Form 5306-A - Application For Approval Of Prototype Simplified Employee Pension (Sep) Or Savings Incentive Match Plan For Employees Of Small Employers (Simple Ira Plan)

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5306-A

Application for Approval of Prototype Simplified Employee

Form

Pension (SEP) or Savings Incentive Match Plan for

(Rev. August 2013)

OMB No. 1545-0199

Employees of Small Employers (SIMPLE IRA Plan)

Department of the Treasury

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

▶

Internal Revenue Service

Information about Form 5306-A and its instructions is at

For IRS Use Only

Enter amount of user fee submitted (see Specific Instructions)

▶

Part I

Identifying Information (see instructions before completing this part)

File folder number

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)

Initial application

Amendment—Enter

(1) Latest letter serial number

(2) Date letter issued

(3) File folder number

▶

If the SEP contains elective deferral provisions, check this box .

▶

4a 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

5b Telephone number

5c Email address

5d If a power of attorney is attached, check box

▶

Type of submission (check one box):

Not a mass submitter

Mass submitter

Identical adoption of a mass submitter

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:

Type of sponsoring organization:

Insurance company

Regulated investment company

Trade or professional organization

Federally insured credit union

Approved non-bank trustee (attach copy of approval

Savings and loan association that qualifies as a bank

letter)

Bank

Part II

SEP Information

Attach a copy of the SEP documents and indicate the article or section and the page number where

For

Plan Article or

Plan

the following provisions appear. If any item does not apply, write “N/A.” Sample language, or a listing

IRS Use

Section

Page

of required modifications (LRMs), is available on the IRS website at IRS.gov. Type “LRM” in the search

Reference

Number

Only

box. Sponsors are encouraged to use LRM language.

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)? .

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)? .

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)? .

This is the amount for 2013. The amount may be increased in future years for cost-of-living adjustments.

Please

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.

Sign

Here

Date

Signature of officer

Title

5306-A

For Paperwork Reduction Act Notice, see the instructions.

Form

(Rev. 8-2013)

Cat. No. 32621R