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The form you are looking for begins on the next page of this file. Before viewing it, 
please see the important update information below.

                           New Mailing Address

The mailing address for certain forms have change since the forms were last published. 
The new mailing address are shown below. 

Mailing Address for Forms 1023, 1024, 1024-A, 1028, 5300, 5307, 5310, 5310-A, 5316, 
8717, 8718, 8940:

Internal Revenue Service   
TE/GE Stop 31A Team 105                              
P.O. Box 12192       
Covington, KY 41012–0192

Deliveries by private delivery service (PDS) should be made to:

Internal Revenue Service 
7940 Kentucky Drive 
TE/GE Stop 31A Team 105 
Florence, KY 41042

This update supplements these forms’ instructions. Filers should rely on this update for 
the change described, which will be incorporated into the next revision of the form’s 
instructions.



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                                                                                                                                          OMB No. 1545-1772
                                                     User Fee for Employee Plan Determination                               For 
Form   8717                                                            Letter Request                                       IRS 
(Rev. September 2017)                                        ▶ Attach to determination letter application.                  Use Amount paid
                                                                                                                            Only
Department of the Treasury                           ▶ Go to www.irs.gov/Form8717 for the latest information.
Internal Revenue Service
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.                      Seethe instructions on 
page 2 for details. For all other applications, leave the certification blank and check the appropriate box and enter the                  user fee incolumnB 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. 9-2017)



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Form 8717 (Rev. 9-2017)                                                                                                                     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 31           Letters, Stop 31 
Specific user fee amounts are no longer listed                                             P.O. Box 12192             201 West Rivercenter Blvd. 
on Form 8717. You must now enter the                                                       Covington, KY 41012-0192   Covington, KY 41011
appropriate user fee when completing line 5. 
Notice 2011-86 is obsoleted. 
                                                  See Notice 2002-1, 2002-1 C.B. 283 as           If you have multiple plans, submit a 
Note: www.pay.gov can be used to pay your         amplified by Notice 2017-1, 2017-2 I.R.B.       separate determination letter application and 
user fee. Be sure to include the payment          367.                                            Form 8717 for each plan.
confirmation page along with Form 8717.
                                                  An eligible employer as defined in section 
General Instructions                              408(p)(2)(C)(i)(l) is an employer which had no  Paperwork Reduction Act Notice. We ask 
                                                  more than 100 employees who received at         for the information on this form to carry out 
Purpose of Form                                   least $5,000 of compensation from the           the Internal Revenue laws of the United 
                                                  employer for the preceding year. In addition,   States. If you want to have your plan 
Generally, a user fee is required with each       an eligible employer must have at least one     approved by the IRS, you are required to give 
application for a determination letter. Use       employee who is not a highly compensated        us the information. We need it to determine 
Form 8717 to submit the appropriate user fee.     employee (as defined in section 414(q)) and is  whether you meet the legal requirements for 
Note: Don't use any part of the form that is      participating in the plan.                      plan approval. Section 7528 authorizes us to 
shaded in gray. Those portions of the form are    The determination of whether an employer        charge a user fee.
no longer functional.                             is an eligible employer is made as of the date  You aren't required to provide the 
                                                  of the request described above. If your         information requested on a form subject to 
Specific Instructions                             application meets these requirements for an     the Paperwork Reduction Act unless the form 
                                                  exemption, complete only the Certification.     displays a valid OMB control number. Books 
Exemption From User Fee                           Don't complete any part of line 5.              or records relating to a form or its instructions 
                                                                                                  must be retained as long as their contents 
The exemption from the user fee applies to all    Payment of User Fee                             may become material in the administration of 
eligible employers (defined later) who request 
a determination letter within the first 5 plan    If you don't meet the conditions for exemption  any Internal Revenue law. Generally, tax 
years or, if later, by the end of any remedial    discussed earlier, a user fee is due.           returns and return information are 
                                                                                                  confidential, as required by section 6103. 
amendment period with respect to the plan         Line 5. User fee. To determine the 
that begins within the first 5 plan years         appropriate user fee to enter on line 5, go to  The time needed to complete and file this 
(“qualifying open remedial amendment              www.irs.gov/Retirement-Plans/User-Fees-         form will vary depending on individual 
period”). The IRS will treat an application for a For-Employee-Plans-Determination-Opinion-       circumstances. The estimated average time is:
determination letter as being filed within a      And-Advisory-Letters. The schedule for user     Recordkeeping       . . .   . .8 hr., 7 min.
qualifying open remedial amendment period if      fees is also set forth in Rev. Proc. 2017-4,    Learning about the law                                
the plan was first in existence no earlier than   2017-1 I.R.B. 146, available at www.irs.gov/    or the form  .    . . . .   . .        .  57 min.
January 1 of the 10th calendar year preceding     irb/2017-01_IRB/ar10.html, or the latest 
the year in which the application is filed (the   annual update.                                  Preparing, copying, assembling  2 hr., 4 min.
“10-year rule”).                                                                                  Sending the form to the IRS   .        . 16 min.
                                                  Check the appropriate box and enter the 
Example. If a determination letter                user fee in column B of line 5. Attach to the   If you have comments about the accuracy 
application for a plan that was first in          left side of the form a check or money order    of these time estimates or suggestions for 
existence during 2007 is filed on                 payable to “United States Treasury” for the     making this form simpler, we would be happy 
December 1, 2017, then the IRS will treat the     full amount of the user fee to Form 8717, if    to hear from you. You can send us comments 
application as having been filed within a         applicable. If payment was made through         from www.irs.gov/FormsPubs. Click on “More 
qualifying open remedial amendment period.        www.pay.gov, a copy of the payment              Information” and then on “Give us feedback.” 
If an application does not satisfy the 10-        confirmation must also be submitted. If you     Or you can write to:
year rule requirements, but the application       don't include the full amount, your application 
satisfies the user fee exemption requirements     may be returned. Attach Form 8717 to your       Internal Revenue Service     
under section 7528(b)(2)(B) (for example, in a    determination letter application.               Tax Forms and Publications 
case in which a qualifying open remedial                                                          1111 Constitution Ave. NW, IR-6526 
amendment period ends more than 10 years                                                          Washington, DC 20224
after the year in which the plan is first in                                                      Don't send this form to this address. 
existence), then no user fee is required. The                                                     Instead, see Where To File, earlier.
applicant should complete only the 
Certification and explain in a cover letter how 
the application satisfies the user fee 
exemption requirements under 
section 7528(b)(2)(B).






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