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Application for Approval of Master
Form 4461 OMB No. 1545-0169
(Rev. January 2012) or Prototype or Volume Submitter
Department of the Treasury This Form Is Open to Public Inspection
Internal Revenue Service Defined Contribution Plans
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. 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: Initial application 2b M&P - File folder number or 2c Date of last
Amendment—Enter file folder number or letter serial VS - Letter serial number letter issued
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 Type of plan:
Money purchase Target benefit
Profit-sharing Profit-sharing/401(k)

8 Filing status of plan:
Standardized plan Volume submitter governmental plan (i.e., described in section 414(d))
Nonstandardized plan 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 Paperwork Reduction Act Notice, see the instructions. Cat. No. 41676M Form 4461 (Rev. 1-2012)

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Form 4461 (Rev. 1-2012)                                                                                                           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 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  (or  10 
           employer-clients  reasonably  expected  to  adopt  a  money  purchase  pension  plan  (MP),  if  you  have  a 
           specimen  MP  and  at  least  one  other  type  of  specimen  plan  that  satisfies  the  30  employer-client 
           requirement)?       . . .  .  .    .   . . .    . . .  . .  . .   . . .    . .    .  . . .    . . . . .
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 sponsors 
               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 (Rev. 1-2012)

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Form 4461 (Rev. 1-2012) Page 3
General Instructions agreement and completed application • A paragraph that clearly describes the
must be provided for each such defined return or return information that you
Purpose of Form contribution plan. In the case of a authorize the IRS to disclose.
simultaneous submission of plans using • An authorized signature (see above).
Form 4461 is used to apply for approval the same basic plan document, submit
of Master or Prototype (M&P) or Volume only one copy of the basic plan As an alternative to providing the above
Submitter (VS) defined contribution document. If the requests are not statement, you may submit Form 2848,
plans. simultaneous, submit separate basic Power of Attorney and Declaration of
Be sure to submit a complete and plan documents and include a cover Representative.
accurate application, including Form letter identifying the original submission.
4461 and Attachment 1 (see The number assigned to the basic plan Definitions
www.irs.gov/pub/irs-tege/ document of a master or prototype plan Adoption agreement. The portion of the
form4461_attachment.pdf or Rev. Proc. must remain the same as in the prior plan containing all the options that the
2011-49, 2011-44 I.R.B. 608). Complete submission. One basic plan document adopting employer may select. The
every applicable line on the application. may not be used for both defined benefit adoption agreement may include blanks
If an item on Attachment 1 does not and defined contribution plans. or fill-in provisions for the employer to
apply, check the “N/A” box or enter A VS practitioner may not combine complete if it also includes parameters
“N/A” on the line where indicated as an different categories in a single specimen on these provisions that preclude an
option. If your application is not plan or application, except that only one employer from completing them in a
complete, we will return it without specimen plan and application is manner that could violate the
processing it. The first page must be required for a VS profit-sharing plan, qualification requirements. Each
typed. Unless otherwise noted, the with or without a 401(k) arrangement. In separate adoption agreement is treated
questions on Form 4461 and Attachment addition, you may not use the same as a separate plan and will receive its
1 apply to both M&P and VS defined basic plan document for governmental own opinion or advisory letter.
contribution plans. plans (i.e., plans described in section Basic plan document. The portion of
Requests for additional information. If 414(d) and nongovernmental plans (i.e., the plan containing all the nonelective
a letter requesting additional information plans not described in section 414(d)). provisions applicable to all adopting
or changes to plan documents is sent to employers. No options (including blanks
the sponsor or VS practitioner or an Where To File to be completed) may be provided in the
authorized representative, such basic plan document except for options
information and/or changes must be Send applications for opinion and
received no later than 30 days from the advisory letters to: in flexible plans.
date of the letter. Failure to respond Internal Revenue Service Volume Submitters without Adoption
timely may result in the application being P.O. Box 2508; Room 5106 Agreements. A VS specimen plan may
considered withdrawn. An extension of Cincinnati, OH 45201 include blanks or fill-in provisions for the
employer to complete only if the plan
the 30-day time limit will only be granted Add “Attn: Pre-approved also includes parameters on these
for good cause. Plans Coordinator.” provisions that preclude an employer
Inadequate submissions. We will For both types of applications, send a from completing them in a manner that
return, without further action, plans that request shipped by Express Mail or a could violate the qualification
are not in substantial compliance with delivery service to the attention of the requirements.
the qualification requirements or plans Pre-approved Plans Coordinator to: Flexible plan. A plan submitted by an
that are so deficient that they cannot be
reviewed in a reasonable amount of Internal Revenue Service M&P mass submitter which contains
time. 550 Main Street certain optional provisions as allowed by
P.O. Box 2508; Room 5106 section 12.03(1) of Rev. Proc. 2011-49.
Who May File Cincinnati, OH 45202 Sponsors which adopt a flexible plan
may include or delete any optional
Master or prototype plans. Sponsors Signature. The application must be provision designated as such in the
and mass submitters (see Definitions signed by a partner or officer of the mass submitter’s plan. A flexible plan
later). applicant who is authorized to sign or adopted by a sponsor which differs from
other person authorized by a power of
Volume submitter plans. Practitioners the mass submitter plan only because of
attorney. The power of attorney should
and mass submitters (see Definitions the deletion of certain optional
be filed with the application.
later). provisions will be treated as a word-for-
Disclosure requested by taxpayer. A word identical plan to the mass
What To File taxpayer may request the IRS to submitter plan.
Submit one copy of Form 4461 and disclose and discuss the return or return Mass submitter. As set forth in Rev.
Attachment 1 for each separate adoption information with any person(s) the Proc. 2011-49, any entity that submits
agreement or for each separate taxpayer designates in a written request. applications on behalf of at least 30
specimen plan where no adoption If you want to designate a person(s) to unaffiliated sponsors or practitioners
agreement is utilized. assist in an application for approval, you each of which is sponsoring, on a word-
must provide the IRS office of for-word identical basis, the same basic
For approval, file this application and jurisdiction with a written request that plan document and one or more of the
each applicable document listed in line contains: adoption agreements associated with
9(a).
• The taxpayer’s name, address, that basic plan document or, in the case
Multiple plans. A sponsor may utilize employer identification number, and plan of VS plans, one or more of the same
one basic plan document for several number(s). lead specimen plans. For a mass
plans. A sponsor may, for example, use submitter of an M&P, once the mass
one basic plan document for a money • The name, address, social security submitter has submitted applications on
purchase plan other than a target benefit number, and telephone number(s) of the
plan, a target benefit plan, and a profit- person or persons whom you are
sharing plan. A separate adoption authorizing to receive return information.

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Form 4461 (Rev. 1-2012) Page 4
behalf of 30 unaffiliated sponsors with basic plan document incorporates a adoption agreement is treated as one
respect to any basic plan document, it trust or custodial account agreement the specimen plan. Notwithstanding the
will be treated as a mass submitter with provisions of which are applicable to all above, any person that has an
respect to all the other basic plan adopting employers, a trust or custodial established place of business in the
documents and associated adoption account document. United States where it is accessible
agreements for which it requests opinion Specimen plan. A specimen plan is a during every business day may sponsor
letters, regardless of the number of sample plan, including the related trust a specimen plan as a word-for-word
identical adopters of such other plans. A or custodial account, of a VS practitioner identical adopter of a specimen plan of a
mass submitter of a VS plan will be (rather than the actual plan of an VS mass submitter, regardless of the
treated as such with respect to each employer). A specimen plan may include number of employers that are expected
specimen plan for which the 30- an adoption agreement. to adopt the plan.
unaffiliated-practitioners requirement is M&P Standardized plan. A plan which
separately met. Sponsor. Any person that has an
established place of business in the meets the specific requirements of
Notwithstanding the above, for an United States where it is accessible Attachment 1, line 11. (See www.irs.gov/
M&P plan, any entity that received a during every business day and pub/irs-tege/form4461_attachment.pdf
favorable TRA ’86 opinion letter for a represents to the IRS that it has at least or Rev. Proc. 2011-49, 2011-44 I.R.B.
plan as a mass submitter under Rev. 30 employer-clients each of which is 615.)
Proc. 89-9, 1989-1 C.B. 780, will reasonably expected to adopt the
continue to be treated as a mass sponsor’s basic plan document and one Specific Instructions
submitter if it submits applications on or more of the adoption agreements Line 1. All applications submitted must
behalf of at least 10 sponsors associated with that basic plan be accompanied by the appropriate user
(regardless of affiliation) each of which is document. Once a person represents to fee and Form 8717, User Fee for
sponsoring, on a word-for-word identical the Service that at least 30 employers Employee Plan Determination, Opinion
basis, the same basic plan document are reasonably expected to adopt its and Advisory Letter Request, as
and one or more of the adoption basic plan document, it will be treated determined from the schedule in Rev.
agreements associated with that basic as a sponsor with respect to all the Proc. 2012-8, 2012-1 I.R.B. 235, (or the
plan document. Once the mass basic plan documents and associated most recent version, updated annually).
submitter has submitted applications on adoption agreements for which it Applications submitted without the
behalf of 10 sponsors with respect to requests opinion letters, regardless of proper user fee will not be processed
any basic plan document, it will be the number of employers that are and will be returned to the applicant.
treated as a mass submitter with respect expected to adopt such other plans.
to all the other basic plan documents Notwithstanding the above, any person Line 3a. Enter the name and address of
and associated adoption agreements for that has an established place of the applicant. If the Post Office does not
which it requests opinion letters, business in the United States where it is deliver mail to the street address and
regardless of the number of identical accessible during every business day the applicant has a P.O. box number,
adopters of such other plans. and is a word-for-word identical adopter show the P.O. box number instead of the
Affiliation is determined under sections or minor modifier adopter of an M&P street address.
414(b) and (c) of the Code. Additionally, plan of a mass submitter will be treated Line 4a. If the person to be contacted is
the following will be considered to be as a sponsor with respect to such plan, other than an employee of the applicant,
affiliated: any law, accounting, regardless of the number of employers please enclose an authorized power of
consulting firm, etc. with its partners, that are expected to adopt such plan. attorney. See Disclosure requested by
members, associates, etc. For purposes Practitioner. Any person that has an taxpayer , earlier.
of determining whether 30 (or 10, if established place of business in the Line 4c. The applicant should include an
applicable) unaffiliated sponsors or United States where it is accessible email address in order for the Service to
practitioners sponsor on a during every business day and send an email of preliminary approval
word-for-word identical basis the same represents to the Service that it has at notifying the applicant that review of the
basic plan document or the same least 30 employer-clients each of which applicable plan has been completed,
specimen plan, the mass submitter is is reasonably expected to adopt a plan subject to final approval by opinion or
treated as an unaffiliated sponsor or that is substantially similar to the VS advisory letter.
practitioner. practitioner’s specimen plan.
Line 5a. Enter the two-digit basic plan
Master plan. A form of plan that is made The required number of employer- document number you have assigned to
available by a sponsor for adoption by clients is reduced to 10 for a money the specimen plan or basic plan
employers for which a single funding purchase pension specimen plan in the document that accompanies (if
medium (for example, a trust or custodial case of a VS practitioner that has applicable) the adoption agreement for
account, see section 4.01 of Rev. Proc. specimen plans for two or more which you are requesting approval. All
2011-49) is established, as part of the separate categories of plans (profit basic or specimen plan documents from
plan, for the joint use of all adopting sharing, money purchase, target benefit), one sponsor or practitioner that are the
employers. A master plan consists of a one of which is a money purchase plan, same (word-for-word) should use the
basic plan document, an adoption and the 30 employer-clients requirement same two-digit number on all
agreement, and, unless included in the has been satisfied with respect to the applications. The first basic plan
basic plan document, a trust or custodial other specimen plan. document submitted should be
account document.
A VS practitioner may submit any numbered “01,” the second, “02,” etc.
Prototype plan. A form of plan that is number of specimen plans for advisory The first specimen plan document
made available by a sponsor for letters provided that the 30 employer- submitted should be numbered “01,” the
adoption by employers under which a clients requirement (or 10, if applicable) second, “02,” etc.
separate funding medium is established is separately satisfied with respect to
for each adopting employer. A prototype each specimen plan. For this purpose,
plan consists of a basic plan document, where an adoption format is used, each
an adoption agreement, and, unless the

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Form 4461 (Rev. 1-2012) Page 5
Line 5b. Enter the three-digit number Line 9d. If you checked “Yes,” submit a You are not required to provide the
you have assigned to the adoption copy of such plan with language information requested on a form that is
agreement for which this application is differences highlighted. Attach a cover subject to the Paperwork Reduction Act
submitted. Each different adoption letter which provides the name and file unless the form displays a valid OMB
agreement designed to accompany a folder number of the plan (including the control number. Books or records
single basic plan document should be name and employee identification relating to a form or its instructions must
given a different three-digit number number of the sponsor), a list of all plans be retained as long as their content may
beginning with “001.” For example, if the written by the plan drafter which are become material in the administration of
first basic plan document of a sponsor substantially identical to the lead plan any Internal Revenue law. Generally,
has four separate adoption agreements, (including the information described tax return and return information are
they should be numbered “001” through above), a description of each place confidential, as required by Code
“004,” and the sponsor should submit where the plan for which the application section 6103.
four separate Forms 4461. Adoption is being submitted is not word-for-word The time needed to complete and file
agreements submitted with the second identical to the language of the lead plan this form will vary depending on
or any subsequent basic plan (including an explanation of the purpose individual circumstances. The estimated
documents (that are not word-for-word and effect of each difference), and a average time is:
identical to a previously submitted basic certification, made under penalty of
plan document) should be similarly perjury by the plan drafter, that the Recordkeeping . . . . 8 hr., 22 min.
numbered beginning with “001.” information describing where the plan Learning about the law
language is not word-for-word identical or the form . . . . . 1 hr., 42 min.
Line 9. Procedural requirements. is true and complete.
Submit a separate application for each Preparing the form . . 4 hr., 42 min.
different plan/adoption agreement Line 9f. The mass submitter should use
combination. Form 4461-B, Application for Approval of Copying, assembling, and
Master or Prototype or Volume sending the form to the IRS . 48 min.
In the case of a VS plan, submit a Submitter Plans, Mass Submitter If you have comments concerning the
separate application for each type of Adopting Sponsor or Practitioner, when accuracy of these time estimates or
plan, except that only one specimen plan submitting applications on behalf of its suggestions for making this form
and application is required for a VS adopting sponsors, and submit Form simpler, we would be happy to hear
profit-sharing plan, either with or without 8717. from you. You can write to the Internal
a 401(k) arrangement. Revenue Service, Tax Products
Paperwork Reduction Act Notice. Coordinating Committee,
We ask for the information on this form SE:W:CAR:MP:T:M:S, 1111 Constitution
to carry out the Internal Revenue laws of Ave. NW, IR-6526, Washington, DC
the United States. You are required to 20224. Do not send this form to this
give us the information. We need it to office. Instead, see Where To File earlier.
determine whether you meet the legal
requirements for plan approval.

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