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                                              Application for Approval of 
Form  4461-B                                                                                           OMB No. 1545-0169 
(Rev. November 2018)        Standardized or Nonstandardized Pre-Approved Plans
Department of the Treasury                    Mass Submitter Adopting Provider
Internal Revenue Service              ▶ Go to www.irs.gov/Form4461B for the latest information.   This Form Is Open to Public Inspection 

File This Form With the Internal Revenue Service                                                  For IRS Use Only 

Section references are to the Internal Revenue Code unless otherwise noted. 

Complete every applicable item on this form. 
1     Enter amount of user fee submitted 
      $ 
2 a   Name of applicant                                                                           2 b Employer identification number 
                                                                                                      of applicant 
      Address (number, street, room or suite no.) (If a P.O. box, see instructions.) 
                                                                                                  2 c Applicant’s telephone no. 
      City                                                State            ZIP code 

3a    Name of person to be contacted                                  3 b Email address           3 c Telephone number 

3 d   If a power of attorney is attached, check the box ▶

4 a   Basic plan document or single document plan number              b   Adoption agreement number, if applicable

5     This plan is:         Word-for-word identical to a pre-approved plan 
                            A minor modification to a pre-approved plan only (see instructions to 
                            line 5 for specific requirements) 
6     Name of mass submitter 

7     Enter the following information for the mass submitter’s plan on which this plan is based (if this application is submitted  
      simultaneously with the mass submitter’s application, see instructions). 
      File folder number 
      Letter serial number 
      Date of letter 

8     Type of plan (select all that apply): 
            Money purchase              Target benefit        Profit-sharing/401(k)             Governmental
            Profit-sharing              Defined benefit       ESOP                              Nonelecting church

9     Filing status of plan (see General Instructions) 
            Standardized plan 
            Nonstandardized plan 

Under penalties of perjury, I declare that the provider has adopted a pre-approved plan that is word-for-word identical to, or a minor modification of, the mass submitter 
plan indicated in lines 6 and 7 above.

(Provider) 
Signature ▶                                                   Title ▶                             Date ▶

(Mass Submitter)  
Signature ▶                                                   Title ▶                             Date ▶
For Paperwork Reduction Act Notice, see the instructions.                     Cat. No. 10235P               Form 4461-B (Rev. 11-2018)

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Form 4461-B (Rev. 11-2018) Page 2
General Instructions Disclosure requested by taxpayer. A A provider may request an opinion
taxpayer may request the IRS to letter for more than one plan provided it
Section references are to the Internal disclose and discuss the return or return represents to the IRS that it has at least
Revenue Code unless otherwise noted. information with any person or persons 30 employer-clients in the aggregate,
whom the taxpayer designates in a each of which is reasonably expected to
Future Developments written request. If you want to designate adopt at least one of the provider’s
For the latest information about a person(s) to assist in an application for plans.
developments related to Form 4461, approval, you must provide the IRS A provider also includes any person
such as legislation enacted after the office of jurisdiction with a written that has an established place of
form was published, go to request that contains the following. business in the United States where it is
www.irs.gov/Form4461B. • The taxpayer’s name, address, accessible during every business day
employer identification number, and plan and offers a plan as a word-for-word
Purpose of Form number(s). identical adopter or minor modifier
Use Form 4461-B to apply for approval • The name, address, social security adopter of a plan of a mass submitter,
of a plan submitted by a mass submitter number, and telephone number(s) of the regardless of the number of employers
on behalf of an adopting provider, which person or persons whom you are that are expected to adopt the plan.
is based on a plan submitted by the authorizing to receive return information.
mass submitter. Specific Instructions
• A paragraph that clearly describes the
Completing Form 4461-B return or return information that you Line 2a. Enter the name and address of
authorize the IRS to disclose. the applicant. If the Post Office doesn’t
Be sure to submit a complete and deliver mail to thestreet address and the
accurate application. Complete every • An authorized signature (see Signature
applicable line on the application. If your above). applicant has aP.O. box number, show
the box numberinstead of the street
application isn’t complete, we will return As an alternative to providing the address.
it without processing it. The application above statement, Form 2848, Power of
must be typed. Attorney and Declaration of Line 3a. The person to contact must be
User fee. All applications must be Representative, may be submitted. an employee or an authorized
representative of the mass submitter. If
accompanied by the appropriate user the person to be contacted is other than
fee from the schedule set forth in Rev. Definitions
an employee of the applicant, please
Proc. 2018-4, 2018-1 I.R.B. 146 (or the Mass submitter. As set forth in Rev. enclose an authorized power of attorney.
most recent version, updated annually); Proc. 2017-41, 2017-29 I.R.B. 92, any See Disclosure requested by taxpayer,
and Form 8717-A, User Fee for entity that submits applications on earlier.
Employee Plan Opinion Letter Request. behalf of at least 30 unaffiliated
Applications submitted without the providers each of whichis sponsoring, Line 4a. Enter the two-digit number you
proper user fee will not be processed on a word-for-wordidentical basis, the have assigned to your single document
and will be returned to the applicant. same plan. A mass submitter is treated plan or basic plan document that
Don’t submit a copy of the plan, as a mass submitter with respect to all of accompanies the adoption agreement
except as provided under the its plans, provided the 30-unaffiliated- for which you are requesting approval. If
instructions to line 5 later. provider requirement is met with respect multiple adoption agreements are linked
to at least one plan. to the same basic plan document, the
same two-digit basic plan document
Who May File Affiliation is determined under sections number should be used for all
Only mass submitters may file this form. 414(b) and (c). Additionally, the following applications.
will be considered to be affiliated: any
Where To File law firm, accounting firm, consulting Line 4b. Enter the three-digit number
firm, etc., with its partners, members, you have assigned to the adoption
Send Form 4461-B to: associates, etc. agreement, if applicable, for which this
application is submitted. Each different
Internal Revenue Service For purposes of determining whether adoption agreement designed to
Attn: Pre-Approved Plans Coordinator 30 unaffiliated providers sponsor on a accompany a single basic plan
Room 6-403, Group 7521 word-for-word identical basis the same document should be given a different
P.O. Box 2508 plan document, the mass submitter is three-digit number beginning with “001.”
Cincinnati, OH 45201-2508 treated as an unaffiliated provider. For example, if the first basic plan
If using Express Mail or a private Provider. A provider is any person document of a provider has four
delivery service, use this address: (including a mass submitter, if separate adoption agreements, they
Internal Revenue Service applicable) that (1) has an established should be numbered “001” through
Attn: Pre-Approved Plans Coordinator place of business in the United States “004” and the mass submitter should
Room 6-403, Group 7521 where it is accessible during every submit four separate Forms 4461-B.
550 Main Street business day, and (2) represents to the Adoption agreements submitted with the
Cincinnati, OH 45202 IRS that it has at least 15 employer- second or any subsequent basic plan
clients, each of which is reasonably documents (that aren’t word-for-word
Signature. The application must be expected to adopt the same pre- identical to a previously submitted basic
signed by the mass submitter and approved plan of the provider. plan document) should be similarly
provider. If a power ofattorney numbered beginning with “001.”
authorizes the mass submitterto sign
the form on behalf of the provider, attach
the powerof attorney to Form 4461-B.

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Form 4461-B (Rev. 11-2018) Page 3
Line 5. In the case of a provider Paperwork Reduction Act Notice. We The time needed to complete and file
adopting a plan (including a flexible plan) ask for the information on this form to this form will vary depending on
that is word-for-word identical to a plan carry out the Internal Revenue laws of individual circumstances. The estimated
of the mass submitter, acopy of the plan the United States. You are required to average time is:
doesn’t have to besubmitted. If the plan give us this information. We need it to Recordkeeping . . . . 5 hr., 58 min.
is a minor modification, themass determine whether you meet the legal
submitter should submitForm 4461-B as requirements for plan approval. Learning about the
law or the form . . . . . . 52 min.
a “placeholder.” When the mass You aren’t required to provide the
submitter receives notification from the information requested on a form that is Preparing the form . . 1 hr., 56 min.
IRS that the IRS has determined that the subject to the Paperwork Reduction Act Copying, assembling, and
lead plan appears to be in full unless the form displays a valid OMB sending the form to the IRS . 16 min.
compliance with the applicable control number. Books or records
qualification requirements, it must relating to a form or its instructions must If you have comments concerning the
submita copy of the mass submitter be retained as long as their content may accuracy of these time estimates or
plan withminor modifications underlined become material in the administration of suggestions for making this form
inred, or otherwise highlighted, as well any Internal Revenue law. Generally, tax simpler, we would be happy to hear
as a statement indicating the location return and return information are from you. You can send us comments
and effect of each change. confidential, as required by section 6103. from www.irs.gov/FormComments. Or
Line 7. If this application is you can write to the Internal Revenue
simultaneously filed withthe mass Service, Tax Forms and Publications
submitter’s application or filedbefore the Division, 1111 Constitution Ave. NW,
information under line 7 isavailable, IR-6526, Washington, DC 20224. Don’t
enter on the “File folder number” line the send Form 4461-B to this address.
basicplan document number and Instead, see Where To File, earlier.
adoption agreementnumber or the
single document plan number of the
mass submitter’s plan on which this plan
is based. Don’t complete the rest of
line 7.

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