Form 8717-A User Fee for Employee Plan Opinion Letter Request

Form

8717-A

(Rev. August 2024)
Department of the Treasury
Internal Revenue Service
1 Name of plan provider

User Fee for Employee Plan Opinion Letter Request

For
IRS
Use
Only

Use this form to make additional payments for applications submitted on
Form 4461, Form 4461-A, Form 4461-B, or Form 4461-C.
Go to www.irs.gov/Form8717A for the latest information.

OMB No. 1545-1772

Amount paid

2 Provider’s employer identification number

3 Plan number

4 Plan name

Applications
5

User fees for pre-approved plans
(1a) Mass or non-mass submitter—per basic plan document with one adoption agreement

.

.

(1a) $

(1b) Mass or non-mass submitter—per each additional adoption agreement

.

.

(1b) $

(2)

(3)

(4)

Attach Check or Money Order Here

User Fee

(5)

.

.

.

.

.

Mass or non-mass submitter single document plan (no adoption agreements)—per each
single document plan . . . . . . . . . . . . . . . . . . . . . . . .

(2)

$

Provider’s identical adoption of mass submitter basic plan document—per adoption
agreement or single document plan . . . . . . . . . . . . . . . . . . .

(3)

$

Provider’s minor modification of mass submitter basic plan document—per adoption
agreement or single document plan . . . . . . . . . . . . . . . . . . .

(4)

$

Assumption of sponsorship of a pre-approved plan—per basic plan document or single
document plan . . . . . . . . . . . . . . . . . . . . . . . . . .

(5)

$

Cat. No. 60826Q

Form 8717-A (Rev. 8-2024)

Page 2

Form 8717-A (Rev. 8-2024)

General Instructions
Section references are to the Internal Revenue
Code.

Future Developments
For the latest information about developments
related to Form 8717-A and its instructions,
such as legislation enacted after they were
published, go to www.irs.gov/Form8717A.

What’s New
Form 8717-A is now used only to make an
additional payment when an insufficient user
fee was paid for an opinion letter application
submitted on Form 4461, Form 4461-A, Form
4461-B, or Form 4461-C. Form 8717-A is no
longer attached to those forms because the
initial user fee payments are made through
www.Pay.gov.

Purpose of Form
Form 8717-A is used to pay any corrected
amount after a fee has been submitted and
processed through www.Pay.gov for a preapproved plan application under the Form
4461 series.

Specific Instructions
Line 5. User fee. To determine the
appropriate user fee to enter on line 5, go to
the schedule for user fees in Rev. Proc.
2024-4, 2024-1 I.R.B. 247, available at
www.irs.gov/irb/2024-01_IRB#RP-2024-4, or
the latest annual update.

Check the appropriate box on line 5 and
enter the amount of additional payment due.
Attach a check or money order made payable
to “United States Treasury” for the additional
user fee to Form 8717-A. If you don’t include
the proper amount, your application may be
returned.

Where To File
Send Form 8717-A and the additional
payment to one of the following.
If sending via U.S. mail:
Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
P.O. Box 2508
Room 6-403, Group 7521
Cincinnati, OH 45201-2508
If sending via Express Mail or Private
Delivery Service:
Internal Revenue Service
Attn: Pre-Approved Plans Coordinator
550 Main Street
Room 6-403, Group 7521
Cincinnati, OH 45202
Paperwork Reduction Act Notice. We ask
for the information on this form to carry out
the Internal Revenue laws of the United
States. Section 7528 authorizes us to charge
a user fee.

You aren’t required to provide the
information requested on a form subject to
the Paperwork Reduction Act unless the form
displays a valid OMB control number. Books
or records relating to a form or its instructions
must be retained as long as their contents
may become material in the administration of
any Internal Revenue law. Generally, tax
returns and return information are
confidential, as required by section 6103.
The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is:
Recordkeeping

.

.

1 hr., 12 min.

Learning about the law
or the form . . . . .

.

.

.

.

Preparing, copying,
assembling, and sending
the form to the IRS . .

.

1 hr., 48 min.

. 34 min.

If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form simpler, we
would be happy to hear from you. You can
send us comments from www.irs.gov/
FormComments. Or you can send your
comments to the Internal Revenue Service,
Tax Forms and Publications Division, 1111
Constitution Ave. NW, IR-6526, Washington,
DC 20224.
Do not send this form to this address.
Instead, see Where To File, earlier.