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Form 5306-A Application for Approval of Prototype Simplified Employee
(Rev. August 2013) Pension (SEP) or Savings Incentive Match Plan for OMB No. 1545-0199
Department of the Treasury Employees of Small Employers (SIMPLE IRA Plan)
Internal Revenue Service (Under section 408(k) or (p) of the Internal Revenue Code)
▶ Information about Form 5306-A and its instructions is at www.irs.gov/form5306a.
For IRS Use Only
1 Enter amount of user fee submitted (see Specific Instructions) ▶ $
Part I Identifying Information (see instructions before completing this part) File folder number
2 Approval requested for:
a Type of plan—
(1) Prototype simplified employee pension (SEP) under section 408(k)
(2) Prototype savings incentive match plan for employees of small employers (SIMPLE IRA plan) under section 408(p)
b Initial application
c Amendment—Enter ▶ (1) Latest letter serial number (2) Date letter issued (3) File folder number

3 If the SEP contains elective deferral provisions, check this box . . . . . . . . . . ▶
4a Name of applicant 4b Applicant’s employer identification number

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

City or town, state, and ZIP code

5a Name of person to be contacted 5b Telephone number

5c Email address
5d If a power of attorney is attached, check box . . ▶
6 Type of submission (check one box): a Not a mass submitter b Mass submitter
c Identical adoption of a mass submitter d Minor modification of a mass submitter
7a If 6c or 6d is checked, enter the mass submitter’s name
b File folder number of the mass submitter’s SEP or SIMPLE IRA plan on which this submission is based:
8 Type of sponsoring organization:
a Insurance company e Regulated investment company
b Trade or professional organization f Federally insured credit union
c Savings and loan association that qualifies as a bank g Approved non-bank trustee (attach copy of approval
d Bank letter)
Part II SEP Information
Attach a copy of the SEP documents and indicate the article or section and the page number where Plan Article or Plan For
the following provisions appear. If any item does not apply, write “N/A.” Sample language, or a listing
of required modifications (LRMs), is available on the IRS website at IRS.gov. Type “LRM” in the search Section Page IRS Use
box. Sponsors are encouraged to use LRM language. Reference Number Only

9a Does the SEP cover all employees who have attained age 21, performed service
for the employer in 3 of the immediately preceding 5 years, and received at least
$550* in compensation from the employer for the year, other than employees who
may be excluded under section 410(b)(3)(A) or (C)? . . . . . . . . . . 1
b Does the SEP provide that all eligible employees will share in an allocation? . . 2
c Does the SEP contain a definite allocation formula that does not discriminate in
favor of highly compensated employees? . . . . . . . . . . . . . 3
d Does the SEP require that it be used only with pre-approved traditional IRAs? . 5
e Does the SEP prohibit restrictions on withdrawals (other than restrictions
permitted under section 408(d)(7)(A) in the case of a salary reduction SEP)? . . 6
f Does the SEP define “compensation” in a manner that satisfies one of the safe
harbor definitions under section 414(s) and limit compensation under section
408(k)(3)(C)? . . . . . . . . . . . . . . . . . . . . . . . 7
* This is the amount for 2013. The amount may be increased in future years for cost-of-living adjustments.
Please 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 Paperwork Reduction Act Notice, see the instructions. Cat. No. 32621R Form 5306-A (Rev. 8-2013)

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Form 5306-A (Rev. 8-2013)                                                                                                                Page  2 
Part III SIMPLE IRA Plan Information 
Attach a copy of the SIMPLE IRA plan documents and indicate the article or section and the page             Plan Article or  Plan        For   
number  where  the  following  provisions  appear.  If  an  item  does  not  apply,  enter  “N/A.”  Sample  Section          Page        IRS Use 
language, or a listing of required modifications (LRMs), is available on the IRS website at IRS.gov. 
Type “LRM” in the search box. Sponsors are encouraged to use LRM language.                                  Reference        Number      Only 
10a Does the plan define the term “employer” to include all members of such groups 
    or entities required to be aggregated with the employer?  .   .         . . . . .  .                                                 1 
b   Does the plan limit adoption to employers that have 100 or less employees who 
    earned $5,000 or more in compensation from the employer during the preceding 
    calendar year?  .       . . . . . . . . .    . .    .     . . .         . . . . .  .                                                 2 
c   Does the plan limit adoption to employers that do not maintain another qualified 
    plan to which contributions are made or benefits accrued?     .         . . . . .  .                                                 3 
d   Does  the  plan  define  the  term  “employee”  to  include  leased  employees  and 
    employees described in section 401(c)(1)?  . . .    .     . . .         . . . . .  .                                                 4 
e   Does  the  plan  cover  all  employees  except  those  that  may  be  excluded  under 
    section 408(p)(4)?  .     . . . . . . . .    . .    .     . . .         . . . . .  .                                                 5 
f   Does the plan provide that each eligible employee may make or modify a salary 
    reduction  agreement  during  the  60-day  period  immediately  preceding  the 
    calendar year after receiving proper notice? . .    .     . . .         . . . . .  .                                                 6 
g   Does  the  plan  provide  that  salary  reduction  contributions  may  not  exceed  the
    statutory limits? .     . . . . . . . . .    . .    .     . . .         . . . . .  .                                                 7 
h   Under the plan, is an eligible employee permitted to terminate a salary reduction 
    election at any time?  .    . . . . . . .    . .    .     . . .         . . . . .  .                                                 8 
i   Is the interest of an eligible employee in the plan nonforfeitable at all times? . .                                                 9 
j   Does the plan provide that the employer will make matching contributions to each 
    eligible  employee’s  SIMPLE  IRA  equal  to  the  employee’s  salary  reduction 
    contribution, up to a limit of 3% of the employee’s compensation for the calendar 
    year?  . . .          . . . . . . . . . .    . .    .     . . .         . . . . .  .                                                 10 
k   Does the plan provide that the employer will make a 2% nonelective contribution 
    to each eligible employee’s SIMPLE IRA in lieu of matching contributions?  .       .                                                 11 
l   Does the plan require that the employer will make salary reduction contributions 
    to eligible employees’ SIMPLE IRAs no later than 30 days after the month in which 
    the amounts would otherwise have been payable to the employee in cash? .           .                                                 12 
m   Unless the employer has chosen, does the plan allow each eligible employee to 
    select the financial institution for their SIMPLE IRA?  . . . .         . . . . .  .                                                 13 
n   If  the  employer  has  selected  the  financial  institution,  does  the  plan  require  the 
    financial institution to meet the notification requirements of section 408(p)(7) and 
    limited in accordance with section 408(p)(2)(B)?  . .     . . .         . . . . .  .                                                 14 
o   Does the plan define “compensation” as described in section 408(p)(6)(A)?  .       .                                                 15 
p   Does the plan require that it be used only with pre-approved SIMPLE IRAs? .        .                                                 16 
q   Does the plan prohibit restrictions on withdrawals?  .    . . .         . . . . .  .                                                 17 
r   Does  the  plan  provide  that  amendments  will  become  effective  only  at  the
    beginning of a calendar year and will conform to the content of the plan notice for 
    the calendar year?  .     . . . . . . . .    . .    .     . . .         . . . . .  .                                                 18 

                                                                                                                             Form 5306-A (Rev. 8-2013)

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Form 5306-A (Rev. 8-2013) Page 3

General Instructions If this is an amendment, include a Paperwork Reduction Act
copy of the amendment and an
Section references are to the Internal explanation of its effect on the SEP Notice
Revenue Code unless otherwise noted. agreement or SIMPLE IRA plan. We ask for the information on this form
Future Developments Where to file. File Form 5306-A with the to carry out the Internal Revenue laws of
Internal Revenue Service, Attention: EP the United States. We need it to ensure
For the latest information about Opinion Letters, P.O. Box 27063, that you are complying with these laws
developments related to Form 5306-A McPherson Station, Washington, DC and to allow us to figure and collect the
and its instructions, such as legislation 20038. right amount of tax. This information is
needed to process your application and
enacted after they were published, go to Signature. An officer who is authorized to determine whether your prototype
www.irs.gov/form5306a. to sign or another person authorized SEP or SIMPLE IRA plan meets the
Purpose of form.Form 5306-A is used under a power of attorney must sign this requirements of section 408(k) or 408(p).
by sponsors who want to get IRS application. (Send the power of attorney You are not required to apply for
approval of their prototype simplified with this application when you file it.) approval; however, if you want to receive
employee pension (SEP) agreements or an opinion letter from the IRS regarding
savings incentive match plans for Specific Instructions your prototype SEP or SIMPLE IRA plan,
employees of small employers (SIMPLE you are required to provide the
IRA plan). User fee. All applications must be information requested on this form.
accompanied by the appropriate user
Who may file. Use Form 5306-A to fee. Applications submitted without the You are not required to provide the
request a favorable opinion letter if: proper user fee will not be processed information requested on a form that is
• You are a bank, federally insured credit and will be returned to the applicant. subject to the Paperwork Reduction Act
unless the form displays a valid OMB
union, savings and loan association that To determine the proper user fee, see control number. Books or records
qualifies as a bank, insurance company, Rev. Proc. 2013-8, 2013-1 I.R.B. 237, relating to a form or its instructions must
regulated investment company, or trade available at www.irs.gov/ be retained as long as their contents
or professional society or association irb/2013-01_IRB/ar13.html, or the may become material in the
(other than an employee association); current superseding revenue procedure. administration of any Internal Revenue
and
Line 2c. If you are amending your law. Generally, tax returns and return
• You want to get a favorable opinion previously approved SEP or SIMPLE IRA information are confidential, as stated in
letter that a SEP agreement or SIMPLE plan, enter the letter serial number, date, section 6103.
IRA plan to be used by more than one and file folder number from the latest The time needed to complete and file
employer is acceptable in form. opinion letter you received for your SEP this form will vary depending on
Who does not need to file. Instead of or SIMPLE IRA plan. individual circumstances. The estimated
designing their own SEP or SIMPLE IRA Line 3. If the application is for a SEP average time is:
plan, sponsors may use one of the Form that provides for elective deferrals Recordkeeping . . . 15 hr., 46 min.
5304 or 5305 series of model forms to intended to meet the requirements of
establish a SEP or a SIMPLE IRA plan. section 408(k)(6), check the box. Learning about the law
Sponsors who use one of these forms or the form . . . . . 1 hr., 23 min.
with individual retirement accounts or The Small Business Job Protection Act
annuities for which the IRS has issued a of 1996 (P.L. 104-188) repealed section Preparing, copying, assembling,
favorable opinion or ruling letter, or with 408(k)(6), effective December 31, 1996, and sending the form
model individual retirement accounts except with respect to a SEP of an to the IRS . . . . . . 1 hr., 42 min.
issued by the IRS, are considered to employer if the terms of the SEP of such If you have comments concerning the
have established a SEP or SIMPLE IRA employer, as in effect on December 31, accuracy of these time estimates or
plan that meets the requirements of 1996, provided for elective deferrals. suggestions for making this form
section 408(k) or 408(p). Do not file Line 4a. Include the suite, room, or simpler, we would be happy to hear from
Form 5306-A if you use a model form. other unit number after the street you. You can send us comments from
Note. The IRS will not issue an opinion number. If the Post Office does not www.irs.gov/formspubs/. Click on “More
letter on a document submitted with deliver mail to the street address and Information” and then on “Comment on
Form 5306-A that is a combination of a you have a P.O. box, show the box Tax Forms and Publications.” Or you can
prototype SEP or SIMPLE IRA plan and number instead of the street address. send your comments to Internal
a prototype individual retirement account Revenue Service, Tax Forms and
or annuity. Publications Division, 1111 Constitution
Ave. NW, IR-6526, Washington, DC
What to file. File this application and 20224. Do not send the form to this
one copy of all documents that make up address. Instead, see Where to file.
the SEP agreement or SIMPLE IRA plan.

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