OMB No. 1545–1772
                                                            User Fee for Employee Plan Opinion                                For 
Form   8717-A                                                   or Advisory Letter Request                                    IRS 
(Rev. September 2016)                                                                                                         Use Amount paid
Department of the Treasury                                  ▶ Attach to applicable Form 4461, 4461-A, or 4461-B.              Only
Internal Revenue Service                           ▶ For the latest information about this form, go to www.IRS.gov/form8717.
1   Name of plan sponsor/practitioner

2   Sponsor’s/practitioner's employer identification number                                                                                  3   Plan number

4   Plan name

                                                                  Applications                                                               User Fee 
                                 5a Volume submitter
                                    (1a) Specimen plan (nonmass) with no/one adoption agreement  .       . . .    . . .     . . . .          (1a) $

                                    (1b) Specimen plan (nonmass) – per each additional adoption agreement  .      . . .     . . . .          (1b) $

                                    (2a) Mass submitter specimen plan with no/one adoption agreement       . .    . . .     . . . .          (2a) $

                                    (2b) Mass submitter – per each additional adoption agreement .     . . . .    . . .     . . . .          (2b) $

                                    (3)  Specimen plan identical to mass submitter specimen plan .     . . . .    . . .     . . . .          (3)  $

                                    (4)  Assumption of sponsorship of an approved specimen plan – per basic plan document  .      .          (4)  $

                                    (5)  Change in name and/or address of practitioner of an approved specimen plan – per basic 
                                         plan document  . . . . . . . . . .       . . . . .            . . . .    . . .     . . . .          (5)  $      0

                                    (6)  Mass submitter/nonmass submitter practitioner – per trust document in excess of 10 .   . .          (6)  $
                                 5b Master & Prototype (M&P):
                                    (1a) Mass Submitter – per basic plan document with one adoption agreement .     . .     . . . .          (1a) $

                                    (1b) Mass Submitter – per each additional adoption agreement       . . . .    . . .     . . . .          (1b) $

                                    (2)  Sponsor’s identical adoption of mass submitter basic plan document – per adoption 
                                         agreement   . .  . . . . . . . . .       . . . . .            . . . .    . . .     . . . .          (2)  $

Attach Check or Money Order Here    (3)  Sponsor’s minor modification of mass submitter basic plan document – per adoption 
                                         agreement   . .  . . . . . . . . .       . . . . .            . . . .    . . .     . . . .          (3)  $

                                    (4a) Nonmass submitter – per basic plan document with one adoption agreement  .         . . . .          (4a) $

                                    (4b) Nonmass submitter – per each additional adoption agreement  .     . .    . . .     . . . .          (4b) $

                                    (5)  Opinion letter for additional optional provisions – per mass submitter basic plan document  .       (5)  $

                                    (6)  Assumption of sponsorship of an approved M&P plan – per basic plan document .        . . .          (6)  $

                                    (7)  Change in name and/or address of sponsor of an approved M&P plan – per basic plan 
                                         document .  . .  . . . . . . . . .       . . . . .            . . . .    . . .     . . . .          (7)  $      0

                                    (8)  Mass submitter/nonmass submitter sponsor – per trust document in excess of 10  .     . . .          (8)  $
                                                                  Cat. No. 60826Q                                                       Form 8717-A (Rev. 9-2016)

Form 8717-A (Rev. 9-2016)                                                                                                               Page 2
Instructions                                     If you have multiple plans, submit a            You aren't required to provide the 
                                                 separate opinion or advisory letter application information requested on a form subject to 
(Section references are to the Internal          and Form 8717-A for each plan.                  the Paperwork Reduction Act unless the form 
Revenue Code unless otherwise noted.)                                                            displays a valid OMB control number. Books 
                                                 Where To File                                   or records relating to a form or its instructions 
Future Developments                                                                              must be retained as long as their contents 
                                                 Include Form 8717-A and user fee with your 
For the latest information about developments    request or application.                         may become material in the administration of 
related to Form 8717-A and its instructions,                                                     any Internal Revenue law. Generally, tax 
such as legislation enacted after they were      Send your request or application to one         returns and return information are 
published, go to www.irs.gov/form8717.           of the following:                               confidential, as required by section 6103.
                                                 If sent via U.S. mail,                          The time needed to complete and file this 
What's New                                       Internal Revenue Service                        form will vary depending on individual 
Specific user fee amounts are no longer listed   Attn: Pre-Approved Plans Coordinator            circumstances. The estimated average time is:
on Form 8717-A. You must now enter the           P.O. Box 2508                                   Recordkeeping   .   . .    .  1 hr., 12 min.
appropriate user fee when completing line 5.     Room 5106, Group 7521 
                                                 Cincinnati, OH 45201                            Learning about the law                                
                                                                                                 or the form . . .   . .    . .     .  34 min.
General Instructions                             If sent via Express Mail or Private  
                                                 Delivery Service,                               Preparing, copying, 
Purpose of Form                                                                                  assembling,  and sending 
                                                 Internal Revenue Service 
Generally, a user fee is required with each      Attn: Pre-Approved Plans Coordinator            the form to the IRS . .    .  1 hr., 48 min.
application for an opinion or advisory letter.   550 Main Street                                 If you have comments concerning the 
Use Form 8717-A to submit the appropriate        Room 5106, Group 7521                           accuracy of this time estimate or suggestions 
fee for the opinion or advisory letter.          Cincinnati, OH 45202                            for making this form simpler, we would be 
                                                                                                 happy to hear from you. You can send your 
Specific Instructions                            Paperwork Reduction Act Notice. We ask          comments to the Internal Revenue Service, 
                                                 for the information on this form to carry out
Line 5. User fee. To determine the                                                               Tax Forms and Publications Division, Room 
                                                 the Internal Revenue laws of the United
appropriate user fee to enter on line 5, go to                                                   6526, 1111 Constitution Ave. NW, 
                                                 States. If you want to have your plan
www.irs.gov/Retirement-Plans/User-fees-for-                                                      Washington, DC 20224. 
                                                 approved by the IRS, you are required to give
Employee-Plans-Determination,-Opinion-and-                                                       Do not send this form to this address. 
                                                 us the information. We need it to determine
Advisory-Letters. The schedule for user fees is                                                  Instead, see Where To File.
                                                 whether you meet the legal requirements for
also set forth in Rev. Proc. 2016-8, 2016-1                                                     
                                                 plan approval. Section 7528 authorizes us to 
I.R.B. 243, (available at www.irs.gov/           charge a user fee.
irb/2016-01_IRB/ar14.html) or the latest 
annual update.
Check the appropriate box on line 5 and 
enter the user fee due. Attach a check or 
money order payable to “United States 
Treasury” for the full amount of the user fee to 
Form 8717-A. If you don't include the full 
amount, your application may be returned.
Attach Form 8717-A to the opinion or 
advisory letter application for Forms 4461, 
4461-A, and 4461-B.