(Rev. November 2019)

Form

5306-A

(Rev. November 2019)

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)

OMB No. 1545-0199

(Under section 408(k) or (p) of the Internal Revenue Code)

▶ Go to www.irs.gov/Form5306A for the latest information.

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)

Prototype savings incentive match plan for employees of small employers (SIMPLE IRA plan) under section 408(p)

(2)

b

Initial application

c

Amendment—Enter ▶

(1) Latest letter serial number

(2) Date letter issued

(3) File folder number

3

4a

If the SEP contains elective deferral provisions, check this box

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

5c

Email address

5b Telephone number

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 box 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:

Insurance company

e

Regulated investment company

a

b

f

Trade or professional organization

Federally insured credit union

c

g

Savings and loan association that qualifies as a bank

Approved non-bank trustee (attach copy of approval

letter)

Bank

d

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 at www.irs.gov/LRMS. 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

$600* in compensation from the employer for the year, other than employees who

may be excluded under section 410(b)(3)(A) or (C)? . . . . . . . . . .

b Does the SEP provide that all eligible employees will share in an allocation? . .

c Does the SEP contain a definite allocation formula that does not discriminate in

favor of highly compensated employees? . . . . . . . . . . . . .

d Does the SEP require that it be used only with pre-approved traditional IRAs? .

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)? . .

f

1

2

3

5

6

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 2019 and 2020. The amount may be increased in future years for cost-of-living adjustments.

Signature of officer

For Paperwork Reduction Act Notice, see the instructions.

▲

▲

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.

Date

Cat. No. 32621R

Title

Form 5306-A (Rev. 11-2019)

Page 2

Form 5306-A (Rev. 11-2019)

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 at www.irs.gov/LRMS. 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? . . . . . . . .

b Does the plan limit adoption to employers that have 100 or fewer employees who

earned $5,000 or more in compensation from the employer during the preceding

calendar year? . . . . . . . . . . . . . . . . . . . . . .

c Does the plan limit adoption to employers that do not maintain another qualified

plan to which contributions are made or benefits accrued? . . . . . . .

d Does the plan define the term “employee” to include leased employees and

employees described in section 401(c)(1)? . . . . . . . . . . . . .

e Does the plan cover all employees except those who may be excluded under

section 408(p)(4)? . . . . . . . . . . . . . . . . . . . . .

1

2

3

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? . . . . . . . . . . . .

g Does the plan provide that salary reduction contributions may not exceed the

statutory limits? . . . . . . . . . . . . . . . . . . . . . .

h Under the plan, is an eligible employee permitted to terminate a salary reduction

election at any time? . . . . . . . . . . . . . . . . . . . .

i

j

k

Is the interest of an eligible employee in the plan nonforfeitable at all times? . .

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? . . . . . . . . . . . . . . . . . . . . . . . . .

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? . .

6

7

8

9

10

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? . .

m Unless the employer has chosen, does the plan allow each eligible employee to

select the financial institution for their SIMPLE IRA? . . . . . . . . . .

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)? . . . . . . . . . . .

o

p

q

r

Does the plan define “compensation” as described in section 408(p)(6)(A)? . .

Does the plan require that it be used only with pre-approved SIMPLE IRAs? . .

Does the plan prohibit restrictions on withdrawals? . . . . . . . . . .

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? . . . . . . . . . . . . . . . . . . . . .

12

13

14

15

16

17

18

Form 5306-A (Rev. 11-2019)

Page 3

Form 5306-A (Rev. 11-2019)

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 plans).

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 at this

address.

Internal Revenue Service

Attn: EP Opinion Letters

TE/GE Stop 31A Team 105

P.O. Box 12192

Covington, KY 41012-0192

Private delivery services (PDSs). PDSs

can't deliver to the address shown

above. If you choose to use a PDS, send

Form 5306-A to this address.

Internal Revenue Service

Attn: EP Opinion Letters

7940 Kentucky Drive

TE/GE Stop 31A Team 105

Florence, KY 41042

Go to www.irs.gov/PDS for the current

list of designated services.

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. 2019-4, 2019-1 I.R.B. 146,

available at www.irs.gov/

irb/2019-01_IRB#RP-2019-04, or the

latest annual update.

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/FormComments. Or you

can write 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, earlier.