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Form 4461-A Application for Approval of Master or OMB No. 1545-0169
(Rev. March 2013) Prototype or Volume Submitter Defined
Department of the Treasury This Form Is Open to Public Inspection
Internal Revenue Service Benefit Plan
File This Form With 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 and Attachment 1-A. (See Rev. Proc. 2011-49, 2011-44 I.R.B. 608.)

See instructions before completing this form.
1 Enter amount of user fee submitted
$
2 a Approval requested: 2b M&P File folder number or 2c Date of last letter issued
Initial application VS-Letter serial number
Amendment—Enter file folder number or letter
serial number and date of last letter issued ▶
3 a Name of applicant 3b Employer identification number
of applicant
Address (number, street, room or suite no.) (If a P.O. box, see instructions)

City State ZIP code 3c Applicant’s telephone no.

3 d Type of applicant (see Definitions in the instructions):
M&P sponsor Volume submitter practitioner
M&P mass submitter Volume submitter mass submitter
4a Name of person to be contacted 4b Telephone number

4 c Email address
4d If a power of attorney is attached, check box . . ▶
5a Basic plan document number 5b Adoption agreement number

6 Form of plan:
Prototype plan Master plan Volume submitter plan
Note: A master plan has only one trust or custodial account for all adopting employers.

7 Does the plan provide for permitted disparity in accordance with section 401(l)? Yes No
8 Filing status of plan:
Standardized plan
Nonstandardized plan
Volume submitter governmental plan (i.e., described in section 414(d))
Volume submitter nongovernmental plan

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.

Signature ▶ Title ▶ Date ▶
For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11416U Form 4461-A (Rev. 3-2013)

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Form 4461-A (Rev. 3-2013)                                                                                                      Page  2 
9     Procedural requirements:                                                                                             Yes No 
a     Have the following been submitted as required by instructions— 
      (1) Adoption agreement?  .     .  .    .   . . .    . . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
      (2) Copy of plan?       . .  . .  .    .   . . .    . . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
      (3) Copy of trust indenture or custodial agreement?  .    .  .    . . .  .  .  . .   .   . . . .    . .    . .
      (4) Copy of Certification of Interim Amendments?  .     . .  .    . . .  .  .  . .   .   . . . .    . .    . .
b     For all M&P sponsors and those VS practitioners who are choosing to include a provision in their  specimen
      plans that allows them to amend on behalf of their adopting employers, will you advise those  employers who 
      cannot or do not adopt the amended or restated plan providing for such authority, that  they may not continue 
      to participate under the M&P plan or the VS plan?     . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
c     For all M&P sponsors and those VS practitioners who are choosing to include a provision in their specimen
      plans that allows them to amend on behalf of their adopting employers, is there a procedure in place for the
      adoption and distribution of the amendments?        . . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
d     Is the plan and trust (or custodial agreement) patterned after and substantially the same as another plan and 
      trust  (or  custodial  agreement)  on  which  a  favorable  letter  has  been  received?  (If  “Yes,”  see  specific 
      instructions.) .    . . . .  . .  .    .   . . .    . . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
e     Non-mass submitter request (M&P complete (1) and (2). VS complete (3)): 
      (1) Do you have at least 30 employer-clients which are reasonably expected to adopt this plan’s basic plan 
          document and one or more of the adoption agreements associated with this basic plan document? If 
          “No,” complete (2)    .  . .  .    .   . . .    . . . .  .    . . .  .  .  . .   .   . . . .    . .    . .
      (2) If “No” to(1), enter the file folder number of the basic plan document for which the requisite number 
          of adopting employer-clients requirement is met: 
      (3) If you are a VS (non-mass submitter) practitioner, do you have at least 30 employer-clients reasonably 
          expected to adopt a plan that is substantially similar to the VS practitioner specimen plan?  . . .    . .
f     Mass submitter request (M&P mass submitter complete (1),(2)    , and (3);VS mass submitter complete(4)): 
      (1) Are applications on behalf of the requisite number of sponsors who are adopting the same basic plan 
          document on a word-for-word identical basis included? If “No,” complete (2)      .   . . . .    . .    . .
      (2) If “No” to (1), enter the file folder number of the basic plan document for which the requisite number 
          of adopting sponsors requirement is met: 
      (3) If this is a flexible plan, answer (a) and (b): 
          (a) Have you bracketed and identified the optional provisions of the plan?   .   .   . . . .    . .    . .
          (b) Have you included a copy of the written representation describing the choices available to sponsoring 
              organizations  and the coordination of optional provisions?  .   .  .  . .   .   . . . .    . .    . .
      (4) For a VS mass submitter, are applications on behalf of at least 30 unaffiliated practitioners sponsoring the
          same specimen plan on a word-for-word identical basis included?  .      .  . .   .   . . . .    . .    . .
Note: This application is designed to be used in conjunction with Rev. Proc. 2011-49. A List of Required Modifications (LRMs) is also 
recommended for use and may be obtained from the IRS website at www.irs.gov/ep.
                                                                                                            Form 4461-A (Rev. 3-2013)

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Form 4461-A (Rev. 3-2013) Page 3

General Instructions For approval, file this application and Disclosure requested by taxpayer. A
each applicable document listed in line taxpayer may request the Service to
Purpose of Form 9a. disclose and discuss the return or return
Use Form 4461-A to apply for approval Multiple plans. A sponsor may utilize information with any person(s) the
of a Master or Prototype (M&P) or one basic plan document for several taxpayer designates in a written request.
Volume Submitter (VS) defined benefit plans. A sponsor may, for example, If you want to designate a person(s) to
plan. submit four applications for a given assist in an application for approval, you
defined benefit basic plan document (a must provide the IRS office of
Be sure to submit a complete and standardized plan with permitted jurisdiction with a written request that
accurate application, including Form disparity, a standardized plan without contains:
4461-A and Attachment 1-A (see permitted disparity, a nonstandardized • The taxpayer’s name, address,
www.irs.gov/pub/irs-tege/form4461- plan with permitted disparity, and a employer identification number, and plan
A_attachment.pdf). Complete every nonstandardized plan without permitted number(s).
applicable line on the application. If an disparity). A separate adoption • The name, address, social security
item on the Attachment 1-A does not agreement and completed application number, and telephone number(s) of the
apply, check the “N/A” box or enter must be provided for each such defined person or persons whom you are
“N/A” on the line where indicated as an benefit plan. In the case of a authorizing to receive return information.
option. If your application is not simultaneous submission using the same
complete, we will return it without basic plan document, only one basic • A paragraph that clearly describes the
processing it. The first page must be plan document need be submitted. If the return or return information that you
typed. Unless otherwise noted, the request is not simultaneous, separate authorize the IRS to disclose.
questions on Form 4461-A and basic plan documents must be • An authorized signature (see above).
Attachment 1-A apply to both M&P and submitted (but the number assigned to
VS defined benefit plans. the basic plan document of a master or As an alternative to providing the
Request for additional information. If a prototype plan remains the same). One above statement, you may submit
letter requesting additional information basic plan document may not be used Form 2848, Power of Attorney and
or changes to plan documents is sent to for both defined benefit and defined Declaration of Representative.
the sponsor, VS practitioner, or an contribution plans.
Definitions
authorized representative, such A VS practitioner is permitted to
information and/or changes must be submit a defined benefit specimen plan Adoption agreement. The portion of the
received no later than 30 days from the which allows for an employer to select plan containing all the options that the
date of the letter. Failure to respond either a benefit formula with or without adopting employer may select. The
timely may result in the application being permitted disparity. You may not use adoption agreement may include blanks
considered withdrawn. An extension of the same specimen plan document for or fill-in provisions for the employer to
the 30-day time limit will only be granted governmental plans (i.e., plans complete if it also includes parameters
for good cause. described in section 414(d)) and on these provisions that preclude an
nongovernmental plans (i.e., plans not employer from completing them in a
Inadequate submissions. The IRS will described in section 414(d)). manner that could violate the
return, without further action, plans that qualification requirements. Each
are not in substantial compliance with Where To File separate adoption agreement is treated
the qualification requirements or plans as a separate plan and will receive its
that are so deficient that they cannot be Send applications for opinion and own opinion or advisory letter.
reviewed in a reasonable amount of time. advisory letters to:
Basic plan document. The portion of
Internal Revenue Service the plan containing all the nonelective
Who May File P.O. Box 2508; Room 5106 provisions applicable to all adopting
Master or prototype plans. Sponsors Cincinnati, OH 45201 employers. No options (including blanks
and mass submitters (see Definitions, Add “Attn: Pre-approved Plans to be completed) may be provided in the
later). Coordinator.” basic plan document except for options
Volume submitter plans. Practitioners For both types of applications, send a in flexible plans.
and mass submitters (see Definitions, request shipped by Express Mail or a Flexible plan. A plan submitted by an
later). delivery service to the attention of the M&P mass submitter which contains
Pre-approved Plans Coordinator to: certain optional provisions as allowed by
What To File section 12.03(1) of Rev. Proc. 2011-49.
Internal Revenue Service
One copy of Form 4461-A and 550 Main Street Sponsors that adopt a flexible plan may
Attachment 1-A for each separate Room 5106 include or delete any optional provision
adoption agreement or for each separate Cincinnati, OH 45202 designated as such in the mass
specimen plan where no adoption submitter’s plan. A flexible plan adopted
agreement is utilized. Signature. Form 4461-A must be signed by a sponsor which differs from the
by a partner or officer of the applicant mass submitter plan only because of the
who is authorized to sign, or other deletion of certain optional provisions
person authorized by a power of will be treated as a word-for-word
attorney. The power of attorney should identical plan to the mass submitter plan.
be filed with the application.

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Form 4461-A (Rev. 3-2013) Page 4
Mass submitter. In Rev. Proc. 2011-49, 4.01 of Rev. Proc. 2011-49) is M&P nonstandardized plan. A plan
any entity that submits applications on established, as part of the plan, for the which meets the specific requirements of
behalf of at least 30 unaffiliated sponsors joint use of all adopting employers. A Attachment 1-A, line 12. (See
each of which is sponsoring, on a word- master plan consists of a basic plan www.irs.gov/pub/irs-tege/form4461-
for-word identical basis, the same basic document, an adoption agreement, and, A_attachment.pdf or Rev. Proc. 2011-49,
plan document and one or more of the unless included in the basic plan 2011-44 I.R.B. 615.)
adoption agreements associated with document, a trust or custodial account Practitioner. Any person that has an
that basic plan document or, in the case document. established place of business in the
of VS plans, one or more of the same Prototype plan. A form of plan that is United States where it is accessible
lead specimen plans. For a mass made available by a sponsor for during every business day and
submitter of an M&P, once the mass adoption by employers under which a represents to the Service that it has at
submitter has submitted applications on separate funding medium is established least 30 employer-clients each of which
behalf of 30 unaffiliated sponsors with for each adopting employer. A prototype is reasonably expected to timely adopt a
respect to any basic plan document, it plan consists of a basic plan document, plan that is substantially similar to the
will be treated as a mass submitter with an adoption agreement, and unless the VS practitioner’s specimen plan. A VS
respect to all the other basic plan basic plan document incorporates a practitioner may submit any number of
documents and associated adoption trust or custodial account agreement the specimen plans for advisory letters
agreements for which it requests opinion provisions of which are applicable to all provided that the 30 employer-clients
letters, regardless of the number of adopting employers, a trust or custodial requirement is separately satisfied with
identical adopters of such other plans. A account document. respect to each specimen plan. For this
mass submitter of a VS plan will be purpose, where an adoption format is
treated as such for each specimen plan Specimen plan. A specimen plan is a
for which the 30-unaffiliated- sample plan, including the related trust used, each adoption agreement is
practitioners requirement is separately or custodial account agreement, of a VS treated as one specimen plan.
met. practitioner (rather than the actual plan Notwithstanding the above, any person
of an employer). A specimen plan may that has an established place of
Notwithstanding the above, for an include an adoption agreement. business in the United States where it is
M&P plan, any entity that received a accessible during every business day
favorable TRA'86 opinion letter for a plan Sponsor. Any person that has an may sponsor a specimen plan as a
as a mass submitter under Rev. Proc. established place of business in the word-for-word identical adopter of a
89-9, 1989-1 C.B. 780, will continue to United States where it is accessible specimen plan of a VS mass submitter,
be treated as a mass submitter if it during every business day and regardless of the number of employers
submits applications on behalf of at least represents to the Service that it has at that are expected to adopt the plan.
10 sponsors (regardless of affiliation) least 30 employer-clients each of which
each of which is sponsoring, on a word- is reasonably expected to adopt the Volume submitters without adoption
for-word identical basis, the same basic sponsor’s basic plan document and one agreements. A VS specimen plan may
plan document and one or more of the or more of the adoption agreements include blanks or fill-in provisions for the
adoption agreements associated with associated with that basic plan employer to complete only if the plan
that basic plan document. Once the document. Once a person represents to also includes parameters on these
mass submitter has submitted the Service that at least 30 employers provisions that preclude an employer
applications on behalf of 10 sponsors are reasonably expected to adopt its from completing them in a manner that
with respect to any basic plan basic plan document, it will be treated could violate the qualification
document, it will be treated as a mass as a sponsor with respect to all the requirements.
submitter with respect to all the other basic plan documents and associated
basic plan documents and associated adoption agreements for which it Specific Instructions
adoption agreements for which it requests opinion letters, regardless of Line 1. All applications submitted must
requests opinion letters, regardless of the number of employers that are be accompanied by the appropriate user
the number of identical adopters of such expected to adopt such other plans. fee and Form 8717-A, User Fee for
other plans. Notwithstanding the above, any person Employee Plan Opinion or Advisory
that has an established place of Letter Request, as determined from the
Affiliation is determined under sections business in the United States where it is schedule set forth in Rev. Proc. 2013-8,
414(b) and (c) of the Code. Additionally, accessible during every business day 2013-8 I.R.B. 237, (or the most recent
the following will be considered to be and is a word-for-word identical adopter version, updated annually). Applications
affiliated: any law, accounting, or minor modifier adopter of an M&P submitted without the proper user fee
consulting firm, etc. with its partners, plan of a mass submitter will be treated will not be processed and will be
members, associates, etc. For purposes as a sponsor with respect to such plan, returned to the applicant.
of determining whether 30 (or 10, if regardless of the number of employers
applicable) unaffiliated sponsors or that are expected to adopt such plan. Line 3a. Enter the name and address of
practitioners sponsor on a word-for- the applicant. If the Post Office does not
word identical basis the same basic plan M&P standardized plan. A plan which deliver mail to the street address and
document or the same specimen plan, meets the specific requirements of the applicant has a P.O. box number,
the mass submitter is treated as an Attachment 1-A, line 11. (See show the P.O. box number instead of the
unaffiliated sponsor or practitioner. www.irs.gov/pub/irs-tege/form4461- street address.
A_attachment.pdf or Rev. Proc. 2011-49,
Master plan. A form of plan that is 2011-44 I.R.B. 615.) Line 4a. If the person to be contacted is
made available by a sponsor for other than an employee of the applicant,
adoption by employers for which a please enclose an authorized power of
single funding medium (for example, a attorney. See Disclosure requested by
trust or custodial account, see section taxpayer, earlier.

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Form 4461-A (Rev. 3-2013) Page 5
Line 4c. The applicant should include an Line 7. Indicate if this plan provides for Privacy Act and Paperwork Reduction
email address in order for the Service to permitted disparity in accordance with Act Notice. We ask for the information
send an email of preliminary approval sections 401(a)(5) and 401(l). on this form to carry out the Internal
notifying the applicant that review of the Line 9. Procedural requirements. A Revenue laws of the United States. You
applicable plan has been completed, separate application must be submitted are required to give us this information.
subject to final approval by opinion or for each different plan/adoption We need it to determine whether you
advisory letter. agreement combination. meet the legal requirements for plan
approval.
Line 5a. Enter the two-digit basic plan In the case of a VS plan, submit a
document number you have assigned to separate application for each type of You are not required to provide the
the specimen plan or basic plan plan. information requested on a form that is
document that accompanies (if subject to the Paperwork Reduction Act
applicable) the adoption agreement for Line 9d. If you checked “Yes,” submit a
which you are requesting approval. All copy of such plan with language unless the form displays a valid OMB
basic or specimen plan documents from differences highlighted. Attach a cover control number. Books or records
one sponsor or practitioner that are the letter which provides the name and file relating to a form or its instructions must
same (word-for-word) should use the folder number of the plan (including the be retained as long as their content may
same two-digit number on all name and EIN of the sponsor), a list of become material in the administration of
applications. The first basic plan all plans written by the plan drafter any Internal Revenue law. Generally, tax
document submitted should be which are substantially identical to the returns and return information are
numbered “01,” the second, “02,” etc. lead plan (including the information confidential, as required by Code section
The first specimen plan document described above), a description of each 6103.
submitted should be numbered “01,” the place where the plan for which the The time needed to complete and file
second “02,” etc. application is being submitted is not this form will vary depending on the
word-for-word identical to the language individual circumstances. The estimated
Line 5b. Enter the three-digit number of the lead plan (including an average time is:
you have assigned to the adoption explanation of the purpose and effect of Recordkeeping . . . . 42 hr., 5 min.
agreement for which this application is each difference), and a certification,
submitted. Each different adoption made under penalty of perjury by the Learning about the law
agreement designed to accompany a plan drafter, that the information or the form . . . . 5 hr., 55 min.
single basic plan document or specimen describing where the plan language is Preparing the form . . 7 hr., 48 min.
plan should be given a different three- not word-for-word identical is true and
digit number beginning with “001.” For complete. Copying, assembling, and
example, if the first basic plan document sending the form to the IRS . 16 min.
of a sponsor has four different adoption Line 9f. The mass submitter should use
agreements, they should be numbered Form 4461-B, Application for Approval If you have comments concerning the
“001” through “004,” and four different of Master or Prototype or Volume accuracy of these time estimates or
Forms 4461-A should be submitted. Submitter Plans, Mass Submitter suggestions for making this form
Adoption agreements submitted with the Adopting Sponsor or Practitioner, when simpler, we would be happy to hear
second or any subsequent basic plan submitting applications on behalf of its from you. You can write to the Internal
documents or specimen plans (that are adopting sponsors/practitioners, and Revenue Service, Tax Products
not word-for-word identical to a submit Form 8717-A. Coordinating Committee,
SE:W:CAR:MP:T:M:S, 1111 Constitution
previously submitted basic plan Ave., NW, IR-6526, Washington, DC
document) should be similarly 20224. Do not send this form to this
numbered beginning with “001.” address. Instead, see Where To File,
earlier.

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