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Form 15417D: 403(b) Plan, Plan Limitation on Contribution and Benefits Worksheet Number 6A – Determination of 403(b) Status
Internal Revenue Service Form 15417-D is the 403(b) Plan Limitation on Contribution and Benefits Worksheet 6A – Determination of 403(b) Status, used by plan sponsors to certify that their plan meets contribution limits, including the $61,000 annual addition cap for 2022.
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IRS Form 15417D - 403(b) Plan, Plan Limitation on Contribution and Benefits Worksheet Number 6A – Determination of 403(b) Status
Internal Revenue Service Form 15417-D is the 403(b) Plan Limitation on Contribution and Benefits Worksheet 6A – Determination of 403(b) Status, used by plan sponsors to certify that their plan meets contribution limits, including the $61,000 annual addition cap for 2022.
Risk Radar
Scan points- 1Leaving any required Yes/No answer blank invalidates the worksheet.
- 2Failing to answer Yes/No for whether the plan defines the limitation year per 1.415(j)-1.
- 3Omitting an explanation for a “No” answer in any section.
- 4Not indicating if the plan defines compensation as “Includible Compensation” per 1.403(b)-2(b)(11).
- 5Skipping Section II when the plan offers elective deferrals.
Plain English
This worksheet lets a 403(b) plan confirm it follows the IRS rules on contribution limits. It asks the plan to answer yes or no to a series of definitions and limits, and to explain any negative answers. The form covers how elective deferrals, catch‑up contributions, and total annual additions are limited.
Submission Date
- Filing date: 2025-03-05 22:10:25
- 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 a 403(b) plan sponsor must certify that the plan meets contribution limits, including the $61,000 annual addition cap for 2022.
- Do not use it when the retirement arrangement is not a 403(b) plan.
- Check WS 5B instead when guidance on contributions to former employees is needed.
Form selector
Use this form or another form?
Plan defines limitation year per 1.415(j)-1
Ensures statutory compliance with limitation‑year definition
✓ Verify the definition matches the code before proceeding
Plan wants to allow special 403(b) catch‑up contributions
Catch‑up eligibility must meet qualified‑organization rules
✓ Confirm employer qualifies under 402(g)(7)(B) before proceeding
Plan includes annual additions that could exceed $61,000
Excess must be held in a separate account per IRC 403(b)
✓ Ensure excess‑handling language is present before proceeding
Deadline or filing window
Not stated in the official source
Checklist
What you need before filling it out
Plan definition of limitation year
Plan document · Section I of worksheet
Definition of Includible Compensation
Plan document · Section I, question c
Special 403(b) catch‑up eligibility
Employer qualification evidence · Section II, question d
Annual addition limit amount
Plan language on $61,000 cap · Section II, question b
Treatment of excess annual additions
Plan provision for separate account · Section II, question c
Before you submit
- 1Review all Yes/No answers for completeness.
- 2Provide an explanation for every "No" answer in the worksheet space.
- 3Verify the plan defines the limitation year in accordance with 1.415(j)-1.
- 4Confirm the plan defines compensation as Includible Compensation per 1.403(b)-2(b)(11).
- 5Check that any special catch‑up rules satisfy the 15‑year service requirement.
- 6Validate the annual addition limit does not exceed $61,000 or 100 % of compensation.
- 7Ensure any excess annual additions are addressed with a separate‑account provision.
- 8Confirm the worksheet includes the plan reference number.
- 9Have an authorized plan official sign where required.
- 10Make a photocopy of the completed worksheet for your records.
How to file this form
- 1Complete all Yes/No sections on the worksheet.
- 2Attach supporting plan documents that substantiate each definition.
- 3Obtain the authorized signature on the completed worksheet.
- 4Make a photocopy of the signed worksheet for your records.
- 5Mail the original worksheet to the IRS address provided in the instructions.
- 6Obtain a delivery receipt or tracking confirmation as proof of filing.
Known limitations
- 1The worksheet does not apply to retirement arrangements that are not 403(b) plans.
- 2It is not suitable when the plan fails to define a limitation year per 1.415(j)-1.
- 3The form cannot be used if the plan lacks a definition of Includible Compensation.
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->Form 15417-D (4-2023) shows the revision date as April 2023; the source does not mention a later version or changes.
What changed or needs a fresh check
- Edition date — confirm the form reads 4-2023 on the cover page.
- Fee — Not stated in the official source
- Mailing address — Not stated in the official source
- Signature — Not stated in the official source
Quick Facts
Downloads
After you file
- 1Retain the signed worksheet and all supporting documents for at least seven years.
- 2Store any referenced plan documents together with the worksheet.
- 3Monitor for any IRS acknowledgment or request for additional information.
- 4If the IRS identifies a discrepancy, file an amended worksheet promptly.
- 5Update the plan’s internal records to reflect any required changes.
- 6Keep copies of all correspondence related to the filing.
Sources
- SRCForm p.1 — revision date appears as (4-2023) on the cover page.
- SRCForm p.2 — annual addition limit stated as $61,000 for 2022, adjusted for cost‑of‑living.
- SRCForm p.1 — question a asks if the plan defines the limitation year per 1.415(j)-1.
- SRCForm p.1 — question c asks if the plan defines compensation as Includible Compensation per 1.403(b)-2(b)(11).
- SRCForm p.2 — question d addresses special section 403(b) catch‑up eligibility for qualified organizations.
- SRCForm p.2 — question e describes allocation order for excess contributions between special catch‑up and age‑50 catch‑up.
- SRCForm p.2 — question c explains excess annual additions are held in a separate account until distributed.
- SRCForm p.3 — question f requires all 403(b) annuity contracts purchased by an employer to be treated as one for section 415 limits.
Common confusion points
Do I need to answer Yes/No for every question?
The instructions state all items must be completed unless the contrary is specifically provided.
→ Verify each question has a response.
What counts as Includible Compensation?
Multiple notes define it, including rules for former employees and self‑employed ministers.
→ Check the plan’s definition section.
How is the $61,000 limit determined?
The worksheet references the 2022 limit adjusted for cost‑of‑living.
→ Confirm the plan’s limit matches the current adjusted amount.
Can excess contributions be allocated to both special catch‑up and age‑50 catch‑up?
The worksheet specifies the order: first to special catch‑up, then to age‑50 catch‑up.
→ Ensure excess is allocated in that sequence.
Does a church employee need 15 years of service for catch‑up?
Special rule for church employees may differ under 1.403(b)-4(e).
→ Review question II(d)(iv) for exceptions.
Are fractional years of service counted?
The definition of “Year of Service” includes fractional credit for partial work periods.
→ Calculate service years according to the plan’s definition.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 15417-D — amend the worksheet and resubmit.
Questions about IRS Form 15417D
What is IRS Form 15417D used for?
This worksheet lets a 403(b) plan confirm it follows the IRS rules on contribution limits. It asks the plan to answer yes or no to a series of definitions and limits, and to explain any negative answers. The form covers how elective deferrals, catch‑up contributions, and total annual additions are limited.
What information does IRS Form 15417D require?
The form collects yes/no responses for plan definitions, limits on elective deferrals, special catch‑up rules, and the maximum annual additions, plus any required explanations for “No” answers.
How do I complete IRS Form 15417D?
Complete every Yes/No item in the worksheet unless the instructions say otherwise. Use the provided space to explain any “No” answer. The worksheet is organized into sections: I. Definitions, II. Limits on Elective Deferrals, and III. Limitations on Annual Additions. After all sections are filled, the form is ready for submission.
Do I need to answer Yes/No for every question?
The instructions state all items must be completed unless the contrary is specifically provided. Verify each question has a response.
What counts as Includible Compensation?
Multiple notes define it, including rules for former employees and self‑employed ministers. Check the plan’s definition section.
How is the $61,000 limit determined?
The worksheet references the 2022 limit adjusted for cost‑of‑living. Confirm the plan’s limit matches the current adjusted amount.
Can excess contributions be allocated to both special catch‑up and age‑50 catch‑up?
The worksheet specifies the order: first to special catch‑up, then to age‑50 catch‑up. Ensure excess is allocated in that sequence.
Does a church employee need 15 years of service for catch‑up?
Special rule for church employees may differ under 1.403(b)-4(e). Review question II(d)(iv) for exceptions.
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