Form 8905
(January 2012)
Department of the Treasury
Internal Revenue Service
Certification of Intent To Adopt a Pre-approved Plan
Eligibility for the six (6) year remedial amendment cycle as
described in Part IV of IRS Revenue Procedure 2007-44
OMB No. 1545-2011
For IRS Use Only
Attach to Form 5300, 5307, 5310
Part I
Plan Sponsor Information - Enter all requested information
1a Employer name
1b Employer Identification Number (EIN)
1c Employer’s plan name
1d Plan number 1e Plan type - Enter 1 for DCP or 2 for DBP
Part II
Master and Prototype (M&P) Sponsor or Volume Submitter Practitioner Information - Enter all requested
information
2a Name of M&P sponsor or volume submitter practitioner
2b M&P sponsor or volume submitter practitioner EIN
2c Name of M&P plan or volume submitter specimen plan (see instructions)
Part III
Certifications
This certification must be signed and dated by both parties before the end of the employer’s applicable five-year remedial amendment cycle as determined under Part III of
Revenue Procedure 2007-44 (see instructions regarding who must sign).
3 Under penalties of perjury the employer identified in line 1a, certifies that it intends to adopt the plan identified in line 2c.
Signature / Title of employer Date
4 The M&P sponsor or volume submitter practitioner, listed above, certifies that an application for an opinion or advisory
letter for the M&P plan or volume submitter specimen plan identified above was filed on or will be filed by
M M D D
Y Y Y Y
Preparer’s signature / Title of M&P sponsor or volume submitter practitioner Date
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 37714B
Form 8905 (1-2012)
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Form 8905 (1-2012)
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General Instructions
Purpose of Form
Use Form 8905 to treat an employer as
eligible for the 6-year remedial
amendment cycle under Part IV of Rev.
Proc. 2007-44, 2007-28 I.R.B. 54.
Who May File
An adopter of an individually designed
plan or pre-approved plan (not otherwise
entitled to the 6-year remedial
amendment cycle) files this form when
necessary to request that their 5-year
remedial amendment cycle be converted
to the 6-year remedial amendment cycle
(as described under Parts III and IV of
Rev. Proc. 2007-44).
When To Complete
Complete Form 8905 before the end of
the employer’s 5-year remedial
amendment cycle as determined under
Part III of Rev. Proc. 2007-44.
How To File
File the completed Form 8905 by
attaching it to one of the following
applications.
• Form 5300, Application for
Determination for Employee Benefit Plan
• Form 5307, Application for
Determination for Adopters of Master or
Prototype or Volume Submitter Plans
• Form 5310, Application for
Determination for Terminating Plan
!
CAUTION
If no Form 5300, 5307, or 5310
filing is made, the employer
should keep the original
certification in their records
and should not file Form 8905 with the
IRS.
Filing a Complete
Certification
Certifications are screened for
completeness. The certification must be
signed and dated by the employer and
the pre-approved plan sponsor or
practitioner.
!
CAUTION
You must retain a complete
certification until it is filed with
the appropriate application.
Specific Instructions
Part I – Plan Sponsor
Information
Line 1a – Employer name. Enter the
company (employer’s) complete name.
Line 1b – Employer Identification
Number (EIN). Enter the 9-digit EIN
assigned to the plan sponsor/employer.
!
CAUTION
Do not use a social security
number or the EIN of the trust.
Line 1c – Employer’s plan name. Enter
the name of the employer’s plan which
will be amended or restated by the
adoption of a pre-approved plan.
Line 1e – Plan Type.
• Enter “1” for a defined contribution
plan (DCP).
• Enter “2” for a defined benefit plan
(DBP).
Part II – M&P Sponsor or
Volume Submitter
Practitioner
Line 2a – Name of M&P sponsor or
volume submitter practitioner. Enter
the name of the M&P sponsor or volume
submitter practitioner whose plan you
will be adopting.
Line 2b – M&P sponsor or volume
submitter practitioner EIN. Enter the 9-
digit EIN assigned to the M&P sponsor
or volume submitter practitioner.
Line 2c – Name of the M&P plan or
volume submitter specimen plan.
Enter the name of the M&P plan or
volume submitter specimen plan the
employer intends to adopt.
Example. Volume Submitter Profit
Sharing Plan.
Part III – Certifications
The employer and the M&P sponsor or
volume submitter practitioner must sign
and date this certification before the end
of the employer’s applicable 5-year
remedial amendment cycle as
determined under Part III, of Rev. Proc.
2007-44. The employer must manually
sign the form. Scanned or stamped
signatures will not be accepted. The
M&P sponsor and the volume submitter
practitioner may use a stamped,
scanned, or electronic signature.
Line 4. Enter the date by which the
opinion or advisory letter application for
the M&P plan or volume submitter
specimen plan being adopted by the
employer was or must be submitted as
determined under Part IV of Rev. Proc.
2007-44.
Paperwork Reduction Act Notice. We
ask for the information on this form to
carry out the Internal Revenue laws of
the United States. You are required to
give us the information. 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.
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 required
by Internal Revenue Code section 6103.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping . . . 3 hr., 21 mins.
Learning about the law
or the form . . . . . . 12 mins.
Preparing, copying,
assembling, and sending
the form to the IRS . . . 15 mins.
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 write to the Internal
Revenue Service, Tax Products
Coordinating Committee,
SE:W:CAR:MP:M:T:S, 1111 Constitution
Ave., NW, IR-6526, Washington, DC
20224. Do not send Form 8905 to this
address; instead, see the instructions for
the application with which this form is
filed.
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