OMB No. 1545-1772
                                                                                        User Fee for Employee Plan Opinion                              For 
Form   8717-A                                                                                         Letter Request                                    IRS 
(Rev. September 2018)                                                                                                                                   Use Amount paid
Department of the Treasury                                                              ▶ Attach to applicable Form 4461, 4461-A, or 4461-B.            Only
Internal Revenue Service                                                              ▶ Go to www.irs.gov/Form8717A for the latest information.
1   Name of plan provider

2   Provider’s employer identification number                                                                                                                       3   Plan number

4   Plan name

                                                                                                  Applications                                                         User Fee 
                                                                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)  Mass or non-mass submitter single document plan (no adoption agreements)—per each 
                                                                       single document plan . . . . . .     . .   . . . . . . . . .           . . . .   . . .       (2)  $

                                                                  (3)  Provider’s identical adoption of mass submitter basic plan document—per adoption 
                                                                       agreement or single document plan  . . .   . . . . . . . . .           . . . .   . . .       (3)  $

                                                                  (4)  Provider’s minor modification of mass submitter basic plan document—per adoption 
                                                                       agreement or single document plan .  . .   . . . . . . . . .           . . . .   . . .       (4)  $

                                                                  (5)  Assumption of sponsorship of a pre-approved plan—per basic plan document .   .   . . .       (5)  $

                                                                  (6)  Change in name and/or address of provider of a pre-approved plan—per basic plan 
                                                                       document . . . . .     . . . . .     . .   . . . . . . . . .           . . . .   . . .       (6)  $

                                Attach Check or Money Order Here

                                                                                                  Cat. No. 60826Q                                              Form 8717-A (Rev. 9-2018)

Form 8717-A (Rev. 9-2018)                                                                                                                  Page 2
General Instructions                             Attach Form 8717-A to the opinion letter           You aren’t required to provide the 
                                                 application for Forms 4461, 4461-A, and            information requested on a form subject to 
Section references are to the Internal Revenue   4461-B.                                            the Paperwork Reduction Act unless the form 
Code.                                                                                               displays a valid OMB control number. Books 
                                                 If you have multiple plans, submit a 
Future Developments                              separate opinion letter application and Form       or records relating to a form or its instructions 
                                                 8717-A for each plan.                              must be retained as long as their contents 
For the latest information about developments                                                       may become material in the administration of 
related to Form 8717-A and its instructions,     Where To File                                      any Internal Revenue law. Generally, tax 
such as legislation enacted after they were                                                         returns and return information are 
published, go to www.irs.gov/Form8717A.          Include Form 8717-A and user fee with your         confidential, as required by section 6103.
                                                 request or application.
                                                                                                    The time needed to complete and file this 
What’s New                                       Send your request or application to one            form will vary depending on individual 
Specific user fee amounts are no longer listed   of the following.                                  circumstances. The estimated average time is:
on Form 8717-A. You must now enter the           If sent via U.S. mail,                             Recordkeeping   .   . .     .  1 hr., 12 min.
appropriate user fee when completing line 5.     Internal Revenue Service                           Learning about the law                                
Purpose of Form                                  Attn: Pre-Approved Plans Coordinator               or the form . . .   . .     . .     .  34 min.
                                                 P.O. Box 2508 
Generally, a user fee is required with each      Room 6-403, Group 7521                             Preparing, copying, 
application for an opinion letter. Use Form      Cincinnati, OH 45201-2508                          assembling,  and sending 
                                                                                                    the form to the IRS . .     .  1 hr., 48 min.
8717-A to submit the appropriate fee for the     If sent via Express Mail or Private  
opinion letter.                                  Delivery Service,                                  If you have comments concerning the 
                                                                                                    accuracy of these time estimates or 
Specific Instructions                            Internal Revenue Service                           suggestions for making this form simpler, we 
                                                 Attn: Pre-Approved Plans Coordinator 
Line 5. User fee. To determine the               550 Main Street                                    would be happy to hear from you. You can 
                                                                                                    send us comments from www.irs.gov/
appropriate user fee to enter on line 5, go to   Room 6-403, Group 7521                             FormComments. Or you can send your 
the schedule for user fees in Rev. Proc.         Cincinnati, OH 45202                               comments to the Internal Revenue Service, 
2018-4, 2018-1 I.R.B. 146, available at 
www.irs.gov/irb/2018-01_IRB#RP-2018-4 or         Paperwork Reduction Act Notice. We ask             Tax Forms and Publications Division, 1111 
the latest annual update.                        for the information on this form to carry out      Constitution Ave. NW, IR-6526, Washington, 
Check the appropriate box on line 5 and          the Internal Revenue laws of the United            DC 20224. 
enter the user fee due. Attach a check or        States. If you want to have your plan              Do not send this form to this address. 
money order payable to “United States            approved by the IRS, you are required to give      Instead, see Where To File, earlier.
Treasury” for the full amount of the user fee to us the information. We need it to determine 
Form 8717-A. If you don’t include the full       whether you meet the legal requirements for 
amount, your application may be returned.        plan approval. Section 7528 authorizes us to 
                                                 charge a user fee.