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Official form guide
Form 15417: 403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status
IRS Form 15417 is a worksheet used to determine a plan’s 403(b) status, assessing employer eligibility, employee eligibility, universal availability of elective deferrals, and non‑elective contribution rules. It notes that corrective plan language must be adopted by June 30 2020 if the Once‑In‑Always‑In rule is not met.
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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 worksheet used to determine a plan’s 403(b) status, assessing employer eligibility, employee eligibility, universal availability of elective deferrals, and non‑elective contribution rules. It notes that corrective plan language must be adopted by June 30 2020 if the Once‑In‑Always‑In rule is not met.
Risk Radar
Scan points- 1Missing the June 30 2020 corrective‑language deadline triggers penalties.
- 2Answering “Yes” when the employer is not eligible under section 1.403(b)-2(b)(8).
- 3Failing to explain a “No” answer in any worksheet section.
- 4Skipping Section III when the sponsor is not a church, QCCO, or government entity.
- 5Not indicating whether the plan follows the Once‑In‑Always‑In rule.
Plain English
This worksheet helps a plan sponsor decide if their 403(b) plan meets the required rules. It checks the employer’s eligibility, which employees can participate, and whether the plan follows the universal availability and non‑elective contribution standards. Any “No” answer must be explained on the form.
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 you need to determine a plan’s 403(b) status by completing the employer eligibility, employee eligibility, universal availability, and non‑elective contribution sections (Form p.1).
- Do not use it when the sponsor is a church or QCCO, because the worksheet instructs to skip the rest of the worksheet (Form p.1).
Form selector
Use this form or another form?
Plan does not offer elective deferrals
Elective‑deferral questions are omitted, requiring the separate worksheet for elective deferrals
✓ Verify the plan truly lacks elective deferrals
Sponsor is a church or QCCO and you must skip the rest of this worksheet
The worksheet directs you to skip all remaining sections for churches or QCCOs
✓ Ensure you do not fill sections meant to be skipped
Plan qualified for operational relief under Notice 2018‑95 and missed the OIAI rule
Corrective language must have been adopted by June 30 2020 (Form p.2)
✓ Check that the plan language meets the Once‑In‑Always‑In rule
Deadline or filing window
Not stated in the official source
Checklist
What you need before filling it out
Employer eligibility question a
Employer’s eligibility determination document · Plan sponsor’s eligibility policy (Form p.1)
Universal availability employee‑hours test (line c)
Hours‑worked records for first 12‑month period and subsequent periods · Payroll records (Form p.1)
Once‑In‑Always‑In rule (line e)
Language adopting corrective plan provisions · Plan amendment dated before June 30 2020 (Form p.2)
Effective opportunity requirement (section f)
Notice of election timing and election change policy · Plan documents describing notice period (Form p.2)
Fail‑safe language for coverage correction (section i‑ii)
Detailed correction testing procedure · Plan language describing fixed rights and testing method (Form p.2)
Before you submit
- 1Complete every Yes/No/N/A box in each section.
- 2Provide a written explanation for every “No” answer in the space provided.
- 3Confirm that the plan sponsor is not a church or QCCO before filling sections beyond I.
- 4Verify the plan’s elective‑deferral status and skip the section if none are offered.
- 5Check that the Once‑In‑Always‑In rule language is present if applicable.
- 6Ensure the effective opportunity requirement language is included.
- 7Sign the worksheet where required.
How to file this form
- 1Answer all Yes/No/N/A questions on the worksheet.
- 2Explain any “No” answers in the designated spaces.
- 3Attach any referenced plan documents or amendments.
- 4Obtain the required signature(s) on the worksheet.
- 5Submit the completed Form 15417 to the appropriate IRS or plan‑sponsor address.
- 6Keep a dated copy of the submitted worksheet for your records.
Known limitations
- 1The worksheet is not used when the sponsor is a church or QCCO; those sponsors skip the rest of the worksheet (Form p.1).
- 2Section IV (non‑elective contributions) is omitted for church, QCCO, or governmental sponsors (Form p.2).
- 3If the plan does not offer elective deferrals, the universal‑availability section is skipped (Form p.1).
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.
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Fillable formOpen in Editor->The worksheet is the 04/23 revision (Form 15417 (4-2023)) as shown on the cover. The source does not reference a separate latest‑information page or detail changes from prior editions.
What changed or needs a fresh check
- Edition date — confirm the form shows (4-2023) as the revision date on the cover (Form p.1).
- Fee — Not stated in the official source — verify on the agency site.
- Mailing address — Not stated in the official source — verify on the agency site.
- Signature — Not stated in the official source — verify on the agency site.
Quick Facts
Downloads
After you file
- 1Retain a complete copy of the worksheet and any supporting documents for at least three years.
- 2Monitor the plan to ensure compliance with the Once‑In‑Always‑In rule if the rule applies.
- 3If an error is discovered, prepare an amended worksheet and resubmit it with a cover letter.
- 4Await confirmation of receipt from the IRS or plan sponsor; follow up if no acknowledgment is received within 30 days.
Sources
- SRCForm p.1 — revision shown as (4-2023) on the cover.
- SRCForm p.1 — instruction to skip the rest of the worksheet if sponsor is a church or QCCO.
- SRCForm p.1 — requirement to use WS 11a if the plan does not offer elective deferrals.
- SRCForm p.2 — note that corrective language for the OIAI rule must be adopted by June 30, 2020 for plans qualified under Notice 2018-95.
- SRCForm p.2 — universal availability section includes the Once‑In‑Always‑In rule question.
- SRCForm p.2 — instructions for the effective opportunity requirement under section 1.403(b)-5(b)(2).
- SRCForm p.2 — guidance that section IV is not completed for church, QCCO, or governmental sponsors.
Common confusion points
Confusion
Why it happens
→ Safe check
Do I need to answer Yes/No/N/A for every line even if not applicable?
The worksheet lists N/A as an option but users may think it can be left blank.
→ Verify that each line is marked with Yes, No, or N/A.
What if the plan sponsor is a church but also offers elective deferrals?
The instructions say to skip the rest of the worksheet for churches or QCCOs.
→ Confirm sponsor classification before proceeding.
Is the Once‑In‑Always‑In rule required for all plans?
Only plans that qualified for operational relief under Notice 2018‑95 must adopt corrective language by June 30 2020.
→ Check whether the plan received that relief.
Do I need to include the plan’s contribution limits in the worksheet?
The worksheet asks about limits but does not provide the numbers.
→ Reference the plan document for the Code limit and contract limit.
Can I skip the fail‑safe language section if the plan has no non‑elective contributions?
Section IV is skipped for churches, QCCOs, or governmental entities, but not otherwise.
→ Confirm whether the plan has non‑elective contributions before completing that section.
Is a signature required on every page?
The source does not specify page‑by‑page signing.
→ Ensure the designated signature line on the worksheet is completed.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 15417 – revise worksheet to address OIAI rule compliance per Notice 2018-95
Questions about IRS Form 15417
What is IRS Form 15417 used for?
This worksheet helps a plan sponsor decide if their 403(b) plan meets the required rules. It checks the employer’s eligibility, which employees can participate, and whether the plan follows the universal availability and non‑elective contribution standards. Any “No” answer must be explained on the form.
What information does IRS Form 15417 require?
The form collects answers to Yes/No questions about employer eligibility (Section I), employee eligibility (Section II), universal availability of elective contributions (Section III), and participation requirements for non‑elective contributions (Section IV), with space to explain any negative answers.
How do I complete IRS Form 15417?
Complete each section (I‑IV) by answering Yes, No, or N/A to every line. Provide explanations for any No answers in the space provided. Verify that the plan addresses the Once‑In‑Always‑In rule and fail‑safe language where required. Sign the worksheet before filing.
Confusion — what should I check?
Why it happens Safe check
Do I need to answer Yes/No/N/A for every line even if not applicable?
The worksheet lists N/A as an option but users may think it can be left blank. Verify that each line is marked with Yes, No, or N/A.
What if the plan sponsor is a church but also offers elective deferrals?
The instructions say to skip the rest of the worksheet for churches or QCCOs. Confirm sponsor classification before proceeding.
Is the Once‑In‑Always‑In rule required for all plans?
Only plans that qualified for operational relief under Notice 2018‑95 must adopt corrective language by June 30 2020. Check whether the plan received that relief.
Do I need to include the plan’s contribution limits in the worksheet?
The worksheet asks about limits but does not provide the numbers. Reference the plan document for the Code limit and contract limit.
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