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Application for Approval of Standardized
Form 4461 OMB No. 1545-0169
(Rev. November 2018) or Nonstandardized Pre-Approved
Department of the Treasury Defined Contribution Plans
Internal Revenue Service ▶ Go to www.irs.gov/Form4461 for the latest information. This Form Is Open to Public Inspection
File This Form With the Internal Revenue Service For IRS Use Only

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

Complete every applicable item on this form and Attachment 1 (see Rev. Proc. 2017-41, 2017-29 I.R.B. 92).

See instructions before completing this form.
1 Enter amount of user fee submitted
$
2 a Approval requested: Initial application 2b File folder number 2c Date of last
Amendment—Enter file folder number in 2b and date letter issued
of last letter issued in 2c.
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):
Provider Mass submitter
4a Name of person to be contacted 4b Telephone number 4c Fax number

4 d Email address
4e If a power of attorney is attached, check the box . . . ▶
5a Basic plan document or single document plan number 5b Adoption agreement number, if applicable

6 Form of plan:
Adoption agreement plan Single document plan
7 Type of plan (select all that apply):
Money purchase Target benefit ESOP Governmental
Profit-sharing Profit-sharing/401(k) Nonelecting church
8 Filing status of plan:
Standardized plan Nonstandardized 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 Paperwork Reduction Act Notice, see the instructions. Cat. No. 41676M Form 4461 (Rev. 11-2018)

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Form 4461 (Rev. 11-2018)                                                                                                      Page  2 
9     Procedural requirements:                                                                                         Yes       No 
a     Have the following been submitted as required by instructions— 
      (1)  Adoption agreement, if applicable?       . .    . . .  . .  . .   . . .    . .    .  . . .    . . . . .
      (2)  Copy of plan?      . .  .  .  .    .   . . .    . . .  . .  . .   . . .    . .    .  . . .    . . . . .
      (3)  Copy of Certification of Interim Amendments?  .     .  . .  . .   . . .    . .    .  . . .    . . . . .

b     Do you have a procedure in place for the adoption and distribution of interim amendments made on behalf of
      adopting employers?  .    .  .  .  .    .   . . .    . . .  . .  . .   . . .    . .    .  . . .    . . . . .

c     Is the plan patterned after, and substantially the same as, another plan submitted?  (If “Yes,” see specific 
      instructions.)     .  . . .  .  .  .    .   . . .    . . .  . .  . .   . . .    . .    .  . . .    . . . . .

d     Provider (non-mass submitter) request. Complete (1) and (2).
      (1)  Do you have at least 15 employer-clients which are reasonably expected to adopt this plan’s basic plan 
           document and adoption agreement or single document plan? .        . . .    . .    .  . . .    . . . . .
      (2)  If you have more than one pre-approved plan, do you have at least 30 employer-clients in the aggregate 
           which are reasonably expected to adopt at least one of the plans?  .  .    . .    .  . . .    . . . . .

e     Mass submitter request. Complete (1),(2),and (3).
      (1)  Are applications on behalf of the requisite number of providers 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 providers 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 providers 
               and the coordination of optional provisions? .     . .  . .   . . .    . .    .  . . .    . . . . .
Note: This application is designed to be used in conjunction with Rev. Proc. 2017-41. 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 (Rev. 11-2018)

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Form 4461 (Rev. 11-2018) Page 3
General Instructions file Form(s) 4461-B, Application for Disclosure requested by taxpayer. A
Approval of Standardized or taxpayer may request the IRS to
Section references are to the Internal Nonstandardized Pre-Approved Plans, disclose and discuss the return or return
Revenue Code unless otherwise noted. as needed. information with any person(s) the
Future Developments Multiple adoption agreement plans. A taxpayer designates in a written request.
provider may utilize one basic plan If you want to designate a person(s) to
For the latest information about document for severalplans. A provider assist in an application for approval, you
developments related to Form 4461, may, for example, useone basic plan must provide the IRS office of
such as legislation enacted after the document for a moneypurchase plan jurisdiction with a written request that
form was published, go to other than a target benefitplan, a target contains:
www.irs.gov/Form4461. benefit plan, and aprofit-sharing plan. A • The taxpayer’s name, address,
separate adoption agreement and employer identification number, and plan
Purpose of Form completed applicationmay need to be number(s).
Form 4461 is used to apply for approval provided for each such defined • The name, address, social security
of standardized or nonstandardized contribution plan. See section 9.06 of number, and telephone number(s) of the
pre-approved defined contribution plans. Rev. Proc. 2017-41 for more details, person or persons whom you are
including special rules for ESOP, authorizing to receive return information.
Be sure to submit a complete and governmental, and nonelecting church
accurate application, including Form plans. In the case of a simultaneous • A paragraph that clearly describes the
4461 and Attachment 1 (see submission of plans using the same return or return information that you
www.irs.gov/retirement-plans/ basic plan document, submit only one authorize the IRS to disclose.
preapproved-plan-submission- copy of the basic plan document. If the • An authorized signature (see above).
procedures or Rev. Proc. 2017-41, requests aren’t simultaneous, submit
2017-29 I.R.B. 92). Complete every separate basic plan documents and As an alternative to providing the above
applicable line on the application. If an include a cover letter identifying the statement, you may submit Form 2848,
item on Attachment 1 doesn’t apply, original submission. The number Power of Attorney and Declaration of
check the “N/A” box or enter “N/A” on assigned to the basic plan document of Representative.
the line where indicated as an option. If a standardized or nonstandardized pre-
your application isn’t complete, we will approved plan must remain the same as Definitions
return it without processing it. The first in the prior submission. One basic plan Adoption agreement. The portion of the
page must be typed. Unless otherwise document may not be used for both plan containing all the options that the
noted, the questions on Form 4461 and defined benefit and defined contribution adopting employer may select. The
Attachment 1 apply to both standardized plans. adoption agreement may include blanks
and nonstandardized pre-approved or fill-in provisions for the employer to
defined contribution plans. Two or more single document plans. A
provider may not combine different complete if it also includes parameters
Requests for additional information. If categories in a single document plan or on these provisions that preclude an
a letter requesting additional information application, except that only one single employer from completing them in a
or changes to plan documents is sentto document plan and application is manner that could violate the
the pre-approved plan provider or an required for a profit-sharing plan, with or qualification requirements. Each
authorized representative, such without a 401(k) arrangement and a separate adoption agreement is treated
information and/or changes must be money purchase plan. See section 9.07 as a separate plan and will receive its
received no later than 30 days from the of Rev. Proc. 2017-41 for more details, own opinion letter.
date of the letter. Failure to respond including special rules for ESOP, Basic plan document. The portion of
timely may result in the application being governmental, and nonelecting church the plan containing all the nonelective
considered withdrawn. An extension of plans. provisions applicable to all adopting
the 30-day time limit will only be granted employers. No options (including blanks
for good cause. Where To File to be completed) may be provided in the
Inadequate submissions. We will Send Form 4461 to: basic plan document except for options
return, without further action, plans that in flexible plans.
aren’t in substantial compliance withthe Internal Revenue Service
qualification requirements or plansthat Attn: Pre-Approved Plans Coordinator Single document plan. A single
are so deficient that they can’t be Room 6-403, Group 7521 document plan may contain alternate
reviewed in a reasonable amount of P.O. Box 2508 paragraphs and options that may be
time. Cincinnati, OH 45201-2508 selected by an adopting employer. A
single document plan may include
If using Express Mail or a private blanks or fill-in provisions for the
Who May File delivery service, use this address: employer to complete only if the plan
A provider or mass submitter of a Internal Revenue Service also includes parameters on these
pre-approved defined contribution plan Attn: Pre-Approved Plans Coordinator provisions that preclude an employer
may file a Form 4461. See Definitions, Room 6-403, Group 7521 from completing them in a manner that
later. 550 Main Street could violate the qualification
Cincinnati, OH 45202 requirements.
What To File
Signature. The application must be
Submit one copy of Form 4461 and signed by a partner or officer of the
Attachment 1 for each separate adoption applicant who is authorized to sign or
agreement or for each single document other person authorized by a power of
plan where no adoption agreement is attorney. The power of attorney should
utilized. For approval, file this application be filed with the application.
and each applicable document listed in
line 9(a). A mass submitter should also

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Form 4461 (Rev. 11-2018) Page 4

Flexible plan. A plan submitted by a Provider. A provider is any person Specific Instructions
mass submitter which containscertain (including a mass submitter, if
optional provisions as allowed by applicable) that (1) has an established Line 1. All applications submitted must
section 10.03(1) of Rev. Proc. 2017-41. place of business in the United States be accompanied by the appropriate user
Providers which adopt a flexible plan where it is accessible during every fee and Form 8717-A, User Fee for
may include or delete any optional business day; and (2) represents to the Employee Plan Opinion Letter Request,
provision designatedas such in the IRS that it has at least 15 employer- as determined from the schedule in Rev.
mass submitter’s plan. A flexible plan clients, each of which is reasonably Proc. 2018-4, 2018-1 I.R.B. 146 (or the
adopted by a provider which differs from expected to adopt the same most recent version, updated annually).
the mass submitterplan only because of pre-approved plan of the provider. Applications submitted without the
the deletion of certain optional A provider may request an opinion proper user fee won’t be processed and
provisions will be treatedas a plan that letter for more than one plan provided it will be returned to the applicant.
is word-for-word identical to the mass represents to the IRS that it has at least Line 3a. Enter the name and address of
submitter plan. 30 employer-clients in the aggregate, the applicant. If the Post Office doesn’t
Mass submitter. As set forth in Rev. each of which is reasonably expected to deliver mail to the street address and
Proc. 2017-41, any entity that submits adopt at least one of the provider’s the applicant has a P.O. box number,
applications on behalf of at least 30 plans. show the P.O. box number instead of the
unaffiliated providerseach of which is A provider also includes any person street address.
sponsoring, on a word-for-word identical that has an established place of Line 4a. If the person to be contacted is
basis, the same plan. A mass submitter business in the United States where it is other than an employee of the applicant,
is treated as a mass submitter with accessible during every business day please enclose an authorized power of
respect to all of its plans, provided the and offers a plan as a word-for-word attorney. See Disclosure requested by
30-unaffiliated-provider requirement is identical adopter or minor modifier taxpayer ,earlier.
met with respect to at least one plan. adopter of a plan of a mass submitter, Line 4c. Enter a fax number to receive
Affiliation is determined under sections regardless of the number of employers notice of preliminary approval of the
414(b) and (c). Additionally, the following that are expected to adopt the plan. applicable plan, subject to final approval
will be considered to be affiliated: any Standardized plan. A standardized plan by opinion letter.
law firm, accounting firm, consulting is a pre-approved plan (other than an Line 5a. Enter the two-digit number you
firm, etc., with its partners, members, ESOP or statutory hybrid plan) that have assigned to your single document
associates, etc. For purposes of meets the requirements set forth in plan or basic plan document that
determining whether 30 unaffiliated section 5.16 of Rev. Proc. 2017-41. accompanies the adoption agreement
providers sponsor on a word-for-word
identical basis the same plan document, Nonstandardized plan. A for which you are requesting approval. If
the mass submitter is treated as an nonstandardized plan is a pre-approved multiple adoption agreements are linked
unaffiliated provider. plan that isn’t a standardized plan and to the same basic plan document, the
that satisfies section 5.15 of Rev. Proc. same two-digit basic plan document
Pre-approved plan. A pre-approved 2017-41. number should be used for all
plan is a plan (including a plan covering applications.
self-employed individuals) that is made ESOP. An ESOP is an employee stock
available by a provider for adoption by ownership plan within the meaning of
employers. The term pre-approved plan section 4975(e)(7).
includes both standardized and Statutory hybrid plan. A statutory
nonstandardized plans. A pre-approved hybrid plan is a defined benefit plan that
plan may be an adoption agreement plan contains a statutory hybrid benefit
or a single document plan. An adoption formula, as defined in Regulations
agreement plan consists of a basic plan section 1.411(a)(13)-1(d)(4). See section
document and an adoption agreement. A 6.03 of Rev. Proc. 2017-41 which limits
single document plan consists of a the type of statutory hybrid plan to a
single plan document offered by a cash balance plan.
provider without an adoption agreement.

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Form 4461 (Rev. 11-2018) Page 5

Line 5b. Enter the three-digit number number of the provider), a list of all plans You aren’t required to provide the
you have assigned to the adoption written by the plan drafter which are information requested on a form that is
agreement for which this application is substantially identical to the lead plan subject to the Paperwork Reduction Act
submitted. Each different adoption (including the information described unless the form displays a valid OMB
agreement designed to accompany a above), a description of each place control number. Books or records
single basic plan document should be where the plan for which the application relating to a form or its instructions must
given a different three-digit number is being submitted isn’t word-for-word be retained as long as their content may
beginning with “001.” For example, if the identical to the language of the lead plan become material in the administration of
first basic plan document of a provider (including an explanation of the purpose any Internal Revenue law. Generally,
has four separate adoption agreements, and effect of each difference), and a tax return and return information are
they should be numbered “001” through certification, made under penalty of confidential, as required by
“004,” and the provider should submit perjury by the plan drafter, that the section 6103.
four separate Forms 4461. Adoption information describing where the plan The time needed to complete and file
agreements submitted with the second language isn’t word-for-word identical is this form will vary depending on
or any subsequent basic plan true and complete. individual circumstances. The estimated
documents (that aren’t word-for-word Line 9e. In addition to filing Form 4461, average time is:
identical to a previously submitted basic the mass submitter should use Form Recordkeeping . . . . 8 hr., 22 min.
plan document) should be similarly 4461-B when submitting applications on
numbered beginning with “001.” behalf of its adopting providers, and Learning about the law
Line 9. Procedural requirements. submit Form 8717-A. or the form . . . . . 1 hr., 42 min.
Submit aseparate applicationfor each Preparing the form . . 4 hr., 42 min.
different plan/adoption agreement Paperwork Reduction Act Notice. Copying, assembling, and
combination or single document plan. We ask for the information on this form sending the form to the IRS . 48 min.
Line 9c. If you checked “Yes,” submit a to carry out the Internal Revenue laws of
copy of such plan with language the United States. You are required to If you have comments concerning the
differences highlighted. Attach a cover give us the information. We need it to accuracy of these time estimates or
letter which provides the name and file determine whether you meet the legal suggestions for making this form
folder number of the plan (including the requirements for plan approval. simpler, we would be happy to hear
name and employer identification from you. You can send us comments
from www.irs.gov/FormComments. Or
you can write to the Internal Revenue
Service, Tax Forms and Publications
Division, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don’t
send Form 4461 to this address. Instead,
see Where To File, earlier.

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