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Savings Incentive Match Plan OMB No. 1545-1502
Form 5304-SIMPLE Do not file
(Rev. March 2012) for Employees of Small Employers (SIMPLE)—Not with the Internal
Department of the Treasury
Internal Revenue Service for Use With a Designated Financial Institution Revenue Service
establishes the following SIMPLE
Name of Employer
IRA plan under section 408(p) of the Internal Revenue Code and pursuant to the instructions contained in this form.
Article I—Employee Eligibility Requirements (complete applicable box(es) and blanks—see instructions)
1 General Eligibility Requirements. The Employer agrees to permit salary reduction contributions to be made in each calendar year to the
SIMPLE IRA established by each employee who meets the following requirements (select either 1a or 1b):
a Full Eligibility. All employees are eligible.
b Limited Eligibility. Eligibility is limited to employees who are described in both (i) and (ii) below:
(i) Current compensation. Employees who are reasonably expected to receive at least $ in compensation
(not to exceed $5,000) for the calendar year.
(ii) Prior compensation. Employees who have received at least $ in compensation (not to exceed $5,000)
during any calendar year(s) (insert 0, 1, or 2) preceding the calendar year.
2 Excludable Employees.
The Employer elects to exclude employees covered under a collective bargaining agreement for which retirement benefits were the subject
of good faith bargaining. Note: This box is deemed checked if the Employer maintains a qualified plan covering only such employees.
Article II—Salary Reduction Agreements (complete the box and blank, if applicable—see instructions)
1 Salary Reduction Election. An eligible employee may make an election to have his or her compensation for each pay period reduced. The
total amount of the reduction in the employee’s compensation for a calendar year cannot exceed the applicable amount for that year.
2 Timing of Salary Reduction Elections
a For a calendar year, an eligible employee may make or modify a salary reduction election during the 60-day period immediately preceding
January 1 of that year. However, for the year in which the employee becomes eligible to make salary reduction contributions, the period during
which the employee may make or modify the election is a 60-day period that includes either the date the employee becomes eligible or the
day before.
b In addition to the election periods in 2a, eligible employees may make salary reduction elections or modify prior elections ,
. If the Employer chooses
this option, insert a period or periods (for example, semi-annually, quarterly, monthly, or daily) that will apply uniformly to all eligible
employees.
c No salary reduction election may apply to compensation that an employee received, or had a right to immediately receive, before execution of
the salary reduction election.
d An employee may terminate a salary reduction election at any time during the calendar year. If this box is checked, an employee who
terminates a salary reduction election not in accordance with 2b may not resume salary reduction contributions during the calendar year.
Article III—Contributions (complete the blank, if applicable—see instructions)
1 Salary Reduction Contributions. The amount by which the employee agrees to reduce his or her compensation will be contributed by the
Employer to the employee’s SIMPLE IRA.
2 a Matching Contributions
(i) For each calendar year, the Employer will contribute a matching contribution to each eligible employee’s SIMPLE IRA equal to the
employee’s salary reduction contributions up to a limit of 3% of the employee’s compensation for the calendar year.
(ii) The Employer may reduce the 3% limit for the calendar year in (i) only if:
(1) The limit is not reduced below 1%; (2) The limit is not reduced for more than 2 calendar years during the 5-year period ending with the
calendar year the reduction is effective; and (3) Each employee is notified of the reduced limit within a reasonable period of time before the
employees’ 60-day election period for the calendar year (described in Article II, item 2a).
b Nonelective Contributions
(i) For any calendar year, instead of making matching contributions, the Employer may make nonelective contributions equal to 2% of
compensation for the calendar year to the SIMPLE IRA of each eligible employee who has at least $ , (not more
than $5,000) in compensation for the calendar year. No more than $250,000* in compensation can be taken into account in determining
the nonelective contribution for each eligible employee.
(ii) For any calendar year, the Employer may make 2% nonelective contributions instead of matching contributions only if:
(1) Each eligible employee is notified that a 2% nonelective contribution will be made instead of a matching contribution; and
(2) This notification is provided within a reasonable period of time before the employees’ 60-day election period for the calendar year
(described in Article II, item 2a).
3 Time and Manner of Contributions
a The Employer will make the salary reduction contributions (described in 1 above) for each eligible employee to the SIMPLE IRA established at the financial
institution selected by that employee no later than 30 days after the end of the month in which the money is withheld from the employee’s pay. See instructions.
b The Employer will make the matching or nonelective contributions (described in 2a and 2b above) for each eligible employee to the SIMPLE
IRA established at the financial institution selected by that employee no later than the due date for filing the Employer’s tax return, including
extensions, for the taxable year that includes the last day of the calendar year for which the contributions are made.
* This is the amount for 2012. For later years, the limit may be increased for cost-of-living adjustments. The IRS announces the increase, if any, in a news release, in the
Internal Revenue Bulletin, and on the IRS’s internet website at IRS.gov.
For Paperwork Reduction Act Notice, see the instructions. Cat. No. 23377W Form 5304-SIMPLE (Rev. 3-2012)

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Form 5304-SIMPLE (Rev. 3-2012) Page 2
Article IV—Other Requirements and Provisions
1 Contributions in General. The Employer will make no contributions to the SIMPLE IRAs other than salary reduction contributions (described in
Article III, item 1) and matching or nonelective contributions (described in Article III, items 2a and 2b).
2 Vesting Requirements. All contributions made under this SIMPLE IRA plan are fully vested and nonforfeitable.
3 No Withdrawal Restrictions. The Employer may not require the employee to retain any portion of the contributions in his or her SIMPLE IRA
or otherwise impose any withdrawal restrictions.
4 Selection of IRA Trustee. The Employer must permit each eligible employee to select the financial institution that will serve as the trustee,
custodian, or issuer of the SIMPLE IRA to which the Employer will make all contributions on behalf of that employee.
5 Amendments To This SIMPLE IRA Plan. This SIMPLE IRA plan may not be amended except to modify the entries inserted in the blanks or
boxes provided in Articles I, II, III, VI, and VII.
6 Effects Of Withdrawals and Rollovers
a An amount withdrawn from the SIMPLE IRA is generally includible in gross income. However, a SIMPLE IRA balance may be rolled over or
transferred on a tax-free basis to another IRA designed solely to hold funds under a SIMPLE IRA plan. In addition, an individual may roll over or
transfer his or her SIMPLE IRA balance to any IRA or eligible retirement plan after a 2-year period has expired since the individual first
participated in any SIMPLE IRA plan of the Employer. Any rollover or transfer must comply with the requirements under section 408.
b If an individual withdraws an amount from a SIMPLE IRA during the 2-year period beginning when the individual first participated in any
SIMPLE IRA plan of the Employer and the amount is subject to the additional tax on early distributions under section 72(t), this additional tax is
increased from 10% to 25%.
Article V—Definitions
1 Compensation
a General Definition of Compensation. Compensation means the sum of the wages, tips, and other compensation from the Employer subject
to federal income tax withholding (as described in section 6051(a)(3)), the amounts paid for domestic service in a private home, local college
club, or local chapter of a college fraternity or sorority, and the employee’s salary reduction contributions made under this plan, and, if
applicable, elective deferrals under a section 401(k) plan, a SARSEP, or a section 403(b) annuity contract and compensation deferred under a
section 457 plan required to be reported by the Employer on Form W-2 (as described in section 6051(a)(8)).

b Compensation for Self-Employed Individuals. For self-employed individuals, compensation means the net earnings from self-employment
determined under section 1402(a), without regard to section 1402(c)(6), prior to subtracting any contributions made pursuant to this plan on
behalf of the individual.
2 Employee. Employee means a common-law employee of the Employer. The term employee also includes a self-employed individual and a
leased employee described in section 414(n) but does not include a nonresident alien who received no earned income from the Employer that
constitutes income from sources within the United States.
3 Eligible Employee. An eligible employee means an employee who satisfies the conditions in Article I, item 1 and is not excluded under
Article I, item 2.
4 SIMPLE IRA. A SIMPLE IRA is an individual retirement account described in section 408(a), or an individual retirement annuity described in
section 408(b), to which the only contributions that can be made are contributions under a SIMPLE IRA plan and rollovers or transfers from
another SIMPLE IRA.
Article VI—Procedures for Withdrawals (The Employer will provide each employee with the procedures for withdrawals
of contributions received by the financial institution selected by that employee, and that financial institution’s name and
address (by attaching that information or inserting it in the space below) unless: (1) that financial institution’s procedures
are unavailable, or (2) that financial institution provides the procedures directly to the employee. See Employee
Notification in the instructions.)

Article VII—Effective Date

This SIMPLE IRA plan is effective . See
instructions.
* * * * *

Name of Employer By: Signature Date

Address of Employer Name and title

Form 5304-SIMPLE (Rev. 3-2012)

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Form 5304-SIMPLE (Rev. 3-2012) Page 3
Model Notification to Eligible Employees
I. Opportunity to Participate in the SIMPLE IRA Plan
You are eligible to make salary reduction contributions to the SIMPLE IRA
plan. This notice and the attached summary description provide you with information that you should consider before you decide whether to
start, continue, or change your salary reduction agreement.
II. Employer Contribution Election
For the calendar year, the Employer elects to contribute to your SIMPLE IRA (employer must select either (1), (2), or (3)):
(1) A matching contribution equal to your salary reduction contributions up to a limit of 3% of your compensation for the year;

(2) A matching contribution equal to your salary reduction contributions up to a limit of % (employer must insert a
number from 1 to 3 and is subject to certain restrictions) of your compensation for the year; or
(3) A nonelective contribution equal to 2% of your compensation for the year (limited to compensation of $250,000*) if you are an
employee who makes at least $ (employer must insert an amount that is $5,000 or less) in compensation for
the year.
III. Administrative Procedures
To start or change your salary reduction contributions, you must complete the salary reduction agreement and return it to
(employer should designate a place or
individual by (employer should insert a date that is not less than 60 days after notice is given).

IV. Employee Selection of Financial Institution
You must select the financial institution that will serve as the trustee, custodian, or issuer of your SIMPLE IRA and notify your Employer of
your selection.

Model Salary Reduction Agreement
I. Salary Reduction Election
Subject to the requirements of the SIMPLE IRA plan of (name of
employer) I authorize % or $ (which equals % of my current rate of pay) to be withheld from
my pay for each pay period and contributed to my SIMPLE IRA as a salary reduction contribution.

II. Maximum Salary Reduction
I understand that the total amount of my salary reduction contributions in any calendar year cannot exceed the applicable amount for that
year. See instructions.
III. Date Salary Reduction Begins
I understand that my salary reduction contributions will start as soon as permitted under the SIMPLE IRA plan and as soon as
administratively feasible or, if later, . (Fill in the date you want the salary reduction contributions to begin.
The date must be after you sign this agreement.)
IV. Employee Selection of Financial Institution
I select the following financial institution to serve as the trustee, custodian, or issuer of my SIMPLE IRA.

Name of financial institution

Address of financial institution

SIMPLE IRA account name and number

I understand that I must establish a SIMPLE IRA to receive any contributions made on my behalf under this SIMPLE IRA plan. If the
information regarding my SIMPLE IRA is incomplete when I first submit my salary reduction agreement, I realize that it must be completed by
the date contributions must be made under the SIMPLE IRA plan. If I fail to update my agreement to provide this information by that date, I
understand that my Employer may select a financial institution for my SIMPLE IRA.
V. Duration of Election
This salary reduction agreement replaces any earlier agreement and will remain in effect as long as I remain an eligible employee under the
SIMPLE IRA plan or until I provide my Employer with a request to end my salary reduction contributions or provide a new salary reduction
agreement as permitted under this SIMPLE IRA plan.
Signature of employee Date
* This is the amount for 2012. For later years, the limit may be increased for cost-of-living adjustments. The IRS announces the increase, if any, in a news release, in the
Internal Revenue Bulletin, and on the IRS website at IRS.gov.
Form 5304-SIMPLE (Rev. 3-2012)

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Form 5304-SIMPLE (Rev. 3-2012) Page 4
General Instructions participating in the SIMPLE IRA plan. If 2. You want employees who are
the failure to continue to satisfy the nonresident aliens receiving no earned
Section references are to the Internal 100-employee limit or the one-plan rule income from you that is income from
Revenue Code unless otherwise noted. described in 1 and 2 above is due to an sources within the United States to be
acquisition or similar transaction eligible under this plan; or
Purpose of Form involving your business, special rules 3. You want to establish a SIMPLE
Form 5304-SIMPLE is a model Savings apply. Consult your tax advisor to find 401(k) plan.
Incentive Match Plan for Employees of out if you can still maintain the plan after
Small Employers (SIMPLE) plan the transaction. Completing Form
document that an employer may use to Certain related employers (trades or 5304-SIMPLE
establish a SIMPLE IRA plan described businesses under common control) must
in section 408(p), under which each be treated as a single employer for Pages 1 and 2 of Form 5304-SIMPLE
eligible employee is permitted to select purposes of the SIMPLE IRA contain the operative provisions of your
the financial institution for his or her requirements. These are: (1) a controlled SIMPLE IRA plan. This SIMPLE IRA plan
SIMPLE IRA. group of corporations under section is considered adopted when you have
These instructions are designed to 414(b); (2) a partnership or sole completed all applicable boxes and
assist in the establishment and proprietorship under common control blanks and it has been executed by you.
administration of the SIMPLE IRA plan. under section 414(c); or (3) an affiliated The SIMPLE IRA plan is a legal
They are not intended to supersede any service group under section 414(m). In document with important tax
provision in the SIMPLE IRA plan. addition, if you have leased employees consequences for you and your
Do not file Form 5304-SIMPLE with required to be treated as your own employees. You may want to consult
the IRS. Instead, keep it with your employees under the rules of section with your attorney or tax advisor before
records. 414(n), then you must count all such adopting this plan.
leased employees for the requirements
For more information, see Pub. 560, listed above. Employee Eligibility
Retirement Plans for Small Business
Requirements (Article I)
(SEP, SIMPLE, and Qualified Plans), and What Is a SIMPLE IRA Plan?
Pub. 590, Individual Retirement Each year for which this SIMPLE IRA
Arrangements (IRAs). A SIMPLE IRA plan is a written plan is effective, you must permit salary
arrangement that provides you and your reduction contributions to be made by
Note. If you used the March 2002, employees with an easy way to make all of your employees who are
August 2005, or September 2008 version contributions to provide retirement reasonably expected to receive at least
of Form 5304-SIMPLE to establish a income for your employees. Under a $5,000 in compensation from you during
model Savings Incentive Match Plan, SIMPLE IRA plan, employees may the year, and who received at least
you are not required to use this version choose whether to make salary $5,000 in compensation from you in any
of the form. reduction contributions to the SIMPLE 2 preceding years. However, you can
IRA plan rather than receiving these expand the group of employees who are
Which Employers May amounts as part of their regular eligible to participate in the SIMPLE IRA
Establish and Maintain a compensation. In addition, you will plan by completing the options provided
SIMPLE IRA Plan? contribute matching or nonelective in Article I, items 1a and 1b. To choose
contributions on behalf of eligible full eligibility, check the box in Article I,
To establish and maintain a SIMPLE IRA employees (see Employee Eligibility item 1a. Alternatively, to choose limited
plan, you must meet both of the Requirements below and Contributions eligibility, check the box in Article I, item
following requirements: later). All contributions under this plan 1b, and then insert “$5,000” or a lower
1. Last calendar year, you had no will be deposited into a SIMPLE compensation amount (including zero)
more than 100 employees (including individual retirement account or annuity and “2” or a lower number of years of
self-employed individuals) who earned established for each eligible employee service in the blanks in (i) and (ii) of
$5,000 or more in compensation from with the financial institution selected by Article I, item 1b.
you during the year. If you have a him or her.
SIMPLE IRA plan but later exceed this In addition, you can exclude from
100-employee limit, you will be treated When To Use Form participation those employees covered
as meeting the limit for the 2 years 5304-SIMPLE under a collective bargaining agreement
for which retirement benefits were the
following the calendar year in which you A SIMPLE IRA plan may be established subject of good faith bargaining. You
last satisfied the limit. by using this Model Form or any other may do this by checking the box in
2. You do not maintain during any part document that satisfies the statutory Article I, item 2. Under certain
of the calendar year another qualified requirements. circumstances, these employees must
plan with respect to which contributions Do not use Form 5304-SIMPLE if: be excluded. See Which Employers May
are made, or benefits are accrued, for Establish and Maintain a SIMPLE IRA
service in the calendar year. For this 1. You want to require that all SIMPLE Plan? above.
purpose, a qualified plan (defined in IRA plan contributions initially go to a
section 219(g)(5)) includes a qualified financial institution designated by you. Salary Reduction
pension plan, a profit-sharing plan, a That is, you do not want to permit each
stock bonus plan, a qualified annuity of your eligible employees to choose a Agreements (Article II)
plan, a tax-sheltered annuity plan, and a financial institution that will initially As indicated in Article II, item 1, a salary
simplified employee pension (SEP) plan. receive contributions. Instead, use Form reduction agreement permits an eligible
A qualified plan that only covers 5305-SIMPLE, Savings Incentive Match employee to make a salary reduction
employees covered under a collective Plan for Employees of Small Employers election to have his or her compensation
bargaining agreement for which (SIMPLE)—for Use With a Designated for each pay period reduced by a
retirement benefits were the subject of Financial Institution; percentage (expressed as a percentage
good faith bargaining is disregarded if or dollar amount). The total amount of
these employees are excluded from

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Form 5304-SIMPLE (Rev. 3-2012) Page 5

the reduction in the employee’s Matching Contributions Additional Information
compensation cannot exceed the In general, you must contribute a matching
applicable amount for any calendar year. contribution to each eligible employee’s Timing of Salary Reduction
The applicable amount is $11,500 for 2012. SIMPLE IRA equal to the employee’s salary Contributions
After 2012, the $11,500 amount may be reduction contributions. This matching
increased for cost-of-living adjustments. In contribution cannot exceed 3% of the The employer must make the salary
the case of an eligible employee who is 50 employee’s compensation. See Definition reduction contributions to the financial
or older by the end of the calendar year, of Compensation, below. institution selected by each eligible
the above limitation is increased by $2,500 employee for his or her SIMPLE IRA no
for 2012. After 2012, the $2,500 amount You may reduce this 3% limit to a lower
may be increased for cost-of-living percentage, but not lower than 1%. You later than the 30th day of the month
adjustments. cannot lower the 3% limit for more than 2 following the month in which the amounts
calendar years out of the 5-year period would otherwise have been payable to the
Timing of Salary Reduction ending with the calendar year the reduction employee in cash.
Elections is effective. The Department of Labor has indicated
that most SIMPLE IRA plans are also
For any calendar year, an eligible employee Note. If any year in the 5-year period subject to Title I of the Employee
may make or modify a salary reduction described above is a year before you first Retirement Income Security Act of 1974
election during the 60-day period established any SIMPLE IRA plan, you will (ERISA). Under Department of Labor
immediately preceding January 1 of that be treated as making a 3% matching regulations at 29 CFR 2510.3-102, salary
year. However, for the year in which the contribution for that year for purposes of reduction contributions must be made to
employee becomes eligible to make salary determining when you may reduce the each participant’s SIMPLE IRA as of the
reduction contributions, the period during employer matching contribution. earliest date on which those contributions
which the employee may make or modify To elect this option, you must notify the can reasonably be segregated from the
the election is a 60-day period that employees of the reduced limit within a employer’s general assets, but in no event
includes either the date the employee reasonable period of time before the later than the 30-day deadline described
becomes eligible or the day before. applicable 60-day election periods for the previously.
You can extend the 60-day election year. See Timing of Salary Reduction
periods to provide additional opportunities Elections above. Definition of Compensation
for eligible employees to make or modify “Compensation” means the amount
salary reduction elections using the blank Nonelective Contributions
described in section 6051(a)(3) (wages,
in Article II, item 2b. For example, you can Instead of making a matching contribution, tips, and other compensation from the
provide that eligible employees may make you may, for any year, make a nonelective employer subject to federal income tax
new salary reduction elections or modify contribution equal to 2% of compensation withholding under section 3401(a)), and
prior elections for any calendar quarter for each eligible employee who has at least amounts paid for domestic service in a
during the 30 days before that quarter. $5,000 in compensation for the year. private home, local college club, or local
You may use the Model Salary Reduction Nonelective contributions may not be chapter of a college fraternity or sorority.
Agreement on page 3 to enable eligible based on more than $250,000* of Usually, this is the amount shown in box 1
employees to make or modify salary compensation. of Form W-2, Wage and Tax Statement.
reduction elections. To elect to make nonelective For further information, see Pub. 15,
Employees must be permitted to contributions, you must notify employees (Circular E), Employer’s Tax Guide.
terminate their salary reduction elections at within a reasonable period of time before Compensation also includes the salary
any time. They may resume salary the applicable 60-day election periods for reduction contributions made under this
reduction contributions for the year if such year. See Timing of Salary Reduction plan, and, if applicable, compensation
permitted under Article II, item 2b. Elections above. deferred under a section 457 plan. In
However, by checking the box in Article II, Note. Insert “$5,000” in Article III, item determining an employee’s compensation
item 2d, you may prohibit an employee 2b(i) to impose the $5,000 compensation for prior years, the employee’s elective
who terminates a salary reduction election requirement. You may expand the group of deferrals under a section 401(k) plan, a
outside the normal election cycle from employees who are eligible for nonelective SARSEP, or a section 403(b) annuity
resuming salary reduction contributions contributions by inserting a compensation contract are also included in the
during the remainder of the calendar year. amount lower than $5,000. employee’s compensation.
For self-employed individuals,
Contributions (Article III) Effective Date (Article VII) compensation means the net earnings
Only contributions described below may be Insert in Article VII the date you want the from self-employment determined under
made to this SIMPLE IRA plan. No provisions of the SIMPLE IRA plan to section 1402(a), without regard to section
additional contributions may be made. become effective. You must insert January 1402(c)(6), prior to subtracting any
1 of the applicable year unless this is the contributions made pursuant to this
Salary Reduction Contributions first year for which you are adopting any SIMPLE IRA plan on behalf of the
As indicated in Article III, item 1, salary SIMPLE IRA plan. If this is the first year for individual.
reduction contributions consist of the which you are adopting a SIMPLE IRA
amount by which the employee agrees to plan, you may insert any date between Employee Notification
reduce his or her compensation. You must January 1 and October 1, inclusive of the You must notify each eligible employee
contribute the salary reduction applicable year. prior to the employee’s 60-day election
contributions to the financial institution period described above that he or she can
selected by each eligible employee. make or change salary reduction elections
and select the financial institution that will
serve as the trustee, custodian, or

*This is the amount for 2012. For later years, the limit may be increased for cost-of-living adjustments. The IRS announces the increase, if any,
in a news release, in the Internal Revenue Bulletin, and on the IRS’s website at IRS.gov.

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Form 5304-SIMPLE (Rev. 3-2012) Page 6

issuer of the employee’s SIMPLE IRA. In Reporting Requirements There is a penalty of $50 per day
this notification, you must indicate imposed on the financial institution for
whether you will provide: You are not required to file any annual each failure to provide the summary
information returns for your SIMPLE IRA description described above. However, if
1. A matching contribution equal to plan, such as Form 5500, Annual the failure was due to reasonable cause,
your employees’ salary reduction Return/Report of Employee Benefit Plan, the penalty will not be imposed.
contributions up to a limit of 3% of their or Form 5500-EZ, Annual Return of
compensation; One-Participant (Owners and Their Paperwork Reduction Act Notice. You
2. A matching contribution equal to Spouses) Retirement Plan. However, you are not required to provide the
your employees’ salary reduction must report to the IRS which eligible information requested on a form that is
contributions subject to a percentage employees are active participants in the subject to the Paperwork Reduction Act
limit that is between 1 and 3% of their SIMPLE IRA plan and the amount of unless the form displays a valid OMB
compensation; or your employees’ salary reduction control number. Books or records
3. A nonelective contribution equal to contributions to the SIMPLE IRA plan on relating to a form or its instructions must
2% of your employees’ compensation. Form W-2. These contributions are be retained as long as their contents
subject to social security, Medicare,
You can use the Model Notification to railroad retirement, and federal may become material in the
Eligible Employees earlier to satisfy unemployment tax. administration of any Internal Revenue
these employee notification law. Generally, tax returns and return
requirements for this SIMPLE IRA plan. A Deducting Contributions information are confidential, as required
Summary Description must also be by section 6103.
provided to eligible employees at this Contributions to this SIMPLE IRA plan
time. This summary description are deductible in your tax year The time needed to complete this
requirement may be satisfied by containing the end of the calendar year form will vary depending on individual
providing a completed copy of pages 1 for which the contributions are made. circumstances. The estimated average
time is:
and 2 of Form 5304-SIMPLE (including Contributions will be treated as made
the information described in for a particular tax year if they are made Recordkeeping . . . . 3 hr., 38 min.
Article VI—Procedures for Withdrawals). for that year and are made by the due Learning about the
If you fail to provide the employee date (including extensions) of your law or the form . . . . 2 hr., 26 min.
notification (including the summary income tax return for that year. Preparing the form . . . . 47 min.
description) described above, you will be If you have comments concerning the
liable for a penalty of $50 per day until Summary Description accuracy of these time estimates or
the notification is provided. If you can Each year the SIMPLE IRA plan is in suggestions for making this form
show that the failure was due to effect, the financial institution for the simpler, we would be happy to hear
reasonable cause, the penalty will not be SIMPLE IRA of each eligible employee from you. You can write to the Internal
imposed. must provide the employer the Revenue Service, Tax Products
If the financial institution’s name, information described in section Coordinating Committee,
address, or withdrawal procedures are 408(l)(2)(B). This requirement may be SE:W:CAR:MP:T:M:S, 1111 Constitution
not available at the time the employee satisfied by providing the employer a Ave. NW, IR-6526, Washington, DC
must be given the summary description, current copy of Form 5304-SIMPLE 20224. Do not send this form to this
you must provide the summary (including instructions) together with the address. Instead, keep it with your
description without this information. In financial institution’s procedures for records.
that case, you will have reasonable withdrawals from SIMPLE IRAs
cause for not including this information established at that financial institution,
in the summary description, but only if including the financial institution’s name
you ensure that it is provided to the and address. The summary description
employee as soon as administratively must be received by the employer in
feasible. sufficient time to comply with the
Employee Notification requirements
earlier.

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