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Form 15417: 403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status
IRS Form 15417 is a 403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status that helps determine plan status for applications submitted to conform to the 2021 RA List (Catalog Number 94028G).
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IRS Form 15417 - 403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status
IRS Form 15417 is a 403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status that helps determine plan status for applications submitted to conform to the 2021 RA List (Catalog Number 94028G).
Risk Radar
Scan points- 1Ensure every item is answered with a Yes/No, as an unanswered line requires explanation.
- 2Failing to explain any 'No' answer in Parts I, II, III, or IV.
- 3Not checking the box for Part III(a) if the sponsor is not a church or QCCO.
- 4Skipping Section IV entirely when the plan sponsor *is* a church, QCCO, or governmental entity.
- 5Failing to answer questions in Part II regarding common law employees or participant definition.
Plain English
This form confirms whether a retirement savings plan meets all IRS rules to be considered a 403(b) plan. It checks if the employer is eligible, if employees can participate, and if there are universal availability requirements met for elective contributions. Completing this worksheet ensures the plan qualifies under tax law.
Submission Date
- Filing date: 2024-12-04 22:10:55
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when determining if a plan meets eligibility and participation requirements for a 403(b) status application submitted to conform to the 2021 RA List (Catalog Number 94028G).
- Do not use it when the plan is already determined to be eligible or when you are only verifying one specific requirement listed in Sections I, II, III, or IV.
- Check Form 15417 instead when determining eligibility and participation for a 403(b) status under the 2021 RA List.
Form selector
Use this form or another form?
Plan is a church or QCCO
Section III applies automatically if sponsor is non-QCCO/government/tax-exempt
✓ Do not complete Section IV; verify this first
Form 15417 (Section III, line 'a')
Plan does not offer elective deferrals
Skip Section III and Worksheet 1A (Elective Deferrals) if true
✓ Ensure you skip the subsequent sections correctly
Form 15417 (Section III, line 'b')
Plan has contributions other than elective deferrals
Complete Section IV and ensure fail-safe language is addressed in Section IV(c)
✓ Verify that matching/non-elective contributions exist before proceeding
Form 15417 (Section IV, line 'b')
Deadline or filing window
This form relates to applications conforming to the 2021 RA List (Form 15417). The instructions do not list specific filing deadlines on this sheet; however, all items must be completed for that submission period.
Checklist
What you need before filling it out
Employer Eligibility (Section I)
Answer 'Yes' or 'No' to line 'a' and 'b' · Section I of Form 15417
Universal Availability Requirement (Section III, line 'd')
Confirm if exclusions are allowed under section 1.403(b)-5(b)(4)(ii) · Section III of Form 15417
Once-In-Always-In Rule (Section III, line 'e')
Confirm plan provides OIAI rule compliance under section 1.403(b)-5(b)(4)(iii) · Section III of Form 15417
Effective Opportunity Requirement (Section III, line 'f')
Answer 'Yes' or 'No' regarding the four sub-points (i-iv) · Section III of Form 15417
Fail-Safe Provision Language (Section IV, line 'c')
Confirm language states exactly how testing and correction occur · Section IV of Form 15417
Before you submit
- 1All items on the worksheet must be completed.
- 2Explain any 'No' answers in Sections I, II, III, and IV using the provided space.
- 3If Section III(a) is 'Yes' (Church/QCCO), confirm that Section IV is skipped entirely.
- 4If Section III(b) is 'No' (no elective deferrals offered), ensure Section III and Worksheet 1A are handled correctly.
- 5For Section III(d), verify how the plan determines <20 hours for both the first 12-month period AND subsequent periods.
- 6For Section III(f)(i), confirm participants are given a reasonable period to make their election.
- 7Confirm that if other benefits exist, they are not conditioned on elective deferrals unless specifically listed in 1.401(k)-1(e)(6)(i)(A), (B) and (D).
How to file this form
- 1Complete all required fields on IRS Form 15417, paying close attention to the specific 'Yes' or 'No' answers in Sections I through IV.
- 2Use the space provided on the worksheet to write explanations for any answer marked 'No'.
- 3If applicable, ensure Section III(d) addresses both the first 12-month period and subsequent periods when determining <20 hour exclusions.
- 4Sign and date IRS Form 15417 before submitting it with your application package to confirm completion.
Known limitations
- 1If the plan sponsor is a church or QCCO, Section III (Universal Availability Requirement for Elective Contributions) can be skipped entirely.
- 2If the plan does not offer elective deferrals, Section III of IRS Form 15417 requires skipping that section and WS 11a (Elective Deferrals for 403(b)).
- 3Section IV (Participation Requirements for Non-Elective Contributions) is not completed if the plan sponsor is a church, QCCO, or governmental entity.
- 4The technical principles detailed in IRS Form 15417 may change due to future regulations or guidelines.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The current edition of IRS Form 15417 is dated 04/23, and applications submitted must conform to the 2021 RA List (Form 15417 (4-2023)). The source does not specify changes from a prior version.
What changed or needs a fresh check
- Edition date — confirm the revision date reads 04/23.
- Catalog Number — confirm the form has Catalog Number 94028G.
- Mailing address — Not stated in the official source.
- Signature — The requirement for signature is not explicitly stated on this worksheet, but it must be completed.
- Plan Name — Ensure the specific name of the plan is written in Section I.
- IRS Publication Number — confirm publish.no.irs.gov.
Quick Facts
Downloads
After you file
- 1Complete all items on IRS Form 15417; a 'Yes' answer generally indicates a favorable conclusion is warranted, while a 'No' answer signals an existing problem.
- 2Use the space provided on the worksheet to explain any response marked as 'No'.
- 3Keep a copy of the completed IRS Form 15417 for your records.
- 4Confirm the application conforms to the 2021 RA List (Form 15417, Catalog Number 94028G).
- 5If Section IV is completed, ensure any 'No' answers are explained; if Section III has a 'No,' that answer must also be explained.
Sources
- SRCInstructions p.1 — All items must be completed for IRS Form 15417.
- SRCForm p.1 — Section I(a) asks if the employer is an eligible employer under section 1.403(b)-2(b)(8).
- SRCForm p.1 — Section I(b) checks if related employers must be considered for contribution exclusion.
- SRCForm p.1 — Section II(a) verifies if contributions are only made on behalf of common law employees providing service.
- SRCForm p.2 — Section III(e) addresses the Once-In-Always-In Rule (OIAI rule) regarding part-time employee exclusions.
- SRCForm p.2 — Section IV(b) asks if the plan has contributions other than elective deferrals (matching, non-elective, etc.).
Common confusion points
What does a 'Yes' or 'No' mean on IRS Form 15417?
A 'Yes' generally suggests a favorable conclusion is warranted, whereas a 'No' indicates an existing problem.
→ Explain any 'No' answers in the designated space.
When must you skip Section III of IRS Form 15417?
If the plan sponsor is a church or QCCO (Qualified Clergy Chambers Organization).
→ Check line III(a) to confirm the entity type.
Does the employer need to consider related employers in eligibility checks?
Yes, check if the plan provides that employees of related employers must be taken into account when determining exclusion from gross income.
→ This is covered under Section I(b) for IRS Form 15417.
What happens if an employee works less than 20 hours per week but doesn't qualify for the part-time exclusion?
The plan must determine if that employee normally works less than 20 hours for (1) the first 12-month period and (2) subsequent periods according to the Regulations.
→ Check lines III(c) and III(d) on IRS Form 15417.
What is the 'Once-In-Always-In Rule' (OIAI rule)?
It means that once an employee satisfies service conditions for a year, they remain eligible even if their hours drop below the minimum level.
→ This applies to the part-time exclusion detailed in Section III(e) of IRS Form 15417.
If there are other contributions besides elective deferrals (like matching), what must be done?
Complete Section IV, and specifically check if the plan includes a fail-safe provision for correcting failures under Section 410(b).
→ This applies when answering 'Yes' to line IV(b) of IRS Form 15417.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Section 410(b) failure correction is addressed by fail-safe language within IRS Form 15417.
Questions about IRS Form 15417
What is IRS Form 15417 used for?
This form confirms whether a retirement savings plan meets all IRS rules to be considered a 403(b) plan. It checks if the employer is eligible, if employees can participate, and if there are universal availability requirements met for elective contributions. Completing this worksheet ensures the plan qualifies under tax law.
Who must file IRS Form 15417?
The form must be completed by the entity sponsoring the 403(b) plan to determine its eligibility status.
What information does IRS Form 15417 require?
Part I covers Employer Eligibility Requirements, Part II details Employee Eligibility, and Parts III and IV cover Universal Availability and Participation Requirements for Non-Elective Contributions. The worksheet requires explanations for any 'No' answers in these sections.
When is IRS Form 15417 due?
The form is used when submitting applications to conform to the 2021 RA List (Form 15417, 4-2023). Specific filing deadlines are not stated on this sheet itself, but it pertains to that submission period.
Where do I file IRS Form 15417?
The instructions do not specify a single service center address; rather, the form is for applications submitted to conform to the 2021 RA List (Form 15417).
How do I complete IRS Form 15417?
All items must be completed before submission. The filer answers 'Yes' or 'No' for each requirement listed in Parts I through IV and uses the space on the worksheet to explain any answer marked 'No'.
What happens if IRS Form 15417 is filed incorrectly?
If any item on Form 15417 is incorrectly answered, it indicates a problem that requires explanation. The technical principles may be changed by future regulations or guidelines.
What does a 'Yes' or 'No' mean on IRS Form 15417?
A 'Yes' generally suggests a favorable conclusion is warranted, whereas a 'No' indicates an existing problem. Explain any 'No' answers in the designated space.
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