OMB No. 1545-1772
                                                                       User Fee for Employee Plan Opinion Letter Request                               For 
Form  8717-A                                                           Use this form to make additional payments for applications submitted on         IRS 
(Rev. August 2024)                                                                      Form 4461, Form 4461-A, Form 4461-B, or Form 4461-C.           Use Amount paid
Department of the Treasury                                                                                                                             Only
Internal Revenue Service                                                                Go to www.irs.gov/Form8717A for the latest information.
1   Name of plan provider

2   Provider’s employer identification number                                                                                                                             3   Plan number

4   Plan name

                                                                                                   Applications                                                           User Fee 
                                                                5 User fees for pre-approved plans
                                                                  (1a) Mass or non-mass submitter—per basic plan document with one adoption agreement  .   .              (1a) $

                                                                  (1b) Mass or non-mass submitter—per each additional adoption agreement  .      . . . . . .              (1b) $

                                                                  (2)  Mass  or  non-mass  submitter  single  document  plan  (no  adoption  agreements)—per  each 
                                                                       single document plan  . . . . . .    . .    . . . . . . . . .           . . . . . . .              (2)  $

                                                                  (3)  Provider’s  identical  adoption  of  mass  submitter  basic  plan  document—per  adoption 
                                                                       agreement or single document plan  . . .    . . . . . . . . .           . . . . . . .              (3)  $

                                                                  (4)  Provider’s  minor  modification  of  mass  submitter  basic  plan  document—per  adoption 
                                                                       agreement or single document plan  . . .    . . . . . . . . .           . . . . . . .              (4)  $

                                                                  (5)  Assumption  of  sponsorship  of  a  pre-approved  plan—per  basic  plan  document  or  single 
                                                                       document plan  . . .    . . . . .    . .    . . . . . . . . .           . . . . . . .              (5)  $

                                Attach Check or Money Order Here

                                                                                                   Cat. No. 60826Q                                                   Form 8717-A (Rev. 8-2024)

Form 8717-A (Rev. 8-2024)                                                                                                                    Page 2
General Instructions                           Check the appropriate box on line 5 and                You aren’t required to provide the 
                                               enter the amount of additional payment due.            information requested on a form subject to 
Section references are to the Internal Revenue Attach a check or money order made payable             the Paperwork Reduction Act unless the form 
Code.                                          to “United States Treasury” for the additional         displays a valid OMB control number. Books 
                                               user fee to Form 8717-A. If you don’t include          or records relating to a form or its instructions 
Future Developments                            the proper amount, your application may be             must be retained as long as their contents 
For the latest information about developments  returned.                                              may become material in the administration of 
related to Form 8717-A and its instructions,                                                          any Internal Revenue law. Generally, tax 
such as legislation enacted after they were    Where To File                                          returns and return information are 
published, go to www.irs.gov/Form8717A.        Send Form 8717-A and the additional                    confidential, as required by section 6103.
                                               payment to one of the following.                       The time needed to complete and file this 
What’s New                                                                                            form will vary depending on individual 
                                               If sending via U.S. mail:
Form 8717-A is now used only to make an                                                               circumstances. The estimated average time is:
additional payment when an insufficient user   Internal Revenue Service                           
fee was paid for an opinion letter application Attn: Pre-Approved Plans Coordinator                   Recordkeeping   .   . .     .  1 hr., 12 min.
submitted on Form 4461, Form 4461-A, Form      P.O. Box 2508                                          Learning about the law                                
4461-B, or Form 4461-C. Form 8717-A is no      Room 6-403, Group 7521                                 or the form . . .   . .     . .       .  34 min.
longer attached to those forms because the     Cincinnati, OH 45201-2508
                                                                                                      Preparing, copying, 
initial user fee payments are made through     If sending via Express Mail or Private                 assembling,  and sending 
www.Pay.gov.                                   Delivery Service:                                      the form to the IRS . .     .  1 hr., 48 min.
Purpose of Form                                Internal Revenue Service                               If you have comments concerning the 
                                               Attn: Pre-Approved Plans Coordinator                   accuracy of these time estimates or 
Form 8717-A is used to pay any corrected       550 Main Street                                        suggestions for making this form simpler, we 
amount after a fee has been submitted and      Room 6-403, Group 7521                                 would be happy to hear from you. You can 
processed through www.Pay.gov for a pre-       Cincinnati, OH 45202                                   send us comments from www.irs.gov/
approved plan application under the Form                                                              FormComments. Or you can send your 
4461 series.                                   Paperwork Reduction Act Notice. We ask                 comments to the Internal Revenue Service, 
                                               for the information on this form to carry out          Tax Forms and Publications Division, 1111 
Specific Instructions                          the Internal Revenue laws of the United                Constitution Ave. NW, IR-6526, Washington, 
Line 5. User fee. To determine the             States. Section 7528 authorizes us to charge           DC 20224. 
appropriate user fee to enter on line 5, go to a user fee.                                            Do not send this form to this address. 
the schedule for user fees in Rev. Proc.                                                              Instead, see Where To File  , earlier.
2024-4, 2024-1 I.R.B. 247,  available at 
www.irs.gov/irb/2024-01_IRB#RP-2024-4  , or 
the latest annual update.