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                                                                                                                                            OMB No. 1545-1772
                                                      User Fee for Employee Plan Determination                                For 
Form 8717                                                                 Letter Request                                      IRS 
(Rev. June 2022)                                                                                                              Use Amount paid
Department of the Treasury                                       Attach to determination letter application.                  Only
Internal Revenue Service                                Go to www.irs.gov/Form8717 for the latest information.
1   Name of plan sponsor (employer if single-employer plan)

2   Sponsor’s employer identification number                     3   Plan number   4   Plan name

Caution: If you qualify for the exemption from user fees for small business employers, complete only the certification below.                        See the instructions on 
page 2 for details. For all other applications, leave the certification blank and check the appropriate box and enter the                    user fee in column B of line 5.
                                                                                   Certification
I  certify  that  the  application  for  a  determination  letter  on  the  qualified  status  of  the  plan  listed  above  meets  the  conditions  for 
exemption from user fees described in section 7528(b)(2)(B) of the Internal Revenue Code.

Sign Here                                                                                                                         Date 

Type or print name and title 
                                                                                                                                  User Fee
                                                                                                                           A                      B  
                                                             Form Submitted                                                   
                                                                                                                  ✴❅❘▼
                                 5a Form 5300:                                                                                                    $ 
                                                                                                                  ✴❅❘▼
                                 b Form 5307:                                                                                                     $
                                                                                                                  ✴❅❘▼
                                 c  Form 5310:                                                                                                    $
                                 d
                                                                                                                  ✴❅❘▼
                                 e  Multiple employer plans (Form 5300  ) . .    . . . . .      .  . . .      . .                                 $
                                 f  Multiple employer plans (Form 5310  ) . .    . . . . .      .  . . .      . . ✴❅❘▼                            $
                                 g  Reserved
                                                                                                                                        ✴❅❘▼
                                    (1a) .    . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (1b)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (2a)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (2b)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                    ( )3    . . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .     ✴❅❘▼
                                    ( )4 .    . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .     ✴❅❘▼
                                 h  Reserved
                                                                                                                                        ✴❅❘▼
                                    (1a)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (1b)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    ( )2   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
Attach Check or Money Order Here    ( )3   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (4a)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    (4b)   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    ( )5   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                                                                                                                        ✴❅❘▼
                                    ( )6   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .
                                    ( )7   .  . . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .     ✴❅❘▼
                                 i  Form 5316:  . . . .      . . .   . .  . .    . . . . .      .  . . .      . . .    . . .  . . .               $
                                                                                   Cat. No. 64727O                                          Form 8717 (Rev. 6-2022)



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Form 8717 (Rev. 6-2022)                                                                                                                      Page 2
Section references are to the Internal Revenue    Where To File (Include Form 8717 and user fee with your request or 
Code unless otherwise noted.                      application.)
Future Developments                                                                              THEN use this address if you send it by:
For the latest information about developments     IF you have this type of 
related to Form 8717 and its instructions,        request or application...                      U.S. mail                 Express Mail or   
                                                                                                                    private delivery service
such as legislation enacted after they were 
published, go to www.irs.gov/Form8717  .          Determination letter                Internal Revenue Service     Internal Revenue Service  
                                                  (Form 5307, 5300, 5310, 5310-A,     Attn: EP Determination       Attn: EP Determination 
What’s New                                        or 5316)                              Letters, Stop 31A Team 105 Letters, Stop 31A Team 105 
Specific user fee amounts are no longer listed                                          P.O. Box 12192             7940 Kentucky Drive 
on Form 8717. You must now enter the                                                    Covington, KY 41012-0192   Florence, KY 41042
appropriate user fee when completing line 5. 
Notice 2011-86 was obsoleted. See Notice 
2017-1, 2017-2 I.R.B. 367.                        See Notice 2002-1, 2002-1 C.B. 283 as                If you have multiple plans, submit a 
                                                  amplified by Notice 2017-1, 2017-2 I.R.B.       separate determination letter application and 
Note: www.pay.gov is required to be used          367.                                            Form 8717 for each plan.
when submitting the user fee with Form 5310 
applications. Starting July 1, 2022, Pay.gov      An eligible employer as defined in section 
will be required for Form 5300 submissions        408(p)(2)(C)(i)(l) is an employer which had no  Paperwork Reduction Act Notice. We ask 
and applicable user fees.                         more than 100 employees who received at         for the information on this form to carry out 
                                                  least $5,000 of compensation from the           the Internal Revenue laws of the United 
General Instructions                              employer for the preceding year. In addition,   States. If you want to have your plan 
                                                  an eligible employer must have at least one     approved by the IRS, you are required to give 
Purpose of Form                                   employee who is not a highly compensated        us the information. We need it to determine 
                                                  employee (as defined in section 414(q)) and is  whether you meet the legal requirements for 
Generally, a user fee is required with each       participating in the plan.                      plan approval. Section 7528 authorizes us to 
application for a determination letter. Use                                                       charge a user fee.
Form 8717 to submit the appropriate user fee.     The determination of whether an employer 
                                                  is an eligible employer is made as of the date       You aren’t required to provide the 
Note: Don’t use any part of the form that is      of the request described above. If your         information requested on a form subject to 
shaded in gray. Those portions of the form are    application meets these requirements for an     the Paperwork Reduction Act unless the form 
no longer functional.                             exemption, complete only the Certification.     displays a valid OMB control number. Books 
                                                  Don’t complete any part of line 5.              or records relating to a form or its instructions 
Specific Instructions                                                                             must be retained as long as their contents 
                                                  Payment of User Fee                             may become material in the administration of 
Exemption From User Fee                           If you don’t meet the conditions for exemption  any Internal Revenue law. Generally, tax 
The exemption from the user fee applies to all    discussed earlier, a user fee is due.           returns and return information are 
eligible employers (defined later) who request    For Form 5310, please submit the                confidential, as required by section 6103. 
a determination letter within the first 5 plan    application and user fee at the same time            The time needed to complete and file this 
years or, if later, by the end of any remedial    through Pay.gov.                                form will vary depending on individual 
amendment period with respect to the plan                                                         circumstances. The estimated average time is:
that begins within the first 5 plan years         Starting July 1, 2022, Form 5300 and any 
(“qualifying open remedial amendment              applicable user fee is required to be           Recordkeeping     .      . . .     1 hr., 40 min.
period”). The IRS will treat an application for a submitted through Pay.gov.                      Learning about the law or the form  24 min.
determination letter as being filed within a      Do not use Form 8717 for Form 5300 or           Preparing, copying, assembling         . 26 min.
qualifying open remedial amendment period if      Form 5310 unless an additional payment for 
the plan was first in existence no earlier than   an insufficient user fee is needed.                  If you have comments about the accuracy 
                                                                                                  of these time estimates or suggestions for 
January 1 of the 10th calendar year preceding     Line 5. User fee. To determine the              making this form simpler, we would be happy 
the year in which the application is filed (the   appropriate user fee to enter on line 5, go to  to hear from you. You can send us comments 
“10-year rule”).                                  www.irs.gov/Retirement-Plans/User-Fees-         from www.irs.gov/FormsPubs  . Click on “More 
Example. If a determination letter                For-Employee-Plans-Determination-Opinion-       Information” and then on “Give us feedback.” 
application for a plan that was first in          And-Advisory-Letters  . The schedule for user 
existence during 2007 is filed on                 fees is also set forth in Appendix A of Rev.         Or you can write to:
December 1, 2017, then the IRS will treat the     Proc. 2022-4, 2022-1 I.R.B. 161 (updated             Internal Revenue Service     
application as having been filed within a         annually), available at www.irs.gov/                 Tax Forms and Publications 
qualifying open remedial amendment period.        irb/2022-01  , or the latest annual update.          1111 Constitution Ave. NW, IR-6526 
If an application does not satisfy the 10-        Check the appropriate box and enter the              Washington, DC 20224
year rule requirements, but the application       user fee in column B of line 5. Attach to the        Don’t send this form to this address. 
satisfies the user fee exemption requirements     left side of the form a check or money order    Instead, see Where To File  , earlier.
under section 7528(b)(2)(B) (for example, in a    payable to “United States Treasury” for the 
case in which a qualifying open remedial          full amount of the user fee to Form 8717, if 
amendment period ends more than 10 years          applicable. If payment was made through 
after the year in which the plan is first in      www.pay.gov  , a copy of the payment 
existence), then no user fee is required. The     confirmation must also be submitted. If you 
applicant should complete only the                don't include the full amount, your application 
Certification and explain in a cover letter how   may be returned. Attach Form 8717 to your 
the application satisfies the user fee            determination letter application.
exemption requirements under 
section 7528(b)(2)(B).






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