For applications submitted to conform to the 2020 RA List

Employee                                                       Explanation No. 3

Benefit                                                        Joint and Survivor

                                                               Determination of
Plans
                                                               Qualification

Note:                                                          The purpose of Worksheet Number 3 (Form 5625) and this 
                                                               explanation is to identify major problems regarding joint and 
Plans submitted during the 2020 Required Amendment List        survivor annuity requirements under Internal Revenue Code 
submission period must satisfy the applicable changes in       sections 401(a)(11) and 417. However, there may be issues 
plan qualification requirements listed in Section IV of Notice not  mentioned  in  the  worksheet  that  could  affect  the  plan’s 
2020-83, 2020-50 I.R.B. 1597 (the 2020 RA List).               qualification.
This publication contains copies of:                           The joint and survivor annuity requirements of sections 401(a)
Form 5625, Worksheet 3                                         (11) and 417 apply to plans to which section 411 applies, except 
Form 6042, Deficiency Checksheet 3                             those  mentioned  in  section  411(e)  (such  as  governmental 
                                                               plans).
These forms are included as examples only and should not 
be completed and returned to the Internal Revenue Service.     Generally, a “Yes” answer to a question on the worksheet 
                                                               indicates a favorable conclusion while a “No” answer signals 
                                                               a  problem  concerning  the  plan  qualification.  This  rule  may 
                                                               be  altered  by  specific  instructions  for  a  given  question. 
                                                               Please explain any “No” answer in the space provided on the 
                                                               worksheet.
                                                               The sections cited at the end of each paragraph of explanation 
                                                               are  to  the  Internal  Revenue  Code  and  the  Income  Tax 
                                                               Regulations.

                                                               The technical principles in this publication may be changed by 
                                                               future regulations or guidelines.

Publication 6391 (Rev. 6-2021)  Catalog Number 48171W  Department of the Treasury  Internal Revenue Service  www.irs.gov

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I. Applicability
The survivor annuity requirements of sections 401(a)(11) and 417 apply to all defined benefit plans and all other plans subject to the funding 
standards of section 412 (i.e., money purchase pension plans, including target benefit plans). There is a special exception, described 
below, for certain money purchase plans that are part of ESOPs. The requirements do not apply to defined contribution plans (other than 
money purchase and target benefit plans) that meet all of the following requirements:
a)  the plan provides that the participant’s nonforfeitable accrued benefit is payable in full, on the participant’s death, to the surviving 
         spouse (unless the participant elects with spousal consent that the benefit be paid instead to a designated beneficiary);
b)  the participant does not elect to receive benefits in the form of a life annuity; and
c)  the plan is not a transferee or offset plan with respect to the participant.
Requirements b) and c) are applied on a participant by participant basis. Therefore, a profit-sharing or stock bonus plan, for example, could 
be subject to the survivor annuity requirements of sections 401(a)(11) and 417 with respect to some participants but not others. See I.b., 
below.
The law provides a special rule in the case of a money purchase ESOP. The portion of a participant’s accrued benefit under such a plan 
that is subject to section 409(h) (“put options”) is treated as though it were provided under a defined contribution plan not subject to section 
412. Thus, if the requirements in a), b), and c), above, are met, the 409(h) part of the participant’s benefit in the money purchase ESOP is 
exempt from the survivor annuity requirements.
401(a)(11)
1.401(a)-20 Q&A 3

Line a. To be exempt from the survivor annuity requirements of sections 401(a)(11) and 417, a defined contribution plan not subject to 
section 412 must provide that the participant’s nonforfeitable accrued benefit is payable in full, on the participant’s death, to the surviving 
spouse or (if there is no surviving spouse, or if the surviving spouse consents in the manner described below) to a designated beneficiary. 
Thus, there can be no forfeiture to the plan on account of death. 
An exception allows a plan to provide that the nonforfeitable account balance is not required to be paid to the surviving spouse if the 
participant and spouse have not been married throughout the one-year period ending on the earlier of the participant’s annuity starting date 
or date of death. 
A participant may waive this spousal benefit in favor of a designated beneficiary at any time provided the spouse properly consents 
to the waiver. Both the participant’s waiver and the spouse’s consent must identify the specific nonspouse beneficiary (including any 
class of beneficiaries or any contingent beneficiaries). The plan must provide that the designated beneficiary cannot be changed without 
subsequent consent by the spouse. Other rules relating to spousal consent are described in II.g., below. These also apply to the waiver of 
the spousal benefit in defined contribution plans exempted from the survivor annuity requirements. Spousal consent is not required in these 
plans for a distribution to the participant or for the use of the accrued benefit as security for a plan loan to the participant. 
A plan does not meet the requirement to pay the nonforfeitable accrued benefit in full to the surviving spouse unless the benefit is available 
to the spouse within a reasonable time after the participant’s death. For this purpose, 90 days is reasonable, and the reasonableness of 
any longer period is based on facts and circumstances. Time periods longer than 90 days are unreasonable if they are less favorable to the 
surviving spouse than any time period that applies to other distributions under the plan.
A plan will also fail this requirement if it does not adjust the spousal benefit for gains and losses occurring after the participant’s death in 
accordance with the plan’s rules for adjusting account balances for other distributions. 
A plan may provide that it will offset any loan outstanding at the participant’s death which is secured by the account balance against the 
spousal benefit.
401(a)(11)(B) and (D)
1.401(a)-20 Q&A 3, 13, 26, and 31 – 33

Line b.i. If the plan offers a life annuity benefit option and the participant selects this option, the survivor annuity requirements will thereafter 
apply with respect to that participant’s benefits under the plan. Thus, in this situation, the survivor annuity requirements may apply under 
the plan on a participant by participant basis. Also, if there is a separate accounting of the account balance subject to the participant’s life 
annuity election, the plan may provide that the survivor annuity requirements apply only to that part of the account balance 
If the plan contains a life annuity benefit option, the terms of the plan must meet the requirements described in the remainder of the 
worksheet for those participants who elect the life annuity.
401(a)(11)(B)
1.401(a)-20 Q&A 4

Line b.ii. A plan that would otherwise be exempt from the survivor annuity requirements will nevertheless have to meet these requirements 
if the plan is a transferee plan with respect to any participant. A plan is a transferee plan if it is a direct or indirect transferee of a participant’s 
benefits that were held on or after January 1, 1985 by a defined benefit plan or by a defined contribution plan that is subject to the survivor 
annuity requirements with respect to that participant. Transfers made before 1985 and rollovers made at any time will not subject the plan 

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to the survivor annuity requirements. If the plan is a transferee plan with respect to a participant, the survivor annuity requirements do not 
apply to other participants solely because of the transfer. Also, if there is an acceptable separate accounting between transferred benefits 
and other benefits, the survivor annuity requirements need only apply to the transferred benefits.
If this plan is a transferee plan or if it permits transfers from plans subject to the survivor annuity requirements, the terms of the plan must 
meet the requirements described in the remainder of the worksheet for those participants with respect to whom the plan is or may become 
a transferee plan.
401( a)(11)(B)
1.401(a)-20 Q&A 5

Line b.iii. If benefits under the plan offset benefits under a defined benefit plan, the plan must meet the requirements described in the 
remainder of the worksheet with respect to those participants whose benefits are offset. A plan will not become subject to the survivor 
annuity requirements on account of the offset, however, unless the plans are maintained by the same employer or by affiliated employers. 
For these purposes, an affiliated employer is any employer that is a member of a group described in section 414(b), (c), (m), or (o).
1.401(a)-20 Q&A 5

II. Joint And Survivor Benefits
The rules of sections 401(a)(11) and 417 apply to participants who have one hour of service or paid leave under the plan after August 22, 
1984. Sections 302 and 303 of the Retirement Equity Act of 1984 contain transition rules that apply to certain other participants, but a plan 
is not required to be amended to set forth these rules. 
The requirements that are described in the remainder of the worksheet and this explanation apply not only to a plan but also to any annuity 
contracts purchased by a plan and distributed to participants or their spouses. For example, deferred annuity contracts that are distributed 
to participants upon termination of a plan would have to provide for payment in the form of a qualified joint and survivor annuity and for 
preretirement survivor annuity coverage in the event of death prior to the time payments under the contract are to commence. The other 
rights and benefits described below would also apply to these contracts.
1.401(a)-20 Q&A 2, 39 and 42

Line a. A plan that is subject to the survivor annuity requirements must provide that a vested participant who is alive on the annuity starting 
date must receive his or her benefit in the form of a qualified joint and survivor annuity (QJSA), unless there has been a proper election by 
the participant, with spousal consent, to waive the QJSA and certain notice requirements have been met.
A vested participant is one who is vested in benefits attributable to either employer or employee contributions. Thus, employees who have 
made mandatory or voluntary contributions to a plan that is subject to the survivor annuity requirements must (absent a proper waiver) 
automatically receive their benefits in the form of a QJSA if they are alive on the annuity starting date, even if they are not vested in any 
employer derived benefits.
A QJSA is an annuity for the life of the participant with a survivor annuity for the life of the spouse which is not less than 50 percent and not 
more than 100 percent of the amount of the annuity payable during the joint lives of the participant and spouse. In the case of an unmarried 
participant, a QJSA is an annuity for the life of the participant.
In a defined contribution plan, the amount of the QJSA benefit is that which can be purchased with the participant’s nonforfeitable account 
balance, including both employer and employee contributions (although accumulated deductible employee contributions - DECs - may 
generally be excluded, as explained below). In a defined benefit plan, the entire vested accrued benefit (including any portion attributable 
to mandatory contributions) is subject to the QJSA requirements and the QJSA for a married participant must be at least as valuable as any 
other optional form of benefit that is payable under the plan at the same time. (See II.e., below.) Where an employee has made voluntary 
contributions to a defined benefit plan, the plan must maintain a separate account for these contributions and provide for their distribution 
as an automatic QJSA.
DECs that are made to either a defined contribution or defined benefit plan are treated as though they were made to a defined contribution 
plan not subject to section 412. 
Thus, if the plan provides that the account balance attributable to DECs is payable in full to the surviving spouse on the participant’s death 
and the participant does not (or cannot) elect to have them paid as a life annuity, the DECs will not be subject to the survivor annuity 
requirements.
A plan is required to pay a qualified preretirement survivor annuity (QPSA) to the surviving spouse of a vested participant who dies before 
the annuity staring date, unless the participant has waived the QPSA with spousal consent (see III, below). Thus, a correct determination 
of the annuity starting date is necessary to establish whether a benefit is to be paid as a QJSA or as a QPSA and will generally affect the 
amount of the annuity payments. The annuity starting date is also used to determine when a participant may elect with spousal consent to 
waive the QJSA and whether benefits can be forfeited on a participant’s death. 
The annuity starting date is the first day of the first period for which an amount is paid as an annuity or any other form. The actual date of a 
participant’s retirement or other separation from service is not relevant. A plan that provides that the QJSA rules apply to retired participants 
and that the QPSA rules apply prior to retirement does not satisfy the requirements of sections 401(a)(11) and 417.

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Example
A defined benefit plan provides that a participant will begin receiving monthly benefit payments starting with the month in which the 
participant attains normal retirement age under the plan (age 65), regardless of whether the participant has actually retired. Participant 
A dies on July 2, 10 days before his 65th birthday and his scheduled retirement date, and before the first benefit payment is actually 
made Participant A and his spouse have not waived the QJSA. Because A was alive on the annuity starting date (July 1), the benefit 
that the plan must pay is a QJSA.
Other rules relating to the annuity staring date are described in II.b. and g., and III.a., below. 
401(a)(11)(A)
417(b) and (f)
1.401(a)-20 Q&A 8, 10, 11, 14, 15 and 25

Line b. There is a special rule for determining the annuity starting date in the case of disability benefits. If a disability benefit is an auxiliary 
benefit, the commencement of the disability benefit payments will not be an annuity starting date for survivor annuity purposes. Therefore, 
the benefit can be paid in a form other than a QJSA without the need for participant and spousal consent. If the disability benefit is not an 
auxiliary benefit, the first day of the first period for which the benefit becomes payable is the annuity starting date and the benefit payments 
must be in the form of a QJSA unless waived by the participant and spouse.
A disability benefit is an auxiliary benefit if the participant will receive at early or normal retirement age a benefit that meets the accrual 
and vesting requirements without taking into account the disability payments. Thus, if a disability benefit reduces the benefit that would 
otherwise have been paid at early or normal retirement age, the disability benefit is not an auxiliary benefit. In addition, a disability benefit 
would not be considered an auxiliary benefit if payment of the disability benefit reduced the array of optional forms of benefit available to 
the participant at early or normal retirement age.
If the plan provides a disability benefit, it must be determined whether the disability benefit is an auxiliary benefit. For example, if a defined 
benefit plan provides that a disabled participant will be entitled to an early distribution of his or her vested accrued benefit, the disability 
benefit will not be an auxiliary benefit because payments will reduce the benefit that would otherwise be paid at early or normal retirement 
age. Similarly, if a defined contribution plan permits distribution of the account when a participant becomes disabled, the disability benefit is 
not an auxiliary benefit. If the plan provides for disability benefits that are not auxiliary benefits, it must provide that the QJSA requirements 
will apply to the payment of these benefits.
417(f)(2)(B)
1.401(a)-20 Q&A 10

Line c. A QJSA is an immediate annuity. Therefore, a plan cannot make a distribution at any time in a form other than a QJSA unless a 
QJSA that commences immediately is available at the same time and the participant has waived it with spousal consent. For example, if 
a plan provides that a participant who retires early will receive either an automatic joint and survivor annuity under which payments will 
commence at NRA or, if elected by the participant and spouse, an immediate single sum payment, the joint and survivor annuity will not be 
a QJSA and the plan will not satisfy the survivor annuity requirements. On the other hand, a terminating plan, for example, could provide for 
distribution of deferred annuity contracts under which neither the QJSA nor any other optional form of benefit would be available until NRA.

Line d. The QJSA for a married participant must be at least as valuable as any other optional form of benefit payable under the plan at the 
same time. 
1.417(e)-1(b)(1)
Example
A defined benefit plan contains an early retirement feature which provides that eligible employees who do not elect another form will 
receive an immediate joint and survivor annuity that is actuarially equivalent to a single life annuity payable at NRA. The other benefit 
forms available at early retirement are an immediate single life annuity that is fully subsidized with respect to the single life annuity 
payable at NRA (that is, there is no reduction in benefit payments on account of early payment) and a single sum actuarially equivalent 
to the single life annuity payable at NRA. Because the joint and survivor annuity is not at least as valuable as the subsidized single life 
annuity, it is not a QJSA and the plan does not satisfy the survivor annuity requirements.
Note that this rule applies only to the QJSA for a married participant. A single life annuity for an unmarried participant will not fail to be a 
QJSA merely because it is less valuable than other spousal forms of a benefit payable under the plan.
1.401(a)-20 Q&A 16

Line e. A plan can always provide for more than one annuity which meets the requirements of a QJSA. For example, a plan could offer 
several joint and survivor annuities that are actuarially equivalent, such as joint and 50%, joint and 66 2/3%, and joint and 100%. A 
participant is always free to choose among QJSAs available under the plan at any time and without the need for spousal consent, provided 
the annuities are actuarially equivalent. However, where a plan does offer two or more actuarially equivalent joint and survivor annuities 
that meet the requirements of a QJSA, it must designate which one will be the automatic form of benefit.
1.401(a)-20 Q&A 16

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Line f. The plan must allow a participant to receive a QJSA distribution at earliest retirement age under the plan.
“Earliest retirement age under the plan” not only determines when a participant must be allowed to obtain a QJSA distribution, but also 
affects when payments under a QPSA must commence and the calculation of the QPSA.(See III.b. and c., below.)
In a plan that allows distributions on separation from service, earliest retirement age is the earliest age at which a participant could separate 
from service and receive a distribution. In a plan that allows in-service distributions, earliest retirement age is the earliest age at which 
such distributions could be made. For any other plan, earliest retirement age is the early retirement age under the plan, if any, or normal 
retirement age under the plan, if there is no early retirement.
If a participant dies or separates from service prior to the earliest retirement age, only the actual years of service completed by the 
participant at the time of separation or death are taken into account in determining that participant’s earliest retirement age. For example, in 
a plan that does not allow distributions before the earlier of age 55 and completion of 10 years of service or age 65, earliest retirement age 
for a participant who separated from service at age 50 with 10 or more years of service would be when the participant attains age 55. At 
that time, the participant would have to be able to take a QJSA distribution under the plan. If the same participant had fewer than 10 years 
of service, the QJSA would have to be available no later than at age 65.
417(a)(7)
417(f)(3)
1.401(a)-20 Q&A 17
1.417(e)-1T

Line g. In addition to providing an automatic QJSA, a plan that is subject to the survivor annuity rules must generally meet certain notice, 
election, and consent requirements regarding the QJSA.
The plan must contain election and consent provisions that meet the following requirements. For years beginning after December 31, 
2006, the participant must be given the opportunity to waive the QJSA during the 180- day period before the annuity starting date (a 90-
day period applies for years beginning before 2007) The participant’s written waiver will not be acceptable unless the spouse consents 
to it in writing during the same 180-day period. Both the participant’s waiver of the QJSA and the spouse’s consent must identify the 
specific nonspouse beneficiary (including any class of beneficiaries or any contingent beneficiaries) and the particular optional form of 
benefit. Neither the beneficiary nor the optional form may be changed without subsequent spousal consent unless in the original consent, 
the spouse acknowledged the right to limit consent to a specific beneficiary and optional form and voluntarily relinquished those rights. 
However, the plan may permit the surviving spouse, or other beneficiary, to change the form of benefit after the participant’s death. The 
spouse’s consent must be witnessed by a plan representative or notary public.
A plan may provide that a legal guardian of the spouse may give consent if the spouse is incompetent. A plan may also provide that consent 
is not required if it is established to the satisfaction of a plan representative that there is nonspouse or the spouse cannot be located, or if a 
court order establishes that the participant is legally abandoned or separated. However, in the latter situation, a qualified domestic relations 
order (QDRO), as defined in section 414(p), may require QJSA coverage of a separated spouse and thus consent. (Note that a plan is not 
required to contain any provisions relating to a QDRO.)
A plan may not accept a pre-nuptial agreement as consent. Also, if a participant divorces and remarries, the former spouse’s consent is not 
binding on the new spouse (unless, and to the extent, provided otherwise by a QDRO).
A plan must also provide participants with notice explaining the terms and conditions of a QJSA, their rights to waive the QJSA and to revoke 
a waiver, and their spouses’ rights regarding consent. In general this written explanation must be provided no more than 180 nor less than 
30 days prior to the annuity starting date and it must explain the terms and conditions of the QJSA; the participant’s right to elect, in writing, 
not to receive the QJSA (with the consent of the participant’s spouse, also in writing, if applicable), and the effect of such an election; the 
participant’s right to revoke an election not to receive the QJSA, and the effect of such a revocation; and the eligibility conditions, material 
features, and relative values of available optional forms of benefit. The participant has a 30-day period following the receipt of the written 
explanation to decide whether to receive a distribution in a form other than a QJSA. A plan may contain language that allows the participant 
to elect (with spousal consent) to waive the 30-day period and receive a distribution in a form other than a QJSA provided the distribution 
begins more than 7 days after the participant received the written explanation. Any election by the participant to waive the 30-day period is 
not valid unless the plan has given the participant information on his right to wait 30 days to consider whether to waive the QJSA, the right to 
revoke the waiver until the later of 7 days following receipt of the written explanation or the annuity starting date, and the plan provides that 
the annuity starting date is a date after the participant has received the written explanation. The plan may contain language that the annuity 
starting date could be a date prior to the time the participant received the written explanation if the participant’s right to waive the QJSA does 
not end less than 30 days after such explanation is provided, subject to the participant’s waiver of the 30-day period, as discussed above.
Example
The plan provides the participant with an explanation of the QJSA and other optional forms of distribution on March 4, 2008. On March 
7, 2008, the participant elects (with the consent of the spouse) to waive the QJSA and receive an immediate distribution of a single life 
annuity. The plan can use an annuity starting date of March 1, 2008, providing the first payment is made to the participant no earlier 
than March 12, 2008. The notice must also be given to currently employed nonvested employees.
Generally, the recommencement of benefit payments to a participant whose benefits were suspended after separation will not create a new 
annuity starting date, unless the plan provides otherwise. Thus, the plan can recommence payments in the form in which benefits were 
being distributed prior to suspension without any new notice or consent. The commencement of benefits to an employee whose benefits 

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were suspended without a separation and who never received payments is treated as the annuity starting date, unless the plan provides 
otherwise.
An annuity starting date after NRA will also apply to additional accruals after the annuity starting date, unless the plan provides otherwise. 
Thus, these additional accruals can be paid in the form in which the prior accruals are being distributed without any new notice or consent. 
An annuity starting date before NRA will not apply to additional accruals after that annuity starting date. 
Example
A participant receives an in-service distribution of voluntary contributions in a single sum payment, after executing a proper waiver of 
the QJSA with spousal consent. When the balance of the participant’s vested benefit under the plan is distributed, it must be paid as a 
QJSA unless there is a new election and a new consent to waive the QJSA within the 180-day period before the new annuity starting 
date.
The plan does not have to meet these notice, election and consent requirements if it fully subsidizes the QJSA and the participant is not 
allowed to waive the QJSA or to select a non-spouse beneficiary. However, if the participant can waive the QJSA or change the beneficiary, 
then all of these requirements will apply. For this purpose, a QJSA is never fully subsidized if the other available optional forms of benefit 
under the plan include a lump sum or a form that guarantees payment of an amount of benefits that could in some circumstances exceed 
the amounts that would be paid under the QJSA.
417(a) 
1.401(a)-20 Q&A 10, 27 - 29, 31, 34 and 36 - 38
1.401(a)-13(g)
1.417(e)-1(b)(3)

Line h. The plan must provide that a participant will be allowed to change an election previously made at any time during the 180-day 
period before the annuity starting date. If the change in election is not a revocation of the waiver of the QJSA, the spouse must consent to 
the change (unless a general consent has been given). A plan may preclude a spouse from revoking consent to a specific waiver, or it may 
permit revocation of spousal consent.
417(a)
1.401(a)-20 Q&A 30

Line i. A plan does not have to treat a participant as married unless the participant and spouse have been married throughout the one-year 
period ending on the earlier of the annuity starting date or the date of the participant’s death. Nevertheless, a participant and spouse who 
remain married for one year must be treated as married for a year on the annuity starting date even if this is not the case. Therefore, the 
plan must provide an automatic QJSA to any participant who is married on the annuity starting date. If the spouses do not remain married 
for one year (because of death or divorce), the plan may revoke the spouse’s benefit rights and it need not recalculate and correct amounts 
already paid to the participant. 
The spouse to whom a participant is married on the annuity starting date is the one who is entitled to QJSA coverage in the event of 
the participant’s death (unless otherwise provided in a QDRO), even if they are not married on the date of death. Also, a plan cannot 
discontinue survivor payments under a QJSA because of remarriage of the surviving spouse. A QDRO can require that a divorced spouse 
be treated as a current spouse for QJSA purposes. 
417(d)
1.401(a)-20 Q&A 25
1.401(a)-13(g)

Line j. For distributions with annuity starting dates in plan years beginning after December 31, 2007, plans subject to section 401(a)(11) 
must offer to participants a specified optional form of benefit as an alternative to the QJSA. In particular, these plans must provide to a 
participant who waives the QJSA an opportunity to elect a qualified optional survivor annuity (“QOSA”) during the applicable election period 
and must provide a written explanation to participants of the terms and conditions of the QOSA. A QOSA as an annuity for the life of a 
participant with a survivor annuity for the life of the participant’s spouse that is equal to a specified applicable percentage of the amount of 
the annuity that is payable during the joint lives of the participant and the spouse, and that is the actuarial equivalent of a single life annuity 
for the life of the participant. A QOSA also includes a distribution option in a form having the effect of such an annuity.
The level of spouse survivor annuity that must be provided under a QOSA depends upon the level of spouse survivor annuity provided 
under a plan’s QJSA (that is, the QJSA form of benefit that is provided to a married participant in the absence of a waiver of such form of 
benefit). If the QJSA for a married participant provides a survivor annuity for the life of the participant’s spouse that is less than 75 percent 
of the amount of the annuity that is payable during the joint lives of the participant and the participant’s spouse, the QOSA must provide 
a spouse survivor annuity percentage of 75 percent. If the QJSA for a married participant provides a survivor annuity for the life of the 
participant’s spouse that is greater than or equal to 75 percent of the amount of the annuity that is payable during the joint lives of the 
participant and the participant’s spouse, the QOSA must provide a spouse survivor annuity percentage of 50 percent.
417(a)(1)(A)
Notice 2008-30

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Line k. Retroactive annuity starting dates apply to defined benefit plans only. A retroactive annuity starting date is an annuity starting date 
that occurs on or before the date the written explanation required under section 417(a)(3) is provided to the participant. Retroactive annuity 
starting dates may be used only if the plan provides for it and the participant affirmatively elects to use the retroactive annuity starting date. 
For a participant who affirmatively elects the retroactive annuity starting date, the plan is required to provide that the participant is in the 
same position he or she would have been had the participant’s benefit payments actually commenced on the retroactive annuity starting 
date. That is, future periodic payments must be the same as the periodic payments the participants would have been paid had the benefit 
payments actually commenced on the annuity starting date. A participant cannot elect a retroactive annuity starting date that precedes the 
date the participant could have started to receive benefits under the plan terms in effect as of the retroactive annuity starting date. 
Plan benefits must be determined as of the retroactive annuity starting date. The plan benefits must satisfy section 417(e)(3), if applicable 
and section 415 with the applicable interest rate and applicable mortality table determined as of the retroactive annuity starting date.
Annuity payments that otherwise satisfy the requirements for a qualified joint and survivor annuity under section 417(b) will not fail to be 
treated as a qualified joint and survivor annuity for purposes of section 415(b)(2) because the participant elects the retroactive annuity 
starting date and a make-up payment is required. A participant must receive a make-up payment to reflect a missed payment or payments 
for the period from the retroactive annuity starting date to the date of the actual make-up payment. 
A distribution may have a retroactive annuity starting date if the following requirements found in section 1.417(e)- 1(b)(3)(v) are satisfied. 
However, the plan may require additional conditions. 
1)  The participant’s spouse as of the time distributions actually commence must consent to the retroactive annuity starting date in 
       a manner which satisfies the requirements found in section 417(a)(2). However, spousal consent is only necessary where the 
       survivor annuity is less than fifty percent of the amount of the annuity payable during the life of the participant under a currently 
       commencing qualified joint and survivor annuity. Also, notice, consent, and (3) apply.
2)  The plan must demonstrate that the distributions satisfy the limitations under section 415 as of the date distributions commence, 
       unless the distribution commences no more than twelve months after the retroactive annuity starting date 
3)  A retroactive annuity starting date distribution must be no less than the benefit produced by applying the applicable interest rate 
       and the applicable mortality table determined as of the date the distribution commences to the annuity form that corresponds to 
       the annuity form that was used to determine the benefit amount as of the retroactive annuity starting date.
Effective: Plan years beginning on or after January 1, 2004
417(a)
417(a)(7)(A)
417(b)
417(e)(3)
1.417(e)-1(b)(3)

III. Preretirement Survivor Annuities
Line a. A plan that is subject to the survivor annuity requirements must provide that the surviving spouse of a vested participant who dies 
before the annuity starting date must receive a qualified pre-retirement survivor annuity (QPSA), unless there has been a proper election to 
waive the QPSA and certain notice requirements have been met. A QPSA is an immediate annuity for the life of the surviving spouse of a 
participant. An unmarried participant is deemed to have waived the QPSA. The amount of payments under a QPSA and the time at which 
the QPSA is calculated are described in III.b. and c., below.
The terms “annuity starting date” and “vested participant” have the same meaning as in II.a., above. Thus, the surviving spouse of an 
employee who dies before the annuity starting date and is vested only in employee derived benefits must receive a QPSA. Also, in the case 
of separated and retired participants, QPSA coverage will continue, unless waived with spousal consent, until the annuity starting date.
In certain situations, the annuity starting date may occur with respect to only part of a participant’s benefit. In this case, distribution of the 
part of the benefit for which the annuity starting date has occurred is subject to the QJSA requirements while the remainder of the benefit 
is subject to the QPSA requirements.
Example
A participant in a money purchase pension plan wants to take an in-service distribution of her voluntary employee contributions prior 
to separation from service. Any such distribution is subject to the QJSA requirements. However, the rest of the participant’s vested 
account remains subject to the QPSA requirements until the annuity starting date has occurred for these benefits. 
A plan that is subject to the survivor annuity requirements may provide for a forfeiture upon the participant’s death provided death occurs 
before the annuity starting date and the required QPSA is not forfeited. (Also see III.b.ii., below, regarding forfeiture on account of a 
participant’s death in a contributory defined contribution plan.) A defined benefit plan may provide for forfeiture of the QPSA if the spouse 
does not survive until the date prescribed under the plan for commencement of the QPSA or any later commencement date that has been 
elected by the spouse. A defined contribution plan may not forfeit the account balance even if the spouse dies prior to the time it is used to 
purchase the QPSA.
401(a)(11)(A)
417(c)
1.401(a)-20 Q&A 8, 9, 13, 19 and 25

Page 8                                        For applications submitted to conform to the 2020 RA List

Line b.i. The amount of each QPSA payment under a defined benefit plan may not be less than the amount that would be paid under 
the survivor annuity portion of a QJSA. If the participant dies after attaining the earliest retirement age under the plan, the amount of the 
payment is the amount that would have been paid to the survivor if the participant had retired with an immediate QJSA on the day before 
death. If the participant’s death occurs on or before attaining the earliest retirement age under the plan, the amount of the payment is the 
amount that would have been paid to the survivor if the participant had a) separated from service on the earlier of the date of death or the 
date of any actual separation, b) survived until the earliest retirement age and retired at that time with an immediate QJSA, and c) died the 
next day. For this purpose, the term “earliest retirement age under the plan” has the same meaning as in II.f., above.
Example
A vested participant in a defined benefit plan dies at age 45 with 8 years of service. Under the plan, benefits may not be distributed 
until age 65 or age 55 with 10 years of service. The QPSA has not been waived. Because the participant would not have been eligible 
to receive benefits at age 55 had she survived until then, the QPSA is calculated on the basis of a QJSA commencing at age 65. If the 
participant had 10 or more years of service at the time of death, the QPSA would be calculated on the basis of a QJSA commencing 
at age 55.
The defined benefit QPSA is based only on the benefits in which the participant was vested immediately prior to death. For example, life 
insurance proceeds need not be distributed as an annuity to the surviving spouse provided the surviving spouse receives the required 
QPSA.
A voluntary contribution account in a defined benefit plan is subject to the QPSA rules that apply to a defined contribution plan.
417(c)(1)
1.401(a)-20 Q&A 12, 15 and 18

Line b.ii. The amount of the QPSA in a defined contribution plan cannot be less than the amount that can be purchased with 50 percent of 
the non-forfeitable account balance as of the date of death, including any life insurance proceeds or other amounts in which the participant 
becomes vested upon death. If the plan provides for a forfeiture on account of the participant’s death, no more than a proportional percent of 
any contributions that may not be forfeited (such as elective and employee contributions) may be used to provide the QPSA. For example, 
if the QPSA is based on 50 percent of the account balance, only 50 percent of the non-forfeitable contributions may be used for the QPSA.
417(c)(2)
1.401(a)-20 Q&A 12, 20

Line c.i. A defined benefit plan must allow the surviving spouse of a participant who dies before the earliest retirement age to direct the 
commencement of QPSA payments no later than the month in which the participant would have attained the earliest retirement age. 
Where the participant dies after the earliest retirement age, the plan must allow the spouse to direct commencement of payments within a 
reasonable time after the participant’s death.
417(c)(1)(B)
1.401(a)-20,Q&A 22

Line c.ii. A defined contribution plan must allow the surviving spouse to direct commencement of QPSA payments within a reasonable time 
after the participant’s death.
417(c)(1)(B)
1.401(a)-20, Q&A 22

Line d. The QPSA is calculated as of the earliest retirement age if the participant dies before that time, or as of the date of death if the 
participant dies after the earliest retirement age. Therefore, if payments to the surviving spouse commence before or after the earliest 
retirement age, the plan must provide for reasonable actuarial adjustment to reflect the early or delayed payment.
1.401(a)-20, Q&A 19

Line e. A defined benefit plan may charge a participant for the cost of providing the QPSA. A plan will not violate section 411 merely 
because it reduces the accrued benefit to reasonably reflect the cost of the QPSA. However, for plan years beginning after 1988, the plan 
may not charge for the QPSA prior to the later of the time the participant can waive the QPSA or when the participant is given notice of the 
right to waive the QPSA.
417(f)(4)
1.401(a)-20, Q&A 21

Line f. In addition to providing an automatic QPSA, a plan that is subject to the survivor annuity rules must generally meet certain notice, 
election, and consent requirements regarding the QPSA that are similar to the requirements that apply to a QJSA. The plan must contain 
election and consent provisions that meet the following requirements. The participant must be given the opportunity to waive the QPSA 
starting with the first day of the plan year in which the participant attains age 35. Generally, the participant may not be allowed to waive the 
QPSA before this time, although the plan may provide for an earlier waiver (with spousal consent) if written explanation of the QPSA is given 
to the participant and the waiver becomes invalid with the beginning of the plan year in which the participant attains age 35. A participant 
who separates from service before the year in which he or she attains age 35 may elect at any time after separation (with spousal consent) 
to waive the QPSA with respect to benefits accrued before separation. The participant’s written waiver will not be acceptable unless the 
spouse consents to it in writing during the same election period. Both the participant’s waiver and the spouse’s consent must state the 

Page 9                                                                        For applications submitted to conform to the 2020 RA List
specific nonspouse beneficiary (including any class of beneficiaries or any contingent beneficiaries). The particular optional form of benefit 
does not require the spouse’s consent. The beneficiary may not be changed without subsequent spousal consent unless in the original 
consent, the spouse acknowledged the right to limit consent to a specific beneficiary and voluntarily relinquished this right. The plan may 
permit the surviving spouse, or other beneficiary, to change the form of benefit after the participant’s death. All other requirements that apply 
to the waiver of a QJSA also apply to the waiver of a QPSA (see II.g., above).
A plan must also provide participants with notice explaining the QPSA that is comparable to the QJSA explanation. (See II.g., above.) In 
the case of a participant who separates from service before age 35, the notice must be given within one year before or after the date of 
separation. In other cases, the notice must generally be given between the first day of the plan year in which the participant turns age 32 
and the last day of the plan year before the participant turns 35. However, if the first anniversary of participation will occur after the end of 
this period, notice may be given within a year before or after the date of participation. The notice must also be given to currently employed 
non-vested employee.
The plan does not have to meet these notice, election and consent requirements if it fully subsidizes the QPSA and the participant is not 
allowed to waive the QPSA or to select a non-spouse beneficiary. For this purpose, a QPSA is fully subsidized if there is no charge or 
reduction to the benefit for the QPSA coverage. In a defined contribution plan, the QPSA is always fully subsidized as there can be no 
charge or account reduction. However, if the participant can waive the QPSA or change the beneficiary, then all of the notice, election, and 
consent requirements will apply. 
417(a) 
1.401(a)-20 Q&A 10, 27 - 29, 31, 33 - 38
1.401(a)-13(g) 

Line g. The plan must provide that a participant will be allowed to change an election previously made at any time during the applicable 
election period. If the change in election involves a change in beneficiary, other than a change back to a QPSA, the spouse must consent 
to the change (unless a general consent has been given). A plan may preclude a spouse from revoking consent to a specific waiver, or it 
may permit revocation of spousal consent.
417(a)
1.401(a)-2,0 Q&A 30

Line h. A plan may require that a participant and spouse be married throughout the one-year period ending on the date of the participant’s 
death as a condition of QPSA coverage. It may not impose a marriage requirement longer than this. A plan may not discontinue QPSA 
payments because of remarriage of the surviving spouse. A QDRO may require that a former spouse be treated as a current spouse for 
QPSA purposes.
401(a)(11)(d)
417(d)
1.401(a)-20, Q&A 25
1.401(a)-13(g)

IV. Spousal Consent And Plan Loans
Line a. A plan may not distribute any part of a participant’s accrued benefit at any time in a form other than a QJSA or a QPSA without the 
written consent of the spouse (or surviving spouse) unless the present value of the non-forfeitable benefit does not exceed $5,000. Spousal 
consent is not required for the distribution of a QJSA at any time, but the participant must consent to any distribution while the benefit is 
immediately distributable (that is, prior to the later of age 62 or normal retirement age (as defined in section 411(a)(8)) unless the present 
value of the non-forfeitable benefit does not exceed $5,000. For distributions made on or after March 28, 2005, mandatory distributions of 
more than $1,000 from a qualified plan must be paid in a direct rollover to an IRA if the distributee does not make an affirmative election 
to have the amount paid in a direct rollover to an eligible retirement plan or to receive the distribution directly. Spousal consent is required 
for such a distribution only if the plan is subject to the joint and survivor annuity and preretirement survivor annuity requirements and the 
present value of the distributee’s non-forfeitable benefit under the plan exceeds $5,000. Present value is determined for these purposes 
without taking into account any amounts the participant rolled over into the employer’s plan. For rules relating to the determination of 
present value in a defined benefit plan, see Worksheet and Explanation No. 2A.
411(a)(11)
401(a)(31)(B)
417(e)
1.417(e)-1(b)

Line b. A plan may not require a surviving spouse to begin receiving benefits under a QPSA while the benefit is immediately distributable. 
A benefit is immediately distributable until such time as the participant would have attained the later of age 62 or normal retirement age 
(as defined in section 411(a)(8)). The plan may distribute the QPSA without spousal consent once it is no longer immediately distributable.
417(e)
1.417(e)-1(b) and -1(c)

Page 10                                                                For applications submitted to conform to the 2020 RA List

Line c. If the plan provides for loans to participants, it must also provide that written spousal consent to the use of the participant’s accrued 
benefit as security for a loan must be obtained, even if the accrued benefit is not the primary security. This requirement applies separately 
to the renegotiation, extension, renewal, or other revision of an existing loan. The consent of the spouse must be obtained within the 90-day 
period that ends on the date on which the loan is to be secured. Consent is not needed if the participant is not married at the time the loan 
is secured or if the participant’s total accrued benefit does not exceed $5,000. Spousal consent is not required if the plan or participant is 
not subject to section 401(a)(11) at the time the accrued benefit is used as security. Subsequent spousal consent is not needed for a set 
off of the loan against the accrued benefit n default even if the participant was not married when the loan was secured or is married to a 
different spouse. The plan may provide that in determining the amount of a QJSA or QPSA, it will reduce the accrued benefit by any security 
interest held by the plan for an outstanding loan at the time of payment or death, provided the security interest is treated as payment in 
satisfaction of the loan under the plan.
417(a)(4; )417(c)(3)
1.401(a)-20,Q&A 24

V. Same-Sex Spouses
Until the Supreme Court’s decision in in U.S. v. Windsor, 570 U.S. 12 (2013), found it unconstitutional, Section 3 of the Defense of Marriage 
Act (DOMA) prohibited the recognition of same-sex spouses for purposes of Federal tax law. Specifically, section 3 of DOMA provided that 
in determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and 
agencies of the United States, the word ‘marriage’ means only a legal union between one man and one woman as husband and wife, and 
the word ‘spouse’ refers only to a person of the opposite sex who is a husband or a wife. (See 1 U.S.C. § 7 after amendment.) As a result, 
same-sex spouses were not recognized for purposes of the Code with respect to qualified retirement plans.
In the Windsor decision, the Supreme Court held on June 26, 2013 that section 3 of DOMA is unconstitutional because it violates the Fifth 
Amendment. Subsequent to Windsor, Rev. Rul. 2013-17 held that, (1) for Federal tax purposes, the terms “spouse,” “husband and wife,” 
“husband,” and “wife” include an individual married to a person of the same sex if the individuals are lawfully married under state law, and 
the term “marriage” includes such a marriage between individuals of the same sex; (2) For Federal tax purposes, the IRS adopts a general 
rule recognizing a marriage of same-sex individuals that was validly entered into in a state whose laws authorize the marriage of two 
individuals of the same sex even if the married couple is domiciled in a state that does not recognize the validity of same-sex marriages. (3) 
For Federal tax purposes, the terms “spouse,” “husband and wife,” “husband,” and “wife” do not include individuals (whether of the opposite 
sex or the same sex) who have entered into a registered domestic partnership, civil union, or other similar formal relationship recognized 
under state law that is not denominated as a marriage under the laws of that state, and the term “marriage” does not include such formal 
relationships.
The holdings of Rev. Rul. 2013-17 apply for all Federal tax purposes, including for purposes of the Federal tax rules that apply to qualified 
retirement plans under section 401(a). The ruling provides that the holdings will be applied prospectively as of September 16, 2013. 
On April 4, 2014, the IRS issued Notice 2014-19 to provide additional guidance with respect to qualified retirement plans. Notice 2014-19 
provided that any retirement plan qualification rule that applies because a participant is married must be applied with respect to a participant 
who is married to an individual of the same sex. For example, a participant in a plan subject to the rules of section 401(a)(11) who is married 
to a same-sex spouse cannot waive a QJSA without obtaining spousal consent pursuant to section 417. A retirement plan will not be 
treated as failing to meet the requirements of section 401(a) merely because it did not recognize the same-sex spouse of a participant as 
a spouse before June 26, 2013. For Federal tax purposes, effective as of September 16, 2013, Rev. Rul. 2013-17 (i) adopts a general rule 
recognizing a marriage of same-sex individuals that is validly entered into in a state whose laws authorize the marriage of two individuals of 
the same sex, even if the individuals are domiciled in a state that does not recognize the validity of same-sex marriages, and (ii) provides 
that individuals (whether part of an opposite-sex or same-sex couple) who have entered into a registered domestic partnership, civil union, 
or other similar formal relationship recognized under state law that is not denominated as a marriage under the laws of that state are not 
treated as married. Accordingly, a retirement plan will not be treated as failing to meet the requirements of section 401(a) merely because 
the plan, prior to September 16, 2013, recognized the same-sex spouse of a participant only if the participant was domiciled in a state that 
recognized same-sex marriages. 
A qualified retirement plan will not lose its qualified status due to an amendment to reflect the outcome of Windsor for some or all purposes 
as of a date prior to June 26, 2013, if the amendment complies with applicable qualification requirements (such as section 401(a)(4)). 
Recognizing same-sex spouses for all purposes under a plan prior to June 26, 2013, however, may trigger requirements that are difficult 
to implement retroactively (such as the ownership attribution rules) and may create unintended consequences. Provided that applicable 
qualification requirements are otherwise satisfied, a plan sponsor’s choice of a date before June 26, 2013, and the purposes for which the 
plan amendments recognize same-sex spouses before June 26, 2013, do not affect the qualified status of the plan. For example, for the 
period before June 26, 2013, a plan sponsor may choose to amend its plan to reflect the outcome of Windsor solely with respect to the 
QJSA and QPSA requirements of section 401(a)(11) and, for those purposes, solely with respect to participants with annuity starting dates 
or dates of death on or after a specified date.
Whether a plan must be amended to reflect the outcome of Windsor and the guidance in Rev. Rul. 2013-17 and Notice 2014-19 depends on 
the terms of the specific plan. If a plan’s terms with respect to the requirements of section 401(a) define a marital relationship by reference 
to section 3 of DOMA or are otherwise inconsistent with the outcome of Windsor or the guidance in Rev. Rul. 2013-17 or Notice 2014-19, 
then an amendment to the plan that reflects the outcome of Windsor and the guidance in Rev. Rul. 2013-17 and Notice 2014-19 is required 
by the date specified in Q&A-8 of Notice 2014-19. Q&A-8 of Notice 2014-19 provides that the deadline to adopt a plan amendment pursuant 
to this notice is the later of (i) the otherwise applicable deadline under section 5.05 of Rev. Proc. 2007-44, or its successor, or (ii) December 

Page 11                                                      For applications submitted to conform to the 2020 RA List
31, 2014. Moreover, in the case of a governmental plan, any amendment made pursuant to this notice need not be adopted before the close 
of the first regular legislative session of the legislative body with the authority to amend the plan that ends after December 31, 2014. If a 
plan’s terms are not inconsistent with the outcome of Windsor and the guidance in Rev. Rul. 2013-17 and Notice 2014-19, an amendment 
generally would not be required. If a plan sponsor chooses to apply the rules in a manner that reflects the outcome of Windsor for a period 
before June 26, 2013, an amendment to the plan that specifies the purpose and date as of which the rules are applied in this manner is 
required. The deadline for this amendment is the date specified in Q&A-8 of Notice 2014-19. 

                                                           For applications submitted to conform to the 2020 RA List

                                Employee Benefit Plan

                                Joint and Survivor 
                               (Worksheet Number 3 – Determination of Qualification)
Instructions – All items must be completed. A “Yes” answer generally indicates a favorable conclusion is warranted, while a “No” 
answer indicates a problem exists. Please use the space on the worksheet to explain any “No” answer. See Publication 6391, 
Explanation Number 3, for guidance in completing this form.
The technical principles in this worksheet may be changed by future regulations or guidelines.
Name of plan

I. Applicability                                                                              Plan Reference                         Yes No N/A
a. Is the plan a defined contribution plan (other than a money purchase or target
benefit plan) that provides that the surviving spouse or, if the surviving spouse
consents, a designated beneficiary, shall upon the participant’s death receive the
full nonforfeitable accrued benefit of the participant? (If “Yes,” answer (b); if “No,” go
to II.) [350]
b. Is this a plan that:
(i) Offers benefits in the form of a life annuity, or [351]
(ii) Is a transferee of benefits from a plan subject to sections 401(a)(11) and 417, or
     [352]
(iii) Offsets benefits under a defined benefit plan? [353]
(If the answer to b.(i), (ii), or (iii) is “Yes,” see Explanations and go to II; if “No,” do not complete the rest of this worksheet)
II. Joint and Survivor Benefit                                                                Plan Reference                         Yes No N/A
a. Does the plan provide for the payment of benefits in the form of a Qualified Joint
and Survivor Annuity (QJSA) in the case of a vested participant who survives until
the annuity starting date? [354]
b. If the plan provides for disability benefits that are not auxiliary benefits, does the
plan treat the first day of the first period for which these benefits are to be paid as
the annuity starting date? [355]
c. Is the QJSA under the plan an annuity that commences immediately? [356]
d. Is the QJSA for a married participant at least as valuable as any other optional form
of benefit payable under the plan at the same time? [357]
e. If the plan provides for two or more actuarially equivalent annuities that satisfy the
requirements for a QJSA, does it specify which is the automatic form? [358]
f. Is the participant allowed to receive a QJSA distribution at earliest requirement ageprovided as an example only and should not be 
under the plan? [359]
g. Does the plan provide that the participant can elect during the applicable election
period not to take a QJSA only with the spouse’s consent to a specific beneficiary
and a particular optional form of benefit? [360, 361]
h. Does the plan provide that a participant who is to receive a QJSA may elect, with
spousal consent, not to take the QJSA and may revoke the election, or choose
again to take the QJSA, at any time and any number of times within the applicable
election period? [362]
This form is
i. Does the plan provide an automatic QJSA to a participant who is married on the
annuity starting date, regardless of whether married throughout the one-year periodcompleted or returned to the Internal Revenue Service
ending on the annuity starting date? [363, 364]
j. Does the plan provide for a Qualified Optional Survivor Annuity (QOSA)? [365]

Form 5625 (Rev. 6-2021)        Catalog Number 42700L       publish.no.irs.gov            Department of the Treasury - Internal Revenue Service

                                                                                  For applications submitted to conform to the 2020 RA List
II. Joint and Survivor Benefit – Continued                                                 Plan Reference          Yes No              N/A
k. If the plan is a defined benefit plan that provides for the election of a retroactive annuity starting date:
  (i) Have the notice and consent requirements under IRC 417 been satisfied with 
     respect to the retroactive annuity starting date? [366]
(ii) Are any missed payments addressed in a manner that satisfies the final 
     regulations under IRC 417? [367]
III. Preretirement Survivor Annuities                                                      Plan Reference          Yes No              N/A
a. Does the plan provide the surviving spouse of a vested participant who dies before 
  the annuity starting date with a Qualified Preretirement Survivor Annuity (QPSA)? 
  [368]
b. Is the amount of the QPSA correctly defined:
  (i) In the case of a defined benefit plan? [369, 370]
(ii) In the case of a defined contribution plan? [371]
c. Does the plan provide that the surviving spouse can begin receiving the QPSA:
  (i) In a defined benefit plan, no later then the month the participant would have 
     attained earliest retirement age (or within a reasonable time after death, if later)? 
     [372]
(ii) In a defined contribution plan, within a reasonable time after the participant’s 
     death? [373]
d. In a defined benefit plan that allows the QPSA to be paid earlier or later than the 
  time described in III.c.(i) does the plan make actuarial adjustments to reflect the 
  early or delayed payment? [374]
e. In a defined benefit plan that charges the participant for the cost of the QPSA, is the 
  charge inapplicable prior to the later of the time the participant can waive the QPSA 
  or when the participant is given notice of the right to waive the QPSA? [375]
f.  Does the plan provide that the participant can elect during the applicable election 
  period to waive the QPSA only with spousal consent to a specific nonspouse 
  beneficiary? [376, 377]
g. Does the plan provide that a participant may revoke a waiver of the QPSA at any 
  time and any number of times during the applicable election period? [378]
h. Does the plan limit any marriage requirement for the QPSA to no more than one 
  year before the participant’s death? [379]
IV. Spousal Consents and Plan Loans                                                        Plan Reference          Yes No              N/A
a. Does the plan require the consent of the spouse (or surviving spouse) to any 
  distribution in any form other than a QJSA (or QPSA), except where the present 
  value of the nonforfeitable benefit does not exceed $5,000? [380]provided as an example only and should not be 

b. Does the plan require the consent of the surviving spouse to the distribution of a 
  QPSA while it is immediately distributable, except where the present value of the 
  nonforfeitable benefit does not exceed $5,000? [381]
c. If the plan provides for participant loans, does it require spousal consent to the use 
  of the accrued benefit as security for the loan? [382]
V. Same-Sex Spouses                                                                        Plan Reference          Yes No              N/A
a.ThisAre plan provisionsformconsistentiswith U.S. v. Windsor, 570 U.S. 12 (2013) and the 
  guidance in Rev. Rul. 2013-17 and Notice 2014-19? (For example, a definition of 
  spouse that refers to section 3 of DOMA, or that defines spouse as being of the completed or returned to the Internal Revenue Service
  opposite sex would require amendment.) [383]

Form 5625 (Rev. 6-2021)  Catalog Number 42700L                     publish.no.irs.gov Department of the Treasury - Internal Revenue Service

                                                              For applications submitted to conform to the 2020 RA List
                        Employee Plan Deficiency Checksheet
                        Attachment Number 3
                                         Joint and Survivor
For IRS Use             Please furnish the amendment(s) requested in the section(s) checked below.
     350       Section   of the plan should be amended to provide that the participant’s nonforfeitable accrued benefit 
     I.a.      will be payable in full, upon the participant’s death, to the surviving spouse. The plan may provide that this 
               benefit will be paid instead to a designated beneficiary if the participant executes a written waiver of the spousal 
               benefit, the spouse consents to the waiver, and both the waiver and the spouse’s consent state the specific 
               nonspouse beneficiary. IRC section 401(a)(11)(B) and Regs. section 1.401(a)-20 Q&As 3, 32 and 33.
     351       Section   of the plan should be amended to provide that if a participant elects at any time to receive 
     I.b.(i)   benefits in the form of a life annuity, the requirements described in sections 401(a)(11)(A) and 417 of the Code, 
               and the regulations thereunder, will always thereafter apply to the participant’s benefits under the plan.  If the 
               plan provides for a separate accounting of the account balance subject to the participant’s life annuity election, 
               these requirements need only apply to the separate account. IRC sections 401(a)(11) and 417(a) and Regs. 
               section 1.401(a)-20 Q&A 4.
     352       Section   of the plan should be amended to provide that the requirements described in sections 
     I.b.(ii)  401(a)(11)(A) and 417 of the Code, and the regulations thereunder, will apply to a participant’s benefits if, with 
               respect to the participant, the plan is a direct or indirect transferee of benefits held on or after January 1, 1985 
               by a defined benefit plan or a defined contribution plan subject to the requirements of section 401(a)(11) and 
               417. If the plan provides for a separate accounting of the participant’s benefits, these requirements need only
               apply to the separate account. IRC section 401(a)(11) and 417(a) and Regs. section 1.401(a)-20 Q&A 5.
     353       Section   of the plan should be amended to provide that the requirements described in sections 
     I.b.(iii) 401(a)(11)(A) and 417 of the Code, and the regulations thereunder, apply with respect to those participants 
               whose benefits under the plan are used to offset benefits under a defined benefit plan. IRC sections 401(a)(11) 
               and 417(a) and Regs. section 1.401(a)-20 Q&A 5.
     354       Section   of the plan should be amended to provide that if a participant with vested benefits attributable 
     II.a.     to employer or employee contributions survives until the annuity starting date (that is, the first day of the first 
               period for which an amount is paid as an annuity or any other form), the plan will provide for benefits in the form 
               of a qualified joint and survivor annuity. For this purpose a qualified joint and survivor annuity for an unmarried 
               participant is a single life annuity. IRC sections 401(a)(11) and 417(a) and Regs. section 1.401(a)-20 Q&As 8 
               and 25
     355       Section   of the plan should be amended to provide that for purposes of determining whether a 
     II.b.     participant’s benefit is to be paid in the form of a qualified joint and survivor annuity, the first day of the first 
               period for which the disability benefit described therein is to be paid will be treated as an annuity starting date. 
               IRC section 417(f)(2)(B) and Regs. section 1.401(a)-20 Q&A 10.
     356       Section   of the plan should be amended to provide that the payments under the qualified joint and 
     II.c.     survivor annuity will commence immediately. Regs. section 1.417(e)-1(b)(1).
     357       The qualified joint and survivor annuity for a married participant must be at least as valuable as any other 
     II.d.     optional form of benefit payable under the plan at the same time. Section   of the plan should be 
               amended accordingly. Regs. section 1.401(a)-20 Q&A 16.provided as an example only and should not be 
     358       Section   of the plan should be amended to designate which of the actuarially equivalent joint and 
     II.e.     survivor annuities under the plan is the automatic qualified joint and survivor annuity. Regs. section 1.401(a)-20 
               Q&A 16.
     359       Section   of the plan should be amended to provide that a participant who elects to receive a 
     II.f.     distribution on or after attainment of earliest retirement age (that is, the earliest date on which the participant 
               could elect to receive retirement benefits under the plan) will receive the distribution in the form of a qualified 
               joint and survivor annuity unless the participant and spouse consent to payment in another form. IRC section 
               417(f)(3) and Regs. section 1.401(a)-20 Q&A 17.
This form is

     completed or returned to the Internal Revenue Service

Form 6042 (Rev. 6-2021) Catalog Number 43036Q publish.no.irs.gov     Department of the Treasury - Internal Revenue Service

Page 2                                                              For applications submitted to conform to the 2020 RA List
     360, 361    Section        of the plan should be amended to provide that during a period that begins on the first day of 
       II.g.     the 180 day period ending on the annuity starting date and ends on the later of the annuity starting date or the 
                 30th day after the plan administrator provides the participant with a written explanation of the Qualified Joint and 
                 Survivor Annuity (QJSA), a participant may waive the QJSA form of benefit if the following conditions are 
                 satisfied: (1) the participant’s spouse consents in writing to the election and the spouse’s consent is witnessed 
                 by a plan representative or notary public; (2) the participant’s waiver and the spouse’s consent state the specific 
                 nonspouse beneficiary (including any class of beneficiaries or contingent beneficiaries) and the particular 
                 optional form of benefit, neither of which may be further modified (except back to a QJSA) without subsequent 
                 spousal consent (unless expressly permitted by the spouse); and (3) the spouse’s consent acknowledges the 
                 effect of the election. IRC sections 417(a) and Regs. sections 1.401(a)-20 Q&A 31, 1.417(e)-1(b) and 1.417
                 (e)-1T.
       362       Section        of the plan should be amended to provide that a participant who has elected to waive the 
       II.h.     qualified joint and survivor annuity with spousal consent may revoke the election at any time and any number of 
                 times during the 180 day period ending on the annuity starting date. IRC section 417(a)(1).
     363, 364    Any marriage requirement for the participant and spouse must be limited to the one-year period ending on the 
       II.i.     earlier of the annuity starting date or the date of death. Nevertheless, the plan must treat a participant and 
                 spouse who are married on the annuity starting date as having been married during the one-year period ending 
                 on that date if they remain married for one year. Therefore, the plan must pay to such a participant the benefit 
                 that is to commence on the annuity starting date in the form of a qualified joint and survivor annuity. If the 
                 participant and spouse do not remain married for one year, the plan may provide that the spouse loses any 
                 survivor benefit rights and that any amount paid to the participant will not be retroactively corrected. Section 
                          of the plan should be amended accordingly. IRC section 417(d) and Regs. section 1.401(a)-20 
                 Q&A 25.
       365       Section        of the plan should be amended to provide for a Qualified Optional Survivor Annuity (QOSA). 
       II.j.     A QOSA is an optional form of benefit that provides a survivor annuity based on the survivor annuity provided 
                 under the plan's QJSA. If the plan's QJSA survivor annuity is less than 75 percent, the QOSA (QJSA) must 
                 provide a 75 percent survivor annuity, If the plan's QJSA provides a survivor annuity of 75 percent or more, the 
                 QOSA must provide a 50 percent survivor annuity.
       366       Section        of the plan should be amended to provide that the participant must affirmatively elect to have 
       II.k.(i)  the retroactive annuity starting date apply to benefit distributions and require the notice, consent and election 
                 rules to waive a qualified joint and survivor annuity to be met. Spousal consent to use the retroactive annuity 
                 starting date is required from the spouse determined as of the time distributions actually commence. IRC 
                 sections 417(a)(1), 417(a)(2), 417(a)(7)(A) and Regs. Section 1.417(e)-1(b)(3).
       367       Section        of the plan should be amended to provide that a participant must receive a make-up payment 
       II.k(ii)  to reflect any missed payments for the period from the retroactive annuity starting date to the date of the actual 
                 make-up payment. 
       368       Section        of the plan should be amended to provide that if a married participant with vested benefits 
       III.a.    attributable to employer or employee contributions dies before the annuity starting date (that is, the first day of 
                 the first period for which an amount is paid as an annuity or any other form), the plan will provide the 
                 participant’s spouse a qualified preretirement survivor annuity unless there has been a proper election to waive 
                 the QPSA and certain notice requirements have been met. IRC sections 401(a)(11) and 417(c) and Regs. 
                 section 1.401(a)-20 Q&A 8.
     369, 370    Sectionprovided of the plan shouldasbe amendedanto provideexamplethat the benefit to be paidonlyto the survivingandspouse should not be 
       III.b.(i) of a participant who dies before the annuity starting date will be determined as follows. If the participant dies 
                 after attaining earliest retirement age under the plan, the benefit may not be less than the benefit that would be 
                 payable to the survivor if the participant had retired with an immediate qualified joint and survivor annuity on the 
                 day before the participant’s death. If the participant dies on or before earliest retirement age, the benefit may not 
                 be less than the benefit that would be payable to the survivor if the participant had separated from service at the 
                 earlier of actual separation or death, survived until the earliest retirement age, retired at that time with an 
                 immediate qualified joint and survivor annuity, and died on the day thereafter. IRC section 417(c)(1) and Regs. 
                 section 1.401(a)-20 Q&A 18.
This371          formSection is of the plan should be amended to provide that the annuity to be provided to the surviving 
     III.b.(ii)  spouse of a participant who dies before the annuity starting date will have a value that is not less than 50 
       completedpercent of the participant’sornonforfeitablereturnedaccount balance,toincludingthethe proceedsInternalof insurance on theRevenue Service
                 participant’s life, as of the date of the participant’s death. No more than a proportional share of those 
                 contributions that may not be forfeited at death (for example, employee contributions) may be used to satisfy 
                 this requirement. IRC section 417(c)(2) and Regs. section 1.401(a)-20 Q&A 20.

Form 6042 (Rev. 6-2021)  Catalog Number 43036Q     publish.no.irs.gov               Department of the Treasury - Internal Revenue Service

Page 3                                                                 For applications submitted to conform to the 2020 RA List
       372       Section  of the plan should be amended to provide that the surviving spouse may direct the 
       III.c.(i) commencement of payments under the qualified preretirement survivor annuity no later than the month in which 
                 the participant would have attained the earliest retirement age under the plan. IRC section 417(c) and Regs. 
                 section 1.401(a)-20 Q&A 22.
       373       Section  of the plan should be amended to provide that the surviving spouse may direct the 
     III.c.(ii)  commencement of payments under the qualified preretirement survivor annuity within a reasonable time after 
                 the participant’s death. IRC section 417(c) and Regs. section 1.401(a)-20 Q&A 22.
       374       When payments under a qualified preretirement survivor annuity begin earlier or later than the earliest 
       III.d.    retirement age, the plan must make reasonable actuarial adjustments to reflect the early or delayed payment. 
                 Section  of the plan should be amended accordingly. Regs. section 1.401(a)-20 Q&A 19.
       375       A defined benefit plan may not charge a participant for the cost of a Qualified Preretirement Survivor Annuity 
       III.e.    (QPSA) (for example, by reducing the participant’s benefit) prior to the later of the time the plan allows the 
                 participant to waive the QPSA and when the plan gives the participant notice of the right to waive the QPSA. 
                 Section  of the plan should be amended accordingly. Regs. section 1.401(a)-20 Q&A 21.
     376, 377    Section  of the plan should be amended to provide that on or after the first day of the plan year in 
       III.f.    which the participant attains age 35 a participant may waive the Qualified Preretirement Survivor Annuity 
                 (QPSA) provided the following conditions are satisfied: (1) the participant’s spouse consents in writing to the 
                 election and the spouse’s consent is witnessed by a plan representative or notary public; (2) the participant’s 
                 waiver and the spouse’s consent state the specific nonspouse beneficiary (including any class of beneficiaries 
                 or contingent beneficiaries), which may not be modified (except back to a QPSA) without subsequent spousal 
                 consent (unless expressly permitted by the spouse); and (3) the spouse’s consent acknowledges the effect of 
                 the election. If the participant separates from service before the plan year in which he or she attains age 35, the 
                 foregoing election may be made on or after the date of separation with respect to benefits accrued prior to 
                 separation. IRC section 417(c) and Regs. section 1.401(a)-20 Q&As 31 and 33.
       378       Section  of the plan should be amended to provide that a participant who has elected to waive the 
       III.g.    qualified preretirement survivor annuity with spousal consent may revoke the election at any time and any 
                 number of times during the period between the first day of the plan year in which the participant attains age 35 
                 and the date of the participant’s death. IRC section 417(c) and Regs. section 1.401(a)-20 Q&A 30.
       379       In the case of a qualified preretirement survivor annuity, any marriage requirement must be limited to no more 
       III.h.    than one year before the participant’s death. Section    of the plan should be amended accordingly. 
                 IRC section 417(d) and Regs. section 1.401(a)-20 Q&A 25.
       380       A plan may not distribute the participant’s accrued benefit in any form other than a QJSA (or QPSA) without the 
       IV.a.     consent of the participant’s spouse (or surviving spouse), except where the present value of the nonforfeitable 
                 benefit does not exceed $5,000. Section  of the plan should be amended accordingly. IRC section 
                 417(e) and Regs. section 1.417(e)-1(b).
       381       A plan may not require a surviving spouse to begin receiving benefits under a QPSA prior to the time the 
       IV.b.     participant would have attained the later of age 62 or normal retirement age (as defined in section 411(a)(8) of 
                 the Code), except where the present value of the nonforfeitable benefit does not exceed $5,000. Section 
                          of the plan should be amended accordingly. IRC section 417(e) and Regs. sections 1.417(e)-1(b) 
                 and (c).
       382       Section  of the plan should be amended to provide that written spousal consent to the use of a 
                        provided as an example only and should not be 
       IV.c.     participant’s accrued benefit as security for a loan must be obtained within the 180-day period ending on the 
                 date on which the loan is to be secured. IRC section 417(a)(4) and Regs. section 1.401(a)-20 Q&A 24.
       383       Section  of the plan should be amended to comply with the decision in U.S. v. Windsor, 570 U.S. 
       V.a.      12 (2013) and the guidance in Rev. Rul. 2013-17 and Notice 2014-19.

This form is

       completed or returned to the Internal Revenue Service

Form 6042 (Rev. 6-2021)  Catalog Number 43036Q publish.no.irs.gov        Department of the Treasury - Internal Revenue Service