Form 5306-A
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Application for Approval of Prototype Simplified Employee
Pension (SEP) or Savings Incentive Match Plan for
Employees of Small Employers (SIMPLE IRA Plan)
(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.
OMB No. 1545-0199
1 Enter amount of user fee submitted (see Specific Instructions)
$
For IRS Use Only
File folder number
Part I
Identifying Information (see instructions before completing this part)
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
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
4b Applicant’s employer identification number
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
b
Trade or professional organization
c
Savings and loan association that qualifies as a bank
d
Bank
e Regulated investment company
f
Federally insured credit union
g
Approved non-bank trustee (attach copy of approval
letter)
Part II
SEP Information
Attach a copy of the SEP documents and indicate the article or section and the page number where
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
box. Sponsors are encouraged to use LRM language.
Plan Article or
Section
Reference
Plan
Page
Number
For
IRS Use
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
Sign
Here
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.
Signature of officer
Date
Title
For Paperwork Reduction Act Notice, see the instructions.
Cat. No. 32621R
Form 5306-A (Rev. 8-2013)
click to sign
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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
number where the following provisions appear. If an item does not apply, enter “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 box. Sponsors are encouraged to use LRM language.
Plan Article or
Section
Reference
Plan
Page
Number
For
IRS Use
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)
Form 5306-A (Rev. 8-2013)
Page 3
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
Future Developments
For the latest information about
developments related to Form 5306-A
and its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form5306a.
Purpose of form. Form 5306-A is used
by sponsors who want to get IRS
approval of their prototype simplified
employee pension (SEP) agreements or
savings incentive match plans for
employees of small employers (SIMPLE
IRA plan).
Who may file. Use Form 5306-A to
request a favorable opinion letter if:
You are a bank, federally insured credit
union, savings and loan association that
qualifies as a bank, insurance company,
regulated investment company, or trade
or professional society or association
(other than an employee association);
and
You want to get a favorable opinion
letter that a SEP agreement or SIMPLE
IRA plan to be used by more than one
employer is acceptable in form.
Who does not need to file. Instead of
designing their own SEP or SIMPLE IRA
plan, sponsors may use one of the Form
5304 or 5305 series of model forms to
establish a SEP or a SIMPLE IRA plan.
Sponsors who use one of these forms
with individual retirement accounts or
annuities for which the IRS has issued a
favorable opinion or ruling letter, or with
model individual retirement accounts
issued by the IRS, are considered to
have established a SEP or SIMPLE IRA
plan that meets the requirements of
section 408(k) or 408(p). Do not file
Form 5306-A if you use a model form.
Note. The IRS will not issue an opinion
letter on a document submitted with
Form 5306-A that is a combination of a
prototype SEP or SIMPLE IRA plan and
a prototype individual retirement account
or annuity.
What to file. File this application and
one copy of all documents that make up
the SEP agreement or SIMPLE IRA plan.
If this is an amendment, include a
copy of the amendment and an
explanation of its effect on the SEP
agreement or SIMPLE IRA plan.
Where to file. File Form 5306-A with the
Internal Revenue Service, Attention: EP
Opinion Letters, P.O. Box 27063,
McPherson Station, Washington, DC
20038.
Signature. An officer who is authorized
to sign or another person authorized
under a power of attorney must sign this
application. (Send the power of attorney
with this application when you file it.)
Specific Instructions
User fee. All applications must be
accompanied by the appropriate user
fee. Applications submitted without the
proper user fee will not be processed
and will be returned to the applicant.
To determine the proper user fee, see
Rev. Proc. 2013-8, 2013-1 I.R.B. 237,
available at www.irs.gov/
irb/2013-01_IRB/ar13.html, or the
current superseding revenue procedure.
Line 2c. If you are amending your
previously approved SEP or SIMPLE IRA
plan, enter the letter serial number, date,
and file folder number from the latest
opinion letter you received for your SEP
or SIMPLE IRA plan.
Line 3. If the application is for a SEP
that provides for elective deferrals
intended to meet the requirements of
section 408(k)(6), check the box.
The Small Business Job Protection Act
of 1996 (P.L. 104-188) repealed section
408(k)(6), effective December 31, 1996,
except with respect to a SEP of an
employer if the terms of the SEP of such
employer, as in effect on December 31,
1996, provided for elective deferrals.
Line 4a. Include the suite, room, or
other unit number after the street
number. If the Post Office does not
deliver mail to the street address and
you have a P.O. box, show the box
number instead of the street address.
Paperwork Reduction Act
Notice
We ask for the information on this form
to carry out the Internal Revenue laws of
the United States. We need it to ensure
that you are complying with these laws
and to allow us to figure and collect the
right amount of tax. This information is
needed to process your application and
to determine whether your prototype
SEP or SIMPLE IRA plan meets the
requirements of section 408(k) or 408(p).
You are not required to apply for
approval; however, if you want to receive
an opinion letter from the IRS regarding
your prototype SEP or SIMPLE IRA plan,
you are required to provide the
information requested on this form.
You are not required to provide the
information requested on a form that is
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 stated in
section 6103.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping . . . 15 hr., 46 min.
Learning about the law
or the form . . . . . 1 hr., 23 min.
Preparing, copying, assembling,
and sending the form
to the IRS . . . . . . 1 hr., 42 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/formspubs/. Click on “More
Information” and then on “Comment on
Tax Forms and Publications.” Or you can
send your comments to Internal
Revenue Service, Tax Forms and
Publications Division, 1111 Constitution
Ave. NW, IR-6526, Washington, DC
20224. Do not send the form to this
address. Instead, see Where to file.
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