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Form 15417G: 403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status
IRS Form 15417G is a 403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status used to determine plan status. This worksheet requires all items to be completed, and 'Yes' generally indicates a favorable conclusion.
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IRS Form 15417G - 403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status
IRS Form 15417G is a 403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status used to determine plan status. This worksheet requires all items to be completed, and 'Yes' generally indicates a favorable conclusion.
Risk Radar
Scan points- 1Failing to explain any 'No' answer in a section results in an immediate indication of a problem with the plan.
- 2Failing to explain any 'No' answer in Part I (Applicability).
- 3Not specifying how designated Roth contributions are irrevocably designated under Section II(b).
- 4Omitting the plan reference number when answering questions in Parts II, III, IV, V, or VI.
- 5Not checking 'Yes' for all items if a favorable conclusion is warranted.
Plain English
This form helps confirm that an employer's retirement plan meets the rules for allowing employees to make elective deferrals into a 403(b) account. It checks specific criteria regarding contributions, availability, vesting, and automatic contribution arrangements. Completing this worksheet confirms whether the plan qualifies under IRS guidelines.
Submission Date
- Filing date: 2025-03-05 22:10:24
- 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 qualifies as a 403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status.
- Do not use it when the plan does not offer elective deferrals (in which case, skip to Section I(b)).
- Check Worksheet 6A (Limits) instead when determining basic limits or catch-up amounts for contributions.
Form selector
Use this form or another form?
Plan has EACA provisions
Use this section to verify specific requirements like uniformity and notice.
✓ Check the default percentage listed in Section VI(c).
Participant designates Roth contributions irrevocably
This confirms designated Roth contributions are made in lieu of pre-tax deferrals.
✓ Verify the 'Yes' answer on Section II(b).
Plan has universal availability requirements
Refer to Worksheet 1A for detailed eligibility and participation criteria under this section.
✓ Confirm the plan meets the requirements listed in WS 1A.
Need to check withdrawal election timing
This relates to the universal availability/effective opportunity requirement regarding elective deferrals.
✓ Review the discussion mentioned in WS 1a.
Deadline or filing window
While no single filing deadline is stated, if all participants are covered employees, the plan must distribute excess aggregate contributions within 6 months after the end of the plan year to avoid a Code § 4979 10% excise tax. The form itself requires completion of all items.
Checklist
What you need before filling it out
Section I(a) - Does the plan offer elective deferrals?
Yes/No selection in Section I · Worksheet 12A (p.1)
Section II(b) - Are designated Roth contributions irrevocable?
Yes/No selection in Section II · Worksheet 12A (p.1)
Section III(c) - Treatment of excess deferrals
Reference to Worksheet 6A (Limits) · Worksheet 12A (p.1)
Section IV(a) - Universal Availability Requirements
Reference to Worksheet 1A · Worksheet 12A (p.2)
Section VI(c) - Default percentage uniformity requirement
Yes/No selection in Section VI · Worksheet 12A (p.2)
Section VI(f) - Permissible withdrawal timing
Within 90 days · Worksheet 12A (p.2)
Before you submit
- 1Ensure all items on Form 15417G are completed, except shaded cross-references.
- 2Provide an explanation in the space provided if any answer marked 'No' is given (Sections I, II, III).
- 3Confirm that Section VI is completed if the plan contains Eligible Automatic Contribution Arrangements (EACAs).
- 4Verify on Page 2 that the required withdrawal election period is within 90 days (Section VI(a)).
- 5Check that the default elective deferrals are not counted towards the dollar limitation if applicable (Section VI(i)).
- 6Confirm the plan name and reference numbers are filled out for all sections.
- 7Ensure a signature is present on the worksheet.
How to file this form
- 1Complete Section I by answering whether the plan offers elective deferrals, then proceed to Section I(b) if 'Yes'.
- 2Answer questions in Section II regarding contributions, ensuring you explain any 'No' answers.
- 3Review Sections III and IV, referencing Worksheet 6A (Limits) and Worksheet 1A respectively, before answering the yes/no questions.
- 4If EACAs exist, complete Section VI, verifying requirements like uniformity and withdrawal timing.
- 5Sign and date Form 15417G to finalize the determination of 403(b) status. Keep a copy for your records.
Known limitations
- 1The technical principles described in Form 15417G may be changed by future regulations or guidelines.
- 2For the basic limit under section 402(g)(1) on elective deferrals, Worksheet 6A (Limits) must be consulted for details.
- 3For the age 50 and special section 403(b) catch-ups, Worksheet 6A (Limits) provides the necessary information.
- 4For treatment of excess deferrals, Worksheet 6A (Limits) contains the relevant guidance.
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 15417G is dated 04/23. The source does not point to a separate page for the latest information, indicating this version reflects the most recent published status.
What changed or needs a fresh check
- Edition date — confirm the revision date reads 04/23.
- Form number — confirm the form number is Form 15417-G.
- Catalog Number — confirm the catalog number reads 94035V.
- Signature — state that a signature must be provided (implied by instructions, but not explicitly stated on the visible pages).
- Plan Name/Reference — ensure the plan name and reference are filled out for all relevant sections.
Quick Facts
Downloads
After you file
- 1Keep a copy of the completed Form 15417G for your records.
- 2If you answer 'No' to any item, use the space on the worksheet to explain why that answer is 'No'.
- 3Confirm the revision date reads 04/23 on the form.
- 4Use the current edition of Form 15417G (Catalog Number 94035V) when filing.
Sources
- SRCInstructions p.1 — All items must be completed, except for cross-references which are shaded to indicate no answer is required.
- SRCInstructions p.1 — A “Yes” answer generally indicates a favorable conclusion is warranted, while a “No” answer indicates a problem exists.
- SRCInstructions p.1 — Section I(a) asks: Does the plan offer elective deferrals? (If “No,” skip this worksheet; if “Yes,” go on to I(b)).
- SRCInstructions p.1 — Section II(c) asks: Are the designated Roth contributions treated by the employer as includible in the participant’s income at the time the participant would have received that amount in cash if the participant had not made a cash or deferred election.
- SRCInstructions p.2 — Section IV refers to Worksheet 1A (Eligibility and Participation for 403(b) Plans) for universal availability requirements under 1.403(b)-5(b).
- SRCInstructions p.2 — If the plan provides that all participants are covered employees, then it has until 6 months (rather than 2½ months) after the end of the plan year to distribute excess aggregate contributions and avoid the Code § 4979 10% excise tax.
Common confusion points
Does 'Yes' mean everything is fine?
A 'Yes' answer generally indicates a favorable conclusion is warranted on this worksheet.
→ Check the instructions to confirm what a 'favorable conclusion' means for your specific plan.
What do I do if an item is shaded out?
Shaded items are cross-references, meaning no answer is required for that specific field.
→ Verify the shading pattern matches the form you have open.
Does 'No' require a detailed explanation?
Yes, use the space provided on the worksheet to explain any answer marked 'No'.
→ Ensure your explanation directly addresses why the conclusion is unfavorable.
When should I skip this entire worksheet?
Skip Form 15417G if you answer 'No' to question I(a): Does the plan offer elective deferrals?, and then go on to Section I(b).
→ If the plan offers elective deferrals, start with Section I(a) and proceed through the sections.
What is the difference between a general 'Yes' and a specific one?
A general 'Yes' suggests favorability; for example, answering 'Yes' to II(c) means designated Roth contributions are treated as includible in income.
→ Review each section header (I, II, III, IV, V, VI) to see which part of the determination you are confirming.
Is there a specific deadline mentioned?
The form does not list a filing deadline on this page, but it is an 'Elective Deferrals Worksheet 12A – Determination of 403(b) Status'.
→ Check surrounding documentation or IRS guidelines for the required submission date.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Worksheet 6A (Limits) — If you are unsure about limits, this form provides guidance on those calculations.
Questions about IRS Form 15417G
What is IRS Form 15417G used for?
This form helps confirm that an employer's retirement plan meets the rules for allowing employees to make elective deferrals into a 403(b) account. It checks specific criteria regarding contributions, availability, vesting, and automatic contribution arrangements. Completing this worksheet confirms whether the plan qualifies under IRS guidelines.
Who must file IRS Form 15417G?
The entity completing Form 15417G must determine if its plan meets the requirements for elective deferrals, which is necessary for eligibility to make designated Roth contributions.
What information does IRS Form 15417G require?
Part I addresses general applicability; Part II covers contributions and designation of Roth amounts. The worksheet collects data on limits, catch-ups (in Part III), universal availability, vesting, and Eligible Automatic Contribution Arrangements (EACAs) in Parts IV through VI.
When is IRS Form 15417G due?
The source does not state a specific filing deadline for the entire form itself, but it references internal requirements like needing to distribute excess aggregate contributions within 6 months after the end of the plan year if all participants are covered employees.
Where do I file IRS Form 15417G?
The official routing mechanism is not specified as an address, but the form is published by the Department of the Treasury - Internal Revenue Service and can be referenced via publish.no.irs.gov.
How do I complete IRS Form 15417G?
The preparer must complete all items, noting that cross-references are shaded if no answer is needed. The process involves answering questions sequentially across Parts I through VI, detailing whether the plan meets the criteria for each section (e.g., 'Does the plan offer elective deferrals?').
What happens if IRS Form 15417G is filed incorrectly?
If any answer in the worksheet is 'No,' the filer must use the space on the worksheet to explain why that specific condition fails to meet the required standard.
Does 'Yes' mean everything is fine?
A 'Yes' answer generally indicates a favorable conclusion is warranted on this worksheet. Check the instructions to confirm what a 'favorable conclusion' means for your specific plan.
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