Instructions for Form

2025

Instructions for Form

8955-SSA

Annual Registration Statement Identifying Separated

Participants With Deferred Vested Benefits

Section references are to the Internal Revenue Code, unless

otherwise noted. ERISA refers to the Employee Retirement

Income Security Act of 1974.

A Form 8955-SSA need not be filed for a year if no

information is required to be provided for that year by these

instructions.

Future developments. For the latest information about

developments related to Form 8955-SSA and its instructions,

such as legislation enacted after they were published, go to

IRS.gov/Form8955SSA.

Form 8955-SSA may be filed electronically through the

FIRE system or on paper. The IRS and the SSA encourage

all filers to file Form 8955-SSA electronically. Filing

electronically saves time and effort and helps ensure

accuracy. Certain filers, however, are required to file the 2025

Form 8955-SSA electronically. For more information, see

How To File, later.

Purpose of Form

Form 8955-SSA, the designated successor to Schedule SSA

(Form 5500), is used to satisfy the reporting requirements of

section 6057(a). Form 8955-SSA is a stand-alone reporting

form filed with the IRS. See Where To File, later. DO NOT file

Form 8955-SSA with Form 5500, Annual Return/Report of

Employee Benefit Plan, or Form 5500-SF, Short Form

Annual Return/Report of Small Employee Benefit Plan.

Use Form 8955-SSA to report information relating to each

participant who separated from service covered by the plan

and is entitled to a deferred vested benefit under the plan but

is not paid this retirement benefit. The plan administrator of

each plan subject to the vesting requirements must file Form

8955-SSA for participants who have a deferred vested

benefit under the plan and:

• Separated from service covered by the plan, but vested

retirement benefits are not paid and were not previously

reported (using Entry Code A in Part III, line 9, column (a));

• Were previously reported under the plan but whose

information is being corrected (using Entry Code B in Part III,

line 9, column (a));

• Were previously reported as deferred vested participants

on another plan's filing if their benefits were transferred (other

than in a rollover) to the plan of a new employer during the

covered period (using Entry Code C in Part III, line 9, column

(a)); or

• Were previously reported under the plan but have been

paid out or are no longer entitled to those deferred vested

benefits (using Entry Code D in Part III, line 9, column (a)).

For more information on required participant information,

see the instructions for Part III.

The information reported on Forms 8955-SSA is generally

given to the Social Security Administration (SSA). The SSA

provides the reported information to separated participants

when they file for social security benefits.

Note: The SSA no longer processes nonstandard pages 2.

Report information about separated participants only on

page 2 of Form 8955-SSA. If additional space is needed for

separated participants, use additional pages 2 only. Do not

add another page 1 of Form 8955-SSA, spreadsheets, or

other nonstandard formats.

Dec 30, 2025

Reporting requirement. Under section 6057(b), plan

administrators must notify the Secretary of the Treasury of

certain changes to the plan and the plan administrator. These

changes are reported on the plan’s Form 5500 return/report.

Plan administrators should report these changes on the Form

5500 return/report for the plan year in which the change

occurs as indicated in the Form 5500 instructions.

Telephone Assistance

If you have questions and need assistance completing this

form, call the IRS Help Line at 877-829-5500 and follow the

directions as prompted. This toll-free telephone service is

available Monday through Friday.

How To Get Forms and Publications

Internet. You can access the IRS website 24 hours a day, 7

days a week at IRS.gov to:

• Download forms, instructions, and publications;

• Order IRS products online;

• Research your tax questions online;

• Search publications online by topic or keyword; and

• Sign up to receive local and national tax news by email.

You can find forms, instructions, and publications by going

to the IRS website at IRS.gov/FormsPubs or IRS.gov/

OrderForms.

Photographs of Missing Children

The Internal Revenue Service is a proud partner with the

National Center for Missing & Exploited Children® (NCMEC).

Photographs of missing children selected by the Center may

appear in instructions on pages that would otherwise be

blank. You can help bring these children home by looking at

the photographs and calling 1-800-THE-LOST

(1-800-843-5678) if you recognize a child.

General Instructions

Who Must File

Plan administrators of plans subject to the vesting standards

of section 203 of ERISA must file Form 8955-SSA. For

example, the plan administrator of a section 403(b) plan that

Instructions for Form 8955-SSA (2025) Catalog Number 52730V

Department of the Treasury Internal Revenue Service www.irs.gov

is subject to the vesting standards of section 203 of ERISA

must file a Form 8955-SSA for the plan's deferred vested

participants. A plan administrator is not required to report a

separated participant if the participant's deferred vested

benefits are attributable to an annuity contract or custodial

account that is not required to be treated as part of the

section 403(b) plan assets for purposes of the reporting

requirements of ERISA Title I, as set forth in the Department

of Labor (DOL) Field Assistance Bulletin (FAB) 2009-02. For

this exception to apply:

1. The contract or account would have to have been

issued to a current or former employee before January 1,

2009;

2. The employer would have to have ceased having any

obligation to make contributions (including employee salary

reduction contributions), and in fact ceased making

contributions to the contract or account before January 1,

2009;

3. All the rights and benefits under the contract or

account would have to be legally enforceable against the

issuer or custodian by the participant without any involvement

by the employer; and

4. The participant would have to be fully vested in the

contract or account.

For more information, please see DOL FAB 2009-02 at

www.dol.gov.

Sponsors and administrators of government, church, and

other plans that are not subject to the vesting standards of

section 203 of ERISA (including plans that cover only owners

and their spouses or cover only partners and their spouses)

may elect to file Form 8955-SSA voluntarily. See the

instructions for Part I, line A.

Note: If the 2025 Form 5500 is the final return/report of the

plan, the Form 8955-SSA filed for the 2025 plan year must

report information on deferred vested participants, including

reporting that previously reported deferred vested

participants are no longer deferred vested participants.

When To File

In general, if a Form 8955-SSA must be filed for a plan year, it

must be filed by the last day of the seventh month following

the last day of that plan year (plus extensions). This due date

may be extended under some circumstances. See Extension

of Time To File below.

If the filing due date falls on a Saturday, Sunday, or legal

holiday, Form 8955-SSA may be filed on the next day that is

not a Saturday, Sunday, or legal holiday.

Extension of Time To File

Using Form 5558

If filing Form 8955-SSA under an extension of time based on

the filing of Form 5558, Application for Extension of Time To

File Certain Employee Plan Returns, check the “Form 5558”

box on Form 8955-SSA, Part I, line C. A one-time extension

of time (up to 21/2 months) to file Form 8955-SSA may be

obtained by filing Form 5558 on or before the normal due

date (not including any extensions) of Form 8955-SSA.

Beginning January 1, 2025, you can file Form 5558

electronically through the Department of Labor’s EFAST2

(ERISA Filing Acceptance System) or you can file paper

Form 5558 with the Department of the Treasury, Internal

2

Revenue Service Center, Ogden, UT 84201-0045. Because

approved copies of Form 5558 will not be returned to the filer,

you must retain a copy of the Form 5558 that is filed. See the

instructions for Form 5558.

Using Extension of Time To File Federal Income

Tax Return

An automatic extension of time to file Form 8955-SSA until

the due date of the federal income tax return of the employer

will be granted if all of the following conditions are met.

1. The plan year and the employer's tax year are the

same.

2. The employer has been granted an extension of time

to file its federal income tax return after the normal due date

for filing the Form 8955-SSA.

3. A copy of the application for extension of time to file

the federal income tax return is retained with the plan's

records.

Note: A tax-exempt organization filing Form 8868,

Application for Automatic Extension of Time To File an

Exempt Organization Return or Excise Taxes Related to

Employee Benefit Plans, to request an extension of time to

file a Form 990 series return is automatically granted an

extension of time to file Form 8955-SSA until the extended

due date of filing their Form 990 series return if all conditions

listed above are met.

Be sure to check the “automatic extension” box on Part I,

line C, at the top of the form. An extension of time granted by

using this automatic extension procedure CANNOT be

extended further by filing a Form 5558. It also cannot be

extended more than 91/2 months beyond the close of the plan

year.

Other Extensions of Time To File

The IRS may from time to time announce special extensions

of time under certain circumstances, such as extensions for

presidentially declared disasters or for service in, or in

support of, the Armed Forces of the United States in a

combat zone. Go to IRS.gov for announcements of special

extensions. If you are relying on a special extension, check

the box on line C and enter the exact language describing the

announcement in the space provided. For example, indicate

“Disaster Relief Extension” or “Combat Zone Extension.”

Amended Registration Statement

File a 2025 Form 8955-SSA to correct errors and/or

omissions in a previously filed statement. Check the box for

Part I, line B (“amended registration statement”). The

amended Form 8955-SSA must conform to the requirements

under How To File, later.

A full and complete Form 8955-SSA must be filed to

correct any such errors and/or omissions. For example, a full

and complete Form 8955-SSA must be filed if the plan

administrator determines that incorrect information was

provided for a single plan participant.

It is important to use a 2025 Form 8955-SSA to report

revisions to a participant's information previously filed on a

Form 8955-SSA or a Schedule SSA (Form 5500). Because

the SSA provides information that it has on file to individuals

who file for benefits, if this information is not up to date, the

individual may contact the plan administrator to resolve the

difference.

Instructions for Form 8955-SSA (2025)

Prior Year Statement

Although Schedule SSA (Form 5500) was previously used to

satisfy the reporting requirements of section 6057(a) for plan

years prior to January 1, 2009, the Schedule SSA (Form

5500) should no longer be filed under any circumstances.

(See Announcement 2011-21, 2011-12 I.R.B. 567.) Instead,

Form 8955-SSA should be filed for all plan years, including

delinquent returns for plan years before 2009. If a paper 2025

Form 8955-SSA is used to satisfy filing obligations for plan

years before 2009, complete Part I plan year beginning and

plan year ending dates for the appropriate plan year filed.

Forms 8955-SSA for prior years should be sent to the same

address as the 2025 Form 8955-SSA. See Where To File

below.

When To Report a Separated

Participant

In general, for a plan to which only one employer contributes,

a participant must be reported on Form 8955-SSA if:

1. The participant separates from service covered by the

plan in a plan year, and

2. The participant is entitled to a deferred vested benefit

under the plan.

In general, information on the deferred vested retirement

benefit of a plan participant must be filed no later than on the

Form 8955-SSA filed for the plan year following the plan year

in which the participant separates from service covered by

the plan. However, you can report a deferred vested

participant on the Form 8955-SSA filed for the plan year in

which the participant separates from service under the plan if

you want to report earlier. Do not report a participant more

than once unless you are revising or updating information on

a prior Form 8955-SSA or Schedule SSA (Form 5500). See

the Specific Instructions for Part III, line 9, code B, C, or D.

The determination of whether more than one employer

contributes to a plan is based on the number of employers

required to contribute to the plan. A plan to which only one

employer contributes includes a plan maintained by:

• A controlled group of corporations that are treated as a

single employer under section 414(b),

• Trades or businesses under common control that are

treated as a single employer under section 414(c), and

• An affiliated service group that is treated as a single

employer under section 414(m).

In general, for a plan to which more than one employer

contributes, a participant must be reported on Form

8955-SSA if:

1. The participant incurs two successive 1-year breaks in

service (as defined in the plan for vesting purposes), and

2. The participant is (or may be) entitled to a deferred

vested benefit under the plan.

For these purposes, a multiemployer plan described in

section 414(f), a collectively bargained plan described in

section 413(a), a multiple-employer plan described in section

413(c) (including plans described in section 413(e)), and a

multiple-employer plan described in section 403(b)(15) are

each treated as a plan to which more than one employer

contributes.

In general, information about the deferred vested

retirement benefit of a plan participant must be reported on

the Form 8955-SSA filed for the plan year in which the

participant completes the second of two consecutive 1-year

Instructions for Form 8955-SSA (2025)

breaks in service. Consecutive 1-year breaks in service are

defined in the plan for purposes of determining a participant’s

vesting percentage. The participant may be reported earlier

on the Form 8955-SSA filed for the plan year in which the

participant completed the first 1-year break in service.

When Not To Report a Participant

A participant who has not been previously reported is not

required to be reported on Form 8955-SSA if, before the date

the Form 8955-SSA is required to be filed (including any

extension of time to file), the participant:

1. Is paid some or all of the deferred vested retirement

benefit (see the Caution, below),

2. Returns to service covered by the plan and/or accrues

additional retirement benefits under the plan, or

3. Forfeits all the deferred vested retirement benefit.

Caution: If payment of the deferred vested retirement benefit

ceases before ALL of the participant's vested benefit is paid

to the participant or beneficiary, information on the

participant's remaining benefit shall be filed on the Form

8955-SSA filed for the plan year following the last plan year

within which the payment ceased.

Transfer of a Participant's Benefit to

the Plan of a New Employer

When the benefit of a separated participant with deferred

vested benefits is transferred from one plan to the plan of a

new employer, the following apply.

1. The new plan administrator must complete a Form

8955-SSA using Entry Code C for Part III, line 9, column (a),

and specifying the previous sponsor’s EIN in column (h) and

the previous plan number in column (i) to complete the

transfer to the plan.

Note: In the rare case that the previous plan sponsor’s EIN

and previous plan number are not available, the new plan

administrator should complete a Form 8955-SSA using Entry

Code A for Part III, line 9, column (a).

2. The previous plan administrator must complete a Form

8955-SSA using Entry Code D for Part III, line 9, column (a),

to remove the information previously reported under the plan

for deferred vested participants.

Where To File

If Form 8955-SSA is sent by U.S. mail, send the complete

form to:

Department of the Treasury

Internal Revenue Service Center

Ogden, UT 84201-0024

Private delivery services (PDSs). In addition to the U.S.

mail, you can use the PDSs designated by the IRS to meet

the “timely mailing as timely filing/paying” rule for tax returns

and payments. Go to IRS.gov/PDS for the current list of

designated services.

The PDS can tell you how to get written proof of the

mailing date.

PDSs must send Form 8955-SSA to:

Internal Revenue Submission Processing Center

1973 Rulon White Blvd.

Ogden, UT 84201

3

How To File

Follow the line-by-line instructions to complete Form

8955-SSA. Answer all questions about the plan, unless

otherwise specified.

Caution: Form 8955-SSA must be filed with the IRS. Form

8955-SSA is NOT open to public inspection. DO NOT attach

a Form 8955-SSA (or a previous year's Schedule SSA (Form

5500)) to a Form 5500 or Form 5500-SF required to be filed

with the DOL filing system (“EFAST2”).

Mandatory electronic filing. For 2013 and prior years,

filers had the option of filing Form 8955-SSA electronically.

Beginning with the 2014 Form 8955-SSA, however, some

filers are now required to file the form electronically. A filer

must electronically file the 2025 Form 8955-SSA if the filer is

required to file 10 or more returns of any type during the

calendar year that includes the first day of the plan year.

“Returns” for this purpose include information returns (for

example, Forms W-2 and 1099), income tax returns,

employment tax returns (including quarterly Forms 941), and

excise tax returns. If a filer is required to file a Form

8955-SSA electronically but does not, the filer is considered

not to have filed the form even if a paper return is submitted.

See Regulations section 301.6057-3 for more information on

the mandatory electronic filing of Form 8955-SSA.

On a year-by-year basis, the IRS may waive the

requirement to file Form 8955-SSA electronically in cases of

undue economic hardship. In certain circumstances, a Form

8955-SSA filer may be administratively exempt from the

requirement to file electronically. If the IRS's systems do not

support electronic filing of the Form 8955-SSA, taxpayers will

not be required to file electronically. In general, the filer

should maintain documentation supporting the undue

hardship or other applicable reason for not filing

electronically. See Rev. Proc. 2023-31, 2023-40 I.R.B.1057

for more information.

Electronic and paper filing. You can do the following.

• Use SSA-approved software to complete and

electronically file a Form 8955-SSA. For more information, go

to IRS.gov, search for and select “Form 8955-SSA

Resources,” and then select “Approved Software Vendors

Form 8955-SSA.”

• Use a personal computer to complete the online fillable

Form 8955-SSA on the IRS website at IRS.gov/FormsPubs

before printing, signing, and mailing it to the IRS. A barcode

capturing the data you entered on the form will appear on the

completed pages when printed. A form partially completed

online and partially completed (other than the signature) on

printed paper will cause processing delays and may result in

correspondence from the IRS.

• Use a printed Form 8955-SSA ordered from the IRS

website at IRS.gov/OrderForms. When completing the form,

use as many pages 2 of the Form 8955-SSA as necessary to

list separated participants and number the pages in

sequential order.

Note: Remember to use additional pages 2 of the 2025

Form 8955-SSA only if additional pages are needed to add

separated participants. Do not use nonstandard pages 2.

Processing tips. To reduce the possibility of

correspondence and penalties, do the following.

• Sign and date Form 8955-SSA.

• Check your information to avoid errors.

• Complete all applicable lines on the form unless otherwise

specified.

4

• Print all information necessary in the specific fields

provided on the form.

• Do not mark on or near any barcode.

• Do not use glue or other sticky substances on the paper

form.

• Do not staple the form pages. Use binder clips or other

fasteners that do not perforate the paper.

• Do not submit extraneous material or information, such as

arrows used to indicate where to sign, notes between

preparers of the report, or notations on the form.

• File Form 8955-SSA using the address specified in the

instructions under Where To File, earlier.

• Use only whole dollars. Round off cents to whole dollars.

Drop any amount less than 50 cents and increase any

amount from 50 to 99 cents to the next dollar.

Penalties

Section 6652(d)(1) imposes a penalty for failure to file a

registration statement (including failure to include all required

participants). The penalty is $10 for each participant not

reported, multiplied by the number of days the failure

continues. The penalty, up to a maximum of $50,000, is

imposed on the person failing to properly file unless it is

shown the failure is due to reasonable cause.

In the case of a failure to file a notification of a change in

the status of the plan (such as a change in the plan name or a

termination of the plan), or a change in the name or address

of the plan administrator, section 6652(d)(2) imposes a

penalty of $10 for each day during which such failure occurs.

The penalty, up to a maximum of $10,000, is imposed on the

person failing to so file unless it is shown the failure is due to

reasonable cause.

The Code provides that each plan administrator required

to file a registration statement must, before the expiration of

the time prescribed for the filing of the form, also furnish to

each affected participant an individual statement setting forth

the information required to be contained in the form. Section

6690 imposes a penalty of $50 for each willful failure to

furnish a statement, or willful furnishing of a false statement,

on any person required to furnish an individual statement to

each affected participant.

Specific Instructions

PART I

Enter the calendar or fiscal year beginning and ending dates

of the plan year (not to exceed 12 months in length) for which

you are reporting information. Express the dates in numerical

month, day, and year in the following order: (MMDDYYYY).

For a plan year of less than 12 months (short plan year),

enter the short plan year beginning and ending dates on the

line provided at the top of the form. For purposes of this form,

the short plan year ends on the date of a change in

accounting period or the complete distribution of the plan's

assets.

Line A. Check this box if you are electing to file this form

voluntarily. The plan administrators of plans, such as

governmental plans and non-electing church plans, not

subject to the vesting standards of section 203 of ERISA are

not required to file this form but may elect to do so. If such a

plan administrator so elects, the plan administrator is

encouraged to provide as much information as possible, but

no specific requirements are imposed.

Instructions for Form 8955-SSA (2025)

Note: Only the plan administrators of plans subject to the

vesting standards of section 203 of ERISA must file the Form

8955-SSA.

Line B. Check this box if this Form 8955-SSA amends a

previously filed Schedule SSA (Form 5500) or Form

8955-SSA.

Line C. Check the appropriate box if an extension of time

has been filed using Form 5558, or if an automatic or special

extension has been granted. If a special extension has been

granted, enter the description of the special extension exactly

as it is listed in the announcement. See Other Extensions of

Time To File, earlier, for additional information regarding

special extensions.

PART II

Please verify that the employer identification number (EIN)

and plan number (PN) being used on this Form 8955-SSA

are correct for this plan.

Line 1a. Enter the formal name of the plan or enough

information to identify the plan. Abbreviate if necessary.

Line 1b. Enter the three-digit number that the employer or

plan administrator assigned to the plan and uses to file the

plan's Form 5500 return/report.

Line 2a. Enter the name of the plan sponsor. The term “plan

sponsor” means:

• The employer, for a plan that a single employer established

or maintains;

• The employee organization in the case of a plan of an

employee organization; or

• The association, committee, joint board of trustees, or

other similar group or representatives of the parties who

established or maintain the plan (in the case of a plan

established or maintained jointly by one or more employers

and one or more employee organizations, or by two or more

employers).

Note: In the case of a multiple-employer plan, if an

association or similar entity is not the sponsor, enter the

name of a participating employer as sponsor. The plan

administrator of a plan maintained by a controlled group of

corporations should enter the name of the member of the

controlled group that is entered on the Form 5500 return/

report as the plan sponsor. The same name must be used in

all subsequent filings of the Form 8955-SSA for the

multiple-employer plan or controlled group. (See the

instructions for line 5 about changes in sponsorship.)

Line 2b. Enter the sponsor's nine-digit EIN. Do not use a

social security number (SSN). Sponsors without an EIN must

apply for one as soon as possible.

EINs are issued by the IRS. You can apply for an EIN in

one of the following ways.

• Online — Go to the IRS website at IRS.gov/EIN. The EIN is

issued immediately once the application information is

validated. (The online application process is not yet available

for corporations with addresses in foreign countries.)

• By mailing or faxing Form SS-4, Application for Employer

Identification Number.

A multiple-employer plan or plan of a controlled group of

corporations should use the EIN of the sponsor identified on

line 2a. The EIN must be used in all subsequent filings of

Form 8955-SSA. (See the instructions for line 5 about

changes in EIN.)

Instructions for Form 8955-SSA (2025)

If the plan sponsor is a group of individuals, get a single

EIN for the group (providing the group name).

Line 2c. Enter the plan sponsor's trade name if that trade

name is different from the plan sponsor's name entered on

line 2a.

Line 2e. If you want a third party to receive mail for the plan,

enter “C/O” followed by the third party's name and complete

the applicable mailing address on lines 2f through 2l.

Line 2f. Enter the plan sponsor's street address. A post

office box may be entered if the post office does not deliver

mail to the plan sponsor's street address.

Line 2g. Enter the name of the city.

Line 2h. Enter the two-character abbreviation for the U.S.

state or territory.

Line 2j. Enter the foreign province or state, if applicable.

Line 2k. Enter the foreign country, if applicable.

Line 2l. Enter the foreign postal code, if applicable. Leave

the U.S. state and ZIP code blank if completing line 2k or

line 2l.

Line 3a. Enter the plan administrator's name. Enter “Same”

if the plan administrator identified on line 3a is the same as

the plan sponsor identified on line 2a and leave lines 3b

through 3k blank.

“Plan administrator” for this purpose means:

• The person or group of persons specified as the

administrator by the instrument under which the plan is

operated,

• The plan sponsor/employer if an administrator is not so

designated, or

• Any other person prescribed by regulations if an

administrator is not designated and a plan sponsor cannot be

identified.

Note: Employees of the plan sponsor who perform

administrative functions for the plan are generally not plan

administrators unless specifically designated in the plan

document. If an employee of the plan sponsor is designated

as the plan administrator, that employee must obtain an EIN.

Line 3b. Enter the plan administrator's nine-digit EIN. Plan

administrators who do not have an EIN must apply for one as

described in the instructions for line 2b.

Line 3c. If you want a third party to receive mail for the plan

administrator, enter “C/O” followed by the third party's name

and complete the applicable mailing address on lines 3e

through 3k.

Line 3e. Enter the plan administrator's street address. A

post office box may be entered if the post office does not

deliver mail to the sponsor's street address.

Line 3f. Enter the name of the city.

Line 3g. Enter the two-character abbreviation for the U.S.

state or territory.

Line 3i. Enter the foreign province or state, if applicable.

Line 3j. Enter the foreign country, if applicable.

Line 3k. Enter the foreign postal code, if applicable. Leave

the U.S. state and ZIP code blank if completing line 3j or

line 3k.

Line 4. If the plan administrator's name and/or EIN have

changed since the most recent Schedule SSA (Form 5500)

5

or Form 8955-SSA was filed for this plan, enter the plan

administrator's name and EIN as they appeared on the most

recently filed Schedule SSA (Form 5500) or Form 8955-SSA.

Caution: Failure to indicate on line 4 that a plan

administrator was previously identified by a different name or

EIN could result in correspondence from the IRS.

Line 5. If the plan sponsor's name and/or EIN have changed

since the most recently filed Schedule SSA (Form 5500) or

Form 8955-SSA for this plan, enter the plan sponsor's name

and EIN, and the three-digit PN as they appeared on the

most recently filed Schedule SSA (Form 5500) or Form

8955-SSA.

Caution: Failure to indicate on line 5 that a plan sponsor was

previously identified by a different name or EIN could result in

correspondence from the IRS.

Line 6a. For a plan to which only one employer contributes,

provide the total number of participants entitled to a deferred

vested benefit who separated from service in the 2024 plan

year and who were not previously reported. For a plan to

which more than one employer contributes, provide the total

number of participants entitled to a deferred vested benefit

who completed the second of two consecutive 1-year breaks

in service in the 2025 plan year and who were not previously

reported.

Line 6b. For a plan to which only one employer contributes,

provide the total number of participants entitled to a deferred

vested benefit who separated from service under the plan in

the 2025 plan year and who are reported in Part III of this

form. For a plan to which more than one employer

contributes, provide the total number of participants entitled

to a deferred vested benefit who separated from service

under the plan in 2025 or who completed the first 1-year

break in service in the 2025 plan year and who are reported

in Part III of this form. See When To Report a Separated

Participant, earlier.

Caution: Do not include any participants on line 6a or 6b

who were previously reported on a Form 8955-SSA or a

Schedule SSA (Form 5500). Accordingly, only those

participants who are listed with an Entry Code A on page 2

should be included on line 6a or 6b.

Line 7. The sum of lines 6a and 6b should equal the number

on line 7.

Line 8. Check the appropriate box as to whether the plan

administrator provided the individual statement to each

participant required to receive one. See Penalties, earlier.

Signature. Form 8955-SSA must be signed and dated by

the plan sponsor and by the plan administrator. If the plan

administrator and the plan sponsor are the same person,

include only the signature as plan administrator on the form.

If more than one page 2 of the form is filed for one plan, only

one page 1 of Form 8955-SSA should be signed and filed

with the pages 2 for the plan.

PART III

Enter the name of the plan, the PN, and the plan sponsor's

EIN at the top of each page 2.

Line 9, column (a). Enter the appropriate code from the

following list.

6

Code Use this code for a participant not previously

A

reported. Also, complete columns (b) through

(g), as applicable.

Code Use this code for a participant previously

B

reported under the PN shown on this form to

modify some of the previously reported

information. Enter all the current information for

columns (b) through (g), as applicable. You do

not need to report a change in the value of a

participant's account because that is likely to

change. However, you may report such a

change if you want.

Code Use this code for a participant previously

C

reported under the plan of a different plan

sponsor and who will now be receiving a future

benefit from the plan reported on this form.

Also, complete columns (b), (c), (h), and (i).

Code Use this code for a participant previously

D

reported under the PN shown on this form who

is no longer entitled to those deferred vested

benefits. This includes a participant who has

begun receiving benefits, has received a

lump-sum payout, or has been transferred to

another plan (for example, in the case of a plan

termination). Also, complete columns (b) and

(c). Participants should not be reported under

code D merely because they return to the

service of the plan sponsor.

Line 9, column (b). Enter the full nine-digit SSN of each

participant listed. Please do not enter only the last four digits

of the SSN. If the participant is a foreign national employed

outside the United States who does not have an SSN, enter

the word “FOREIGN.”

Line 9, column (c). Enter each participant's name exactly

as it appears on the participant's social security card. Do not

enter periods; however, initials, if on the social security card,

are permitted.

After the last name column, there is a checkmark column.

Check the box for each participant whose information is

based on incomplete records. Information for a participant

may be based on incomplete records where more than one

employer contributes to the plan and the records at the end

of the plan year are incomplete regarding the participant's

service. Check the box next to a participant's name if:

1. The amount of the participant's vested benefit is based

on records that are incomplete as to the participant's covered

service (or other relevant service), or

2. The plan administrator is unable to determine from the

records of the participant's service if the participant is vested

in any deferred retirement benefit but there is a significant

likelihood that the participant is vested in such a benefit. See

Regulations section 301.6057-1(b)(3).

Line 9, column (d). From the following list, select the code

that describes the type of annuity that will be provided for the

participant. Enter the code that describes the type of annuity

that normally accrues under the plan at the time of the

participant's separation from service covered by the plan (or,

Instructions for Form 8955-SSA (2025)

for a plan to which more than one employer contributes, at

the time the participant incurs the second consecutive 1-year

break in service under the plan).

Type of Annuity Code

A A single sum

B Annuity payable over fixed number of years

C Life annuity

D Life annuity with period certain

E Cash refund life annuity

F Modified cash refund life annuity

G Joint and last survivor life annuity

M Other

Line 9, column (e). From the following list, select the code

that describes the benefit payment frequency during a

12-month period.

Type of Payment Code

A Lump sum

B Annually

C Semiannually

D Quarterly

E Monthly

M Other

Line 9, column (f). For a defined benefit plan, enter the

amount (in whole dollars) of the periodic payment that a

participant is entitled to receive.

In general, a deferred vested benefit under a defined

benefit plan would be reported under line 9, column (f), as the

periodic payment that the participant is entitled to receive.

The plan administrator may, however, report a different form

of benefit if the plan administrator considers it more

appropriate. For example, the plan administrator of a cash

balance plan may report a participant's benefit as the

participant's hypothetical account balance. In that case, the

plan administrator may enter code A (a single sum) in column

(d) and code A (a lump sum) in column (e).

For a multiemployer plan, if the amount of the periodic

payment cannot be accurately determined because the plan

administrator does not maintain complete records of covered

service, enter an estimated amount.

Privacy Act and Paperwork Reduction Act Notice. We

ask for the information on this form to carry out the Internal

Revenue laws of the United States. Sections 6057 and 6109

require you to provide the information requested on this form.

We need it to determine whether the plan properly accounts

for the deferred vested retirement benefits of separated

participants. Failure to provide this information, or providing

false or fraudulent information, may subject you to penalties.

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

section 6103.

However, section 6103 authorizes disclosure of the

information to others. Pursuant to section 6057(d), we will

disclose this information to the Social Security Administration

for use in administering the Social Security Act. This

information may also be disclosed to the Department of

Justice for civil or criminal litigation, to the Department of

Labor or the Pension Benefit Guarantee Corporation for use

in administering ERISA, and to cities, states, the District of

Columbia, and U.S. commonwealths and territories for use in

administering their tax laws. It may also be disclosed to other

countries under a tax treaty, to federal and state agencies to

enforce federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat terrorism.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is 49 minutes.

If you have suggestions for making this form simpler, we

would be happy to hear from you. You can send us

comments from IRS.gov/FormComments. Or you can write to

the Internal Revenue Service, Tax Forms and Publications

Division, 1111 Constitution Ave. NW, IR-6526, Washington,

DC 20224. Do not send Form 8955-SSA to this address.

Instead, see Where To File, earlier.

Line 9, column (g). For defined contribution plans, enter

the value (in whole dollars) of the participant's account.

Line 9, columns (h) and (i). Show the EIN and PN of the

plan under which the participant was previously reported.

Instructions for Form 8955-SSA (2025)

7