15417-F
403(b) Plans Nondiscrimination Requirements for Matching Contributions and Employee After-Tax Contributions Worksheet 11A–- Determination of 403(b) Status
Form 15417-F (4-2023) is an IRS worksheet titled 403(b) Plan Nondiscrimination Requirements for Matching Contributions and Employee After-Tax Contributions. Its title also calls it Worksheet 11A, Determination of 403(b) Status. It reviews a named 403(b) plan question by question against section 401(m), with a Plan Reference column and Yes, No and N/A boxes on every item.
The instructions printed at the top of page 1 say "All items must be completed." They explain that a "Yes" answer generally indicates a favorable conclusion is warranted, while a "No" answer indicates a problem exists. If the employer has not requested a determination on an item and is not required to address it, the item is answered "N/A". The form notes that its technical principles may be changed by future regulations or guidelines.
The worksheet does not say who fills it out or where it goes, and no separate instructions are linked to it. You can fill it out free in your browser on this page and download the result without an account.
Whether the worksheet applies, whether coverage requirements are met, and how the plan meets the 401(m) nondiscrimination requirements: the 401(m)(11) safe harbor, the 401(m)(12) QACA safe harbor or the ACP test.
Items a to l, including the basic matching formula printed as a 100% match of the first 3% of compensation deferred, plus 50% match of the next 2%, and the 6% and 4% limits.
Completed only if the plan has QACA provisions. It includes the QACA basic matching formula printed as a 100% match of the first 1% of compensation deferred, plus 50% match of the next 5%.
Whether the plan includes the actual contribution percentage test, prior or current year testing, QNECs to pass the test, and how excess aggregate contributions are distributed or forfeited.
Conditions for treating QNECs as matching contributions, and whether the plan defines highly compensated employee under section 414(q) and compensation for the ACP test.
The worksheet has nine sections over six pages. Each section ends with space to explain any "No" answers.
Enter the name of the 403(b) plan at the top of page 1. It is the only identifying entry on the worksheet.
For each question, enter the plan reference and check Yes, No or N/A. The form says all items are completed and an item not requested and not required is answered "N/A".
If no item in I(a) applies, stop. If the plan is a governmental plan or a church or QCCO plan under I(b), the form says not to complete the remainder.
The form routes 401(m)(11) safe harbor plans to Section IV, 401(m)(12) QACA plans to Section V, and plans using the ACP test to Sections VI and VII.
The form says that if the plan meets Section V and does not provide for after-tax employee contributions, items VI to VIII are not completed because section 401(m) is satisfied.
Use the space at the end of each section to explain any "No" answer.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The worksheet prints no mailing address, filing method, recipient or deadline, and it has no signature line.
The IRS listing gives only the PDF. The directions are the short paragraph at the top of page 1 and the notes printed under some items.
Each page footer prints Form 15417-F (4-2023), Catalog Number 94034K, Department of the Treasury, Internal Revenue Service.
The title calls it Worksheet 11A in the Determination of 403(b) Status series. Section II names Worksheet 5B, Form 15417-C, and item IV(g) names Pub 7335 (Explanation No. 12 Section 401(k) Requirements).
15417-C
104 fields, 3 pages
15417
81 fields, 2 pages
15417-A
26 fields, 1 page
15417-B
133 fields, 3 pages
15417-D
105 fields, 3 pages
15417-G
88 fields, 2 pages
The worksheet does not name who completes it or who receives it. Its Section I decides which 403(b) plans the rest of the worksheet applies to.
No tool matches that search.
The worksheet does not say. It asks about the provisions of a named 403(b) plan and has no preparer, signature or recipient lines.
Section I says not to complete the remainder for a governmental plan under section 414(d) or a plan maintained by a church or QCCO, because these plans are not subject to 401(m).
The form says a "Yes" answer generally indicates a favorable conclusion is warranted, while a "No" answer indicates a problem exists. Each section has space to explain any "No" answer.
A note in Section IV says ADP testing is not applicable to 403(b) plans, but the ACP safe harbor incorporates some requirements of the ADP safe harbors.
A note in Section VIII says salary reduction contributions under a 403(b) plan cannot be taken into account for purposes of the ACP test.
No separate instructions are linked to it. The directions are the paragraph at the top of page 1 and the notes under individual items.