Application for Approval of Prototype or Employer  
Form  5306 
(Rev. November 2019)        Sponsored Individual Retirement Arrangement (IRA)                                            OMB No. 1545-0390 
                              (Under section 408(a), (b), (c), or (p) or section 408A of the Internal Revenue Code) 
Department of the Treasury  
Internal Revenue Service                     ▶ Go to www.irs.gov/Form5306 for the latest information.
                                                                                                      For IRS Use Only 

1     Enter amount of user fee submitted. See Specific Instructions ▶    $                            File folder number
Part I    Identifying Information (see instructions before completing this part) 
2     Approval requested for: 
a     Type of individual retirement arrangement— 
      (1)   Prototype traditional IRA under section 408(a) or 408(b)          (2) Prototype Roth IRA under section 408A 
      (3)   Prototype dual-purpose IRA                                        (4) Prototype SIMPLE IRA under section 408(p) 
      (5)   Roth or traditional IRA established by employer or 
            employee association under section 408(c)
b         Initial application 
c         Amendment—Enter ▶        (1)  Latest letter serial number      (2)  Date letter issued                    (3)  File folder number 

3a    Name of applicant                                                                               3b  Employer identification  
                                                                                                            number of applicant 

      Number, street, and room or suite no. (if a P.O. box, see instructions) 

      City or town, state, and ZIP code 

4a    Name of person to be contacted                                                                  4b  Telephone number 

4 c   Email address 
                                                                         4d  If a power of attorney is attached, check box    .   .          ▶
5 a   Type of sponsoring organization (if you are applying for a ruling under section 408(c), do not complete this item): 
      (1)   Insurance company                                            (5)  Regulated investment company 
      (2)   Trade or professional association                            (6)  Federally insured credit union 
      (3)   Savings and loan association that qualifies as a bank        (7)  Approved non-bank trustee (attach copy of approval letter)
      (4)   Bank 
b     Type of submission (check one box):
      (1)   Not a mass submitter                                         (2)  Mass submitter
      (3)   Identical adoption of a mass submitter                       (4)  Minor modification of a mass submitter
6     Name of trustee or custodian 

      Number, street, and room or suite no. (if a P.O. box, see instructions) 

      City or town, state, and ZIP code 

7     Type of funding entity: 
a         Trust                               c      Insurance company
b         Custodial account                          Annuity contract or endorsement number (see instructions) ▶
          Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and, to the best of my knowledge and belief, 
          it is true, correct, and complete. 
Sign      ▲                                                                                          ▲
Here 
            Signature of officer                                         Date                         Title 
For Privacy Act and Paperwork Reduction Act Notice, see instructions.             Cat. No. 11830C                        Form 5306 (Rev. 11-2019) 

Form 5306 (Rev. 11-2019)                                                                                                            Page  2 
Part II   Plan Information 

Attach a copy of the plan documents and indicate the article or section reference and the page number        Article or       Page  For IRS  
where the following provisions appear. If an item does not apply, enter “N/A.” Sample language, or a listing 
                                                                                                                                    Use  
of required modifications (LRMs), is available at www.irs.gov/LRMS. Sponsors are encouraged to use LRM       Section     Number     Only 
language.                                                                                                    Reference 

8a Does the IRA provide that the trust is created for the exclusive benefit of the participant  
   or his or her beneficiaries, or that the annuity contract must be owned only by the  
   annuitant?            . . . . . . . .          . . . . . .      . . . . . . . . . .                .                             1/13 
b  Does the IRA describe the type of allowable contributions (that is, only cash except 
   for rollovers) and maximum limitation?  .          . . . .      . . . . . . . . . .                .                             2/14 
c  Does  the  IRA  prohibit  the  investment  of  trust  assets  in  collectibles,  or  contain  a  
   statement  informing  individuals  that  an  investment  in  collectibles,  except  for  
   investments  in  certain  coins  and  precious  metals,  will  be  treated  as  a  taxable  
   distribution? .         . . . . . . .          . . . . . .      . . . . . . . . . .                .                             3 
d  Does the IRA prohibit investment in life insurance contracts? .       . . . . . . .                .                             4 
e  Does the IRA provide the rules on required distributions commencing before death?  .                                             5/15 
f  Does the IRA provide the rules on required distributions commencing after death?                   .                             6/16 
g  Does the IRA provide that the account is nonforfeitable?  .         . . . . . . . .                .                             7/17 
h  Does the IRA provide that the contract is nontransferable?          . . . . . . . .                .                             18 
i  Does the IRA provide for application of premium refund (other than refunds attributable  
   to excess contributions) before the end of the calendar year following the year of the  
   refund toward the payment of future premiums or the purchase of additional benefits?                                             19 
j  Does the IRA prohibit commingling assets of trusts?             . . . . . . . . . .                .                             8 
k  Does the IRA provide that annuity contracts must have flexible premiums?  .     . .                .                             20 
l  Does the IRA provide for a separate accounting for the interest of each employee or  
   member of the association? .      . .          . . . . . .      . . . . . . . . . .                .                             9 
m  Does the IRA provide for annual calendar-year reports by trustees or issuers?  .  .                .                             10/21 
n  Does the IRA require substitution of non-bank trustee or custodian when notified by  
   the Commissioner of the Internal Revenue Service? .             . . . . . . . . . .                .                             11 
o  Does the IRA define compensation?  .             . . . . .      . . . . . . . . . .                .                             12/22 
                                                                                                                         Form 5306 (Rev. 11-2019) 

Form 5306 (Rev. 11-2019)                                                                                                    Page  3 
General Instructions                         Where to file. File Form 5306 at this       you want to receive a ruling from the IRS 
                                             address.                                    regarding your prototype or employee 
Section references are to the Internal       Internal Revenue Service                    sponsored individual retirement 
Revenue Code unless otherwise noted.         Attn: EP Opinion Letters                    arrangement, you are required to provide 
Future developments. For the latest          TE/GE Stop 31A Team 105                     the information requested on this form. 
information about developments related       P.O. Box 12192                              Section 6109 requires you to provide the 
to Form 5306 and its instructions, such      Covington, KY 41012-0192                    requested identification numbers. Failure 
as legislation enacted after this form and   Private delivery services (PDSs). PDSs      to provide the information may delay or 
instructions were published, go to           can’t deliver to the address shown          prevent processing your application; 
www.irs.gov/Form5306.                        above. If you choose to use a PDS, send     providing any false information may 
Purpose of form. Sponsoring                  Form 5306 to this address.                  subject you to penalties.
organizations, employers, or employee        Internal Revenue Service                      You are not required to provide the  
associations, use Form 5306 to request       Attn: EP Opinion Letters                    information requested on a form that is  
a ruling as to:                              TE/GE Stop 31A Team 105                     subject to the Paperwork Reduction Act  
• Whether a trust or custodial account       7940 Kentucky Drive                         unless the form displays a valid OMB 
agreement meets the requirements of          Florence, KY 41042                          control number. Books or records 
                                                                                         relating to a form or its instructions must 
section 408(a), 408(c), 408(p), or 408A; or  Go to www.irs.gov/PDS for the current       be retained as long as their contents 
• Whether an individual annuity meets        list of designated services.                may become material in the 
the requirements of section 408(b),          Address. Include the suite, room, or        administration of any Internal Revenue  
408(p), or 408A.                             other unit number after the street          law. 
                                             number. If thePost  Office does not         Generally, tax returns and return  
Who May File                                 deliver mail to the street address and      information are confidential, as stated in  
Opinion letters on prototype IRAs.           you have a P.O. box, show the box           section 6103. However, section 6103 
Form 5306 may be filed by a sponsoring       number instead of the street address.       allows or requires the Internal Revenue 
organization that is:                        Signature. An officer who is authorized     Service to disclose or give such 
• A bank (including savings and loan         to sign or another person authorized        information to the Department of Justice 
associations that qualify as banks and       under a power of attorney must sign this    for civil and criminal litigation, and to 
federally insured credit unions),            application. Send the power of attorney     cities, states, the District of Columbia, 
                                             with this application when you file it.     and U.S. commonwealths and 
• Any person who has IRS approval to                                                     possessions for use in administering 
act as a trustee or custodian,                                                           their tax laws. We may also disclose this 
                                             Specific Instructions 
• An insurance company,                                                                  information to other countries under a 
                                             User fee. All applications must be          tax treaty, to federal and state agencies 
• A regulated investment company, or         accompanied by the appropriate user         to enforce federal nontax criminal laws, 
• A trade or professional society or         fee.Applications submitted without the      or to federal law enforcement and 
association (other than employee             properuser fee will not be processed        intelligence agencies to combat 
associations).                               and will be returned to the applicant.      terrorism.  
Rulings under section 408(c).                To find the proper user fee, see Rev.       The time needed to complete and file 
Employers or employee associations           Proc. 2019-4, 2019-1 I.R.B. 146,            this form will vary depending on 
who want a ruling under section 408(c)       available at www.irs.gov/                   individual circumstances. The estimated 
for a trust that will beused for individual  irb/2019-01_IRB#RP-2019-04, or the          average time is: 
retirement accounts may file this form.      latest annual update.                       Recordkeeping     . . .   11 hr., 43 min.
The term “employee  association” means       Line 2c.If you are amending your plan,      Learning about the 
any organization composed    of two or       enter the file folder number, letter serial law or the form   . . .  . .    . 53 min.
more employees, including,   but not         number, and date from the latest opinion 
limited to, an employee association          letter you received for your plan.          Preparing and sending 
described in section 501(c)(4).                                                          the form to the IRS   .  .  1 hr., 7 min.
                                             Line 7c. Identify the endorsement, the 
Who does not need to file. Sponsors of       contract, or both for which you are         If you have comments concerning the  
programs that use any of the Form 5305       requesting an opinion letter.               accuracy of these time estimates or  
series of model forms should not submit                                                  suggestions for making this form 
their programs to the IRS. These model       Privacy Act and Paperwork                   simpler, we would be happy to hear from 
forms, issued by the IRS, contain                                                        you. You can send us comments from 
language that, if followed, will satisfy the Reduction Act Notice                        www.irs.gov/FormComments. Or you 
applicable statutory requirements.           We ask for the information on this form to  can write to Internal Revenue Service, 
What to file. File Form 5306 and a copy      carry out the Internal Revenue laws of the  Tax Forms and Publications Division, 
of the trust, custodial account, or annuity  United States. We need it to ensure that    1111 Constitution Ave. NW, IR-6526, 
contract and all other applicable            you are complying with these laws and to    Washington, DC 20224. Do not send the 
documents. If you are requesting an          allow us to figure and collect the right    form to this address. Instead, see Where 
opinion letter for an annuity where all the  amount of tax. This information is needed   to file ,earlier.
Internal Revenue Code requirements are       to process your application and to 
set forth in a separate endorsement that     determine whether your individual 
supersedes any conflicting language in       retirement account or individual 
any contract to which it may be              retirement annuity meets the 
attached, submit the endorsement and         requirements of section 408(a), 408(b), 
not the contract.                            408(c), 408(p), or 408A. You are not 
                                             required to apply for approval; however, if