs), is available at www.irs.gov/LRMS. Sponsors Section          Page   IRS Use 
are encouraged to use LRM language.                                                                 Reference        Number Only 
10a Does the plan define the term “employer” to include all members of such groups  
    or entities required to be aggregated with the employer?  .            . . . . .       . .                              1 
b   Does the plan limit adoption to employers that have 100 or fewer employees who  
    earned $5,000 or more in compensation from the employer during the preceding  
    calendar year?  .        . . .   . . . . . . . .    .    .           . . . . . .       . .                              2 
c   Does the plan limit adoption to employers that do not maintain another qualified  
    plan to which contributions are made or benefits accrued?              . . . . .       . .                              3 
d   Does the plan define the term “employee” to include leased employees and  
    employees described in section 401(c)(1)?  . . .    .    .           . . . . . .       . .                              4 
e   Does the plan cover all employees except those who may be excluded under  
    section 408(p)(4)?  .      . .   . . . . . . . .    .    .           . . . . . .       . .                              5 
f   Does the plan provide that each eligible employee may make or modify a salary  
    reduction  agreement  during  the  60-day  period  immediately  preceding  the  
    calendar year after receiving proper notice? . .    .    .           . . . . . .       . .                              6 
g   Does the plan provide that salary reduction contributions may not exceed the 
    statutory limits? .      . . .   . . . . . . . .    .    .           . . . . . .       . .                              7 
h   Under the plan, is an eligible employee permitted to terminate a salary reduction  
    election at any time?  .     .   . . . . . . . .    .    .           . . . . . .       . .                              8 
i   Is the interest of an eligible employee in the plan nonforfeitable at all times? .       .                              9 
j   Does the plan provide that the employer will make matching contributions to each  
    eligible  employee’s  SIMPLE  IRA  equal  to  the  employee’s  salary  reduction  
    contribution, up to a limit of 3% of the employee’s compensation for the calendar  
    year?  . . .           . . . .   . . . . . . . .    .    .           . . . . . .       . .                              10 
k   Does the plan provide that the employer will make a 2% nonelective contribution  
    to each eligible employee’s SIMPLE IRA in lieu of matching contributions?  .             .                              11 
l   Does the plan require that the employer will make salary reduction contributions  
    to eligible employees’ SIMPLE IRAs no later than 30 days after the month in which 
    the amounts would otherwise have been payable to the employee in cash? .                 .                              12 
m   Unless the employer has chosen, does the plan allow each eligible employee to  
    select the financial institution for their SIMPLE IRA? . .           . . . . . .       . .                              13 
n   If the employer has selected the financial institution, does the plan require the  
    financial institution to meet the notification requirements of section 408(p)(7) and 
    limited in accordance with section 408(p)(2)(B)?  . .    .           . . . . . .       . .                              14 
o   Does the plan define “compensation” as described in section 408(p)(6)(A)?  .             .                              15 
p   Does the plan require that it be used only with pre-approved SIMPLE IRAs? .              .                              16 
q   Does the plan prohibit restrictions on withdrawals?  .   .           . . . . . .       . .                              17 
r   Does  the  plan  provide  that  amendments  will  become  effective  only  at  the 
    beginning of a calendar year and will conform to the content of the plan notice for 
    the calendar year? .       . .   . . . . . . . .    .    .           . . . . . .       . .                              18 
                                                                                                              Form 5306-A (Rev. 11-2019)

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Form 5306-A (Rev. 11-2019) Page 3

General Instructions Where to file. File Form 5306-A at this Paperwork Reduction Act
address.
Notice
Section references are to the Internal Internal Revenue Service
Revenue Code unless otherwise noted. Attn: EP Opinion Letters We ask for the information on this form
Future Developments TE/GE Stop 31A Team 105 to carry out the Internal Revenue laws of
P.O. Box 12192 the United States. We need it to ensure
For the latest information about Covington, KY 41012-0192 that you are complying with these laws
and to allow us to figure and collect the
developments related to Form 5306-A Private delivery services (PDSs). PDSs right amount of tax. This information is
and its instructions, such as legislation can't deliver to the address shown needed to process your application and
enacted after they were published, go to above. If you choose to use a PDS, send to determine whether your prototype
www.irs.gov/Form5306A. Form 5306-A to this address. SEP or SIMPLE IRA plan meets the
Purpose of form.Form 5306-A is used Internal Revenue Service requirements of section408(k) or 408(p).
by sponsors who want to getIRS Attn: EP Opinion Letters You are not required to apply for
approval of their prototype simplified 7940 Kentucky Drive approval; however, if you want to receive
employee pension (SEP) agreements or TE/GE Stop 31A Team 105 an opinion letter from the IRS regarding
savings incentive match plans for Florence, KY 41042 your prototype SEP or SIMPLE IRA plan,
employees of small employers (SIMPLE you are required to provide the
IRA plans). Go to www.irs.gov/PDS for the current information requested on this form.
Who may file. Use Form 5306-A to list of designated services.
You are not required to provide the
request a favorable opinion letter if: Signature. An officer who is authorized information requested on a form that is
• You are a bank, federally insured credit to sign or another person authorized subject to the Paperwork Reduction Act
union, savings and loan association that under a power of attorney must sign this unless the form displays a valid OMB
qualifies as a bank, insurance company, application. (Send the power of attorney control number. Books or records
regulated investment company, or trade with this application when you file it.) relating to a form or its instructions must
or professional society or association be retained as long as their contents
(other than an employee association); Specific Instructions may become material in the
and User fee. All applications must be administration of any Internal Revenue
• You want to get a favorable opinion accompanied by the appropriate user law. Generally, tax returns and return
letter that a SEP agreement or SIMPLE fee. Applications submitted without the information are confidential, as stated in
IRA plan to be used by more than one proper user fee will not be processed section 6103.
employer is acceptable in form. and will be returned to the applicant. The time needed to complete and file
Who does not need to file. Instead of To determine the proper user fee, see this form will vary depending on
designing their own SEP or SIMPLE IRA Rev. Proc. 2019-4, 2019-1 I.R.B. 146, individual circumstances. The estimated
plan, sponsors may use one of the Form available at www.irs.gov/ average time is:
5304 or 5305 series of model forms to irb/2019-01_IRB#RP-2019-04, or the Recordkeeping . . . 15 hr., 46 min.
establish a SEP or a SIMPLE IRA plan. latest annual update. Learning about the law
Sponsors who use one of these forms Line 2c. If you are amending your or the form . . . . . 1 hr., 23 min.
with individual retirement accounts or previously approved SEP or SIMPLE IRA Preparing, copying, assembling,
annuities for which the IRS has issued a plan, enter the letter serial number, date, and sending the form
favorable opinion or ruling letter, or with and file folder number from the latest to the IRS . . . . . . 1 hr., 42 min.
model individual retirement accounts opinion letter you received for your SEP
issued by the IRS, are considered to or SIMPLE IRA plan. If you have comments concerning the
have established a SEP or SIMPLE IRA accuracy of these time estimates or
plan that meets the requirements of Line 3. If the application is for a SEP suggestions for making this form
section 408(k) or 408(p). Do not file that provides for elective deferrals simpler, we would be happy to hear from
Form 5306-A if you use a model form. intended to meet the requirements of you. You can send us comments from
section 408(k)(6), check the box.
Note: The IRS will not issue an opinion www.irs.gov/FormComments. Or you
letter on a document submitted with The Small Business Job Protection Act can write to Internal Revenue Service,
Form 5306-A that is a combination of a of 1996 (P.L. 104-188) repealed section Tax Forms and Publications Division,
prototype SEP or SIMPLE IRA plan and 408(k)(6), effective December 31, 1996, 1111 Constitution Ave. NW, IR-6526,
a prototype individual retirement account except with respect to a SEP of an Washington, DC 20224. Do not send the
or annuity. employer if the terms of the SEP of such form to this address. Instead, see Where
employer, as in effect on December 31, to file, earlier.
What to file. File this application and 1996, provided for elective deferrals.
one copy of all documents that make up
the SEP agreement or SIMPLE IRA plan. Line 4a. Include the suite,room, or other
unit number after thestreet number. If
If this is an amendment, include a the Post Office doesnot deliver mail to
copy of the amendment and an the street addressand you have a P.O.
explanation of its effect on the SEP box, show the box number instead of the
agreement or SIMPLE IRA plan. street address.

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