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Formulier 8955-SSA Instructies

Instructies voor formulier 8955-SSA, jaarlijkse registratieverklaring Identificeren van gescheiden deelnemers met vastgestelde voordelen

Rev. 2023

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  • Formulier 8955-SSA - Jaarlijkse registratieverklaring Identificeren van gescheiden deelnemers met vastgestelde voordelen
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Department of the Treasury  
Internal Revenue Service  
2023  
Instructions for Form  
8955-SSA  
Annual Registration Statement Identifying Separated  
Participants With Deferred Vested Benefits  
Section references are to the Internal Revenue Code, unless  
otherwise noted. ERISA refers to the Employee Retirement  
Income Security Act of 1974.  
A Form 8955-SSA need not be filed for a year if no  
information is required to be provided for that year by these  
instructions.  
Future developments. For the latest information about  
developments related to Form 8955-SSA and its instructions,  
such as legislation enacted after they were published, go to  
Form 8955-SSA may be filed electronically through the  
FIRE system or on paper. The IRS and the SSA encourage  
all filers to file Form 8955-SSA electronically. Filing  
electronically saves time and effort and helps ensure  
accuracy. Certain filers, however, are required to file the 2023  
Form 8955-SSA electronically. For more information, see  
How To File.  
Reporting requirement. Under section 6057(b), plan  
administrators must notify the Secretary of the Treasury of  
certain changes to the plan and the plan administrator. These  
changes are reported on the plan’s Form 5500 return/report.  
Plan administrators should report these changes on the Form  
5500 return/report for the plan year in which the change  
occurs as indicated in the Form 5500 instructions.  
Purpose of Form  
Form 8955-SSA, the designated successor to Schedule SSA  
(Form 5500), is used to satisfy the reporting requirements of  
section 6057(a). Form 8955-SSA is a stand-alone reporting  
form filed with the IRS. See Where To File. DO NOT file  
Form 8955-SSA with Form 5500, Annual Return/Report of  
Employee Benefit Plan, or Form 5500-SF, Short Form  
Annual Return/Report of Small Employee Benefit Plan.  
Use Form 8955-SSA to report information relating to each  
participant who separated from service covered by the plan  
and is entitled to a deferred vested benefit under the plan but  
is not paid this retirement benefit. The plan administrator of  
each plan subject to the vesting requirements must file Form  
8955-SSA for participants who have a deferred vested  
benefit under the plan and:  
Telephone Assistance  
If you have questions and need assistance completing this  
form, call the IRS Help Line at 877-829-5500 and follow the  
directions as prompted. This toll-free telephone service is  
available Monday through Friday.  
Separated from service covered by the plan, but vested  
How To Get Forms and Publications  
retirement benefits are not paid and were not previously  
reported (using Entry Code A in Part III, line 9, column (a));  
Internet. You can access the IRS website 24 hours a day, 7  
days a week at IRS.gov to:  
Were previously reported under the plan but whose  
Download forms, instructions, and publications;  
Order IRS products online;  
information is being corrected (using Entry Code B in Part III,  
line 9, column (a));  
Research your tax questions online;  
Were previously reported as deferred vested participants  
Search publications online by topic or keyword; and  
Sign up to receive local and national tax news by email.  
on another plan's filing if their benefits were transferred (other  
than in a rollover) to the plan of a new employer during the  
covered period (using Entry Code C in Part III, line 9, column  
(a)); or  
You can find forms, instructions, and publications by  
visiting the IRS website at IRS.gov/FormsPubs or IRS.gov/  
Were previously reported under the plan but have been  
paid out or are no longer entitled to those deferred vested  
benefits (using Entry Code D in Part III, line 9, column (a)).  
Photographs of Missing Children  
The Internal Revenue Service is a proud partner with the  
Photographs of missing children selected by the Center may  
appear in instructions on pages that would otherwise be  
blank. You can help bring these children home by looking at  
the photographs and calling 1-800-THE-LOST  
For more information on required participant information,  
see the instructions for Part III.  
The information reported on Forms 8955-SSA is generally  
given to the Social Security Administration (SSA). The SSA  
provides the reported information to separated participants  
when they file for social security benefits.  
(1-800-843-5678) if you recognize a child.  
Note. The SSA no longer processes nonstandard pages 2.  
Report information about separated participants only on  
page 2 of Form 8955-SSA. If additional space is needed for  
separated participants, use additional pages 2 only. Do not  
add another page 1 of Form 8955-SSA, spreadsheets, or  
other nonstandard formats.  
General Instructions  
Who Must File  
Plan administrators of plans subject to the vesting standards  
of section 203 of ERISA must file Form 8955-SSA. For  
example, the plan administrator of a section 403(b) plan that  
is subject to the vesting standards of section 203 of ERISA  
Dec 29, 2023  
Cat. No. 52730V  
must file a Form 8955-SSA for the plan's deferred vested  
participants. A plan administrator is not required to report a  
separated participant if the participant's deferred vested  
benefits are attributable to an annuity contract or custodial  
account that is not required to be treated as part of the  
section 403(b) plan assets for purposes of the reporting  
requirements of ERISA Title I, as set forth in the Department  
of Labor (DOL) Field Assistance Bulletin (FAB) 2009-02. For  
this exception to apply:  
1. The contract or account would have to have been  
issued to a current or former employee before January 1,  
2009;  
2. The employer would have to have ceased having any  
obligation to make contributions (including employee salary  
reduction contributions), and in fact ceased making  
contributions to the contract or account before January 1,  
2009;  
Using Extension of Time To File Federal Income  
Tax Return  
An automatic extension of time to file Form 8955-SSA until  
the due date of the federal income tax return of the employer  
will be granted if all of the following conditions are met.  
1. The plan year and the employer's tax year are the  
same.  
2. The employer has been granted an extension of time  
to file its federal income tax return after the normal due date  
for filing the Form 8955-SSA.  
3. A copy of the application for extension of time to file  
the federal income tax return is retained with the plan's  
records.  
Note. A tax-exempt organization filing Form 8868,  
Application for Automatic Extension of Time To File an  
Exempt Organization Return or Excise Taxes Related to  
Employee Benefit Plans, to request an extension of time to  
file a Form 990 series return is automatically granted an  
extension of time to file Form 8955-SSA until the extended  
due date of filing their Form 990 series return if all conditions  
listed above are met.  
Be sure to check the “automatic extension” box on Part I,  
line C, at the top of the form. An extension of time granted by  
using this automatic extension procedure CANNOT be  
extended further by filing a Form 5558. It also cannot be  
extended more than 91/2 months beyond the close of the plan  
year.  
3. All the rights and benefits under the contract or  
account would have to be legally enforceable against the  
issuer or custodian by the participant without any involvement  
by the employer; and  
4. The participant would have to be fully vested in the  
contract or account.  
For more information, please see DOL FAB 2009-02 at  
Sponsors and administrators of government, church, and  
other plans that are not subject to the vesting standards of  
section 203 of ERISA (including plans that cover only owners  
and their spouses or cover only partners and their spouses)  
may elect to file Form 8955-SSA voluntarily. See the  
instructions for Part I, line A.  
Other Extensions of Time To File  
The IRS may from time to time announce special extensions  
of time under certain circumstances, such as extensions for  
presidentially declared disasters or for service in, or in  
support of, the Armed Forces of the United States in a  
combat zone. See IRS.gov for announcements of special  
extensions. If you are relying on a special extension, check  
the box on line C and enter the exact language describing the  
announcement in the space provided. For example, indicate  
“Disaster Relief Extension” or “Combat Zone Extension.”  
Note. If the 2023 Form 5500 is the final return/report of the  
plan, the Form 8955-SSA filed for the 2023 plan year must  
report information on deferred vested participants, including  
reporting that previously reported deferred vested  
participants are no longer deferred vested participants.  
When To File  
In general, if a Form 8955-SSA must be filed for a plan year, it  
must be filed by the last day of the seventh month following  
the last day of that plan year (plus extensions). This due date  
may be extended under some circumstances. See Extension  
of Time To File below.  
Amended Registration Statement  
File a 2023 Form 8955-SSA to correct errors and/or  
omissions in a previously filed statement. Check the box for  
Part I, line B (“amended registration statement”). The  
amended Form 8955-SSA must conform to the requirements  
in the How To File section.  
If the filing due date falls on a Saturday, Sunday, or legal  
holiday, Form 8955-SSA may be filed on the next day that is  
not a Saturday, Sunday, or legal holiday.  
A full and complete Form 8955-SSA must be filed to  
correct any such errors and/or omissions. For example, a full  
and complete Form 8955-SSA must be filed if the plan  
administrator determines that incorrect information was  
provided for a single plan participant.  
Extension of Time To File  
Using Form 5558  
If filing Form 8955-SSA under an extension of time based on  
the filing of Form 5558, Application for Extension of Time To  
File Certain Employee Plan Returns, check the “Form 5558”  
box on Form 8955-SSA, Part I, line C. A one-time extension  
of time (up to 21/2 months) to file Form 8955-SSA may be  
obtained by filing Form 5558 on or before the normal due  
date (not including any extensions) of Form 8955-SSA.  
It is important to use a 2023 Form 8955-SSA to report  
revisions to a participant's information previously filed on a  
Form 8955-SSA or a Schedule SSA (Form 5500). Because  
the SSA provides information that it has on file to individuals  
who file for benefits, if this information is not up to date, the  
individual may contact the plan administrator to resolve the  
difference.  
You can paper file Form 5558 with the IRS. File paper  
Form 5558 with the Department of the Treasury, Internal  
Revenue Service Center, Ogden, UT 84201-0045. Because  
approved copies of Form 5558 will not be returned to the filer,  
you must retain a copy of the Form 5558 that is filed. See the  
instructions for Form 5558.  
Prior Year Statement  
Although Schedule SSA (Form 5500) was previously used to  
satisfy the reporting requirements of section 6057(a) for plan  
years prior to January 1, 2009, the Schedule SSA (Form  
5500) should no longer be filed under any circumstances.  
2
Instructions for Form 8955-SSA (2023)  
(See Announcement 2011-21, 2011-12 I.R.B. 567.) Instead,  
Form 8955-SSA should be filed for all plan years, including  
delinquent returns for plan years before 2009. If a paper 2023  
Form 8955-SSA is used to satisfy filing obligations for plan  
years before 2009, complete Part I plan year beginning and  
plan year ending dates for the appropriate plan year filed.  
Forms 8955-SSA for prior years should be sent to the same  
address as the 2023 Form 8955-SSA. See Where To File  
below.  
When Not To Report a Participant  
A participant who has not been previously reported is not  
required to be reported on Form 8955-SSA if, before the date  
the Form 8955-SSA is required to be filed (including any  
extension of time to file), the participant:  
1. Is paid some or all of the deferred vested retirement  
benefit (see the Caution),  
2. Returns to service covered by the plan and/or accrues  
additional retirement benefits under the plan, or  
When To Report a Separated  
Participant  
3. Forfeits all the deferred vested retirement benefit.  
If payment of the deferred vested retirement benefit  
In general, for a plan to which only one employer contributes,  
a participant must be reported on Form 8955-SSA if:  
ceases before ALL of the participant's vested benefit  
!
CAUTION  
is paid to the participant or beneficiary, information on  
1. The participant separates from service covered by the  
the participant's remaining benefit shall be filed on the Form  
8955-SSA filed for the plan year following the last plan year  
within which the payment ceased.  
plan in a plan year, and  
2. The participant is entitled to a deferred vested benefit  
under the plan.  
Transfer of a Participant's Benefit to  
the Plan of a New Employer  
In general, information on the deferred vested retirement  
benefit of a plan participant must be filed no later than on the  
Form 8955-SSA filed for the plan year following the plan year  
in which the participant separates from service covered by  
the plan. However, you can report a deferred vested  
When the benefit of a separated participant with deferred  
vested benefits is transferred from one plan to the plan of a  
new employer:  
participant on the Form 8955-SSA filed for the plan year in  
which the participant separates from service under the plan if  
you want to report earlier. Do not report a participant more  
than once unless you are revising or updating information on  
a prior Form 8955-SSA or Schedule SSA (Form 5500). See  
the Specific Instructions for Part III, line 9, code B, C, or D.  
1. The new plan administrator must complete a Form  
8955-SSA using Entry Code C for Part III, line 9, column (a),  
and specifying the previous sponsor’s EIN in column (h) and  
the previous plan number in column (i) to complete the  
transfer to the plan.  
Note. In the rare case that the previous plan sponsor’s EIN  
and previous plan number are not available, the new plan  
administrator should complete a Form 8955-SSA using Entry  
Code A for Part III, line 9, column (a).  
2. The previous plan administrator must complete a Form  
8955-SSA using Entry Code D for Part III, line 9, column (a),  
to remove the information previously reported under the plan  
for deferred vested participants.  
The determination of whether more than one employer  
contributes to a plan is based on the number of employers  
required to contribute to the plan. A plan to which only one  
employer contributes includes a plan maintained by:  
A controlled group of corporations that are treated as a  
single employer under section 414(b),  
Trades or businesses under common control that are  
treated as a single employer under section 414(c), and  
An affiliated service group that is treated as a single  
Where To File  
employer under section 414(m).  
If Form 8955-SSA is sent by United States mail, send the  
complete form to:  
In general, for a plan to which more than one employer  
contributes, a participant must be reported on Form  
8955-SSA if:  
Department of the Treasury  
Internal Revenue Service Center  
Ogden, UT 84201-0024  
1. The participant incurs two successive 1-year breaks in  
service (as defined in the plan for vesting purposes), and  
2. The participant is (or may be) entitled to a deferred  
vested benefit under the plan.  
Private delivery services (PDSs). In addition to the United  
States mail, you can use the private delivery services  
designated by the IRS to meet the “timely mailing as timely  
filing/paying” rule for tax returns and payments. Go to  
IRS.gov/PDS for the current list of designated services.  
For these purposes, a multiemployer plan described in  
section 414(f), a collectively bargained plan described in  
section 413(a), a multiple-employer plan described in section  
413(c) (including plans described in section 413(e)), and a  
multiple-employer plan described in section 403(b)(15) are  
each treated as a plan to which more than one employer  
contributes.  
The PDS can tell you how to get written proof of the  
mailing date.  
Private delivery services must send Form 8955-SSA to:  
In general, information about the deferred vested  
Internal Revenue Submission Processing Center  
1973 Rulon White Blvd.  
retirement benefit of a plan participant must be reported on  
the Form 8955-SSA filed for the plan year in which the  
participant completes the second of two consecutive 1-year  
breaks in service. Consecutive 1-year breaks in service are  
defined in the plan for purposes of determining a participant’s  
vesting percentage. The participant may be reported earlier  
on the Form 8955-SSA filed for the plan year in which the  
participant completed the first 1-year break in service.  
Ogden, UT 84201  
How To File  
Follow the line-by-line instructions to complete Form  
8955-SSA. Answer all questions about the plan, unless  
otherwise specified.  
3
Instructions for Form 8955-SSA (2023)  
Form 8955-SSA must be filed with the IRS. Form  
8955-SSA is NOT open to public inspection. DO  
NOT attach a Form 8955-SSA (or a previous year's  
Note. Remember to use additional pages 2 of the 2023  
Form 8955-SSA only if additional pages are needed to add  
separated participants. Do not use nonstandard pages 2.  
!
CAUTION  
Schedule SSA (Form 5500)) to a Form 5500 or Form  
5500-SF required to be filed with the Department of Labor  
(DOL) filing system (“EFAST2”).  
Processing tips. To reduce the possibility of  
correspondence and penalties:  
Sign and date Form 8955-SSA.  
Check your information to avoid errors.  
Mandatory electronic filing. For 2013 and prior years,  
filers had the option of filing Form 8955-SSA electronically.  
Beginning with the 2014 Form 8955-SSA, however, some  
filers are now required to file the form electronically. A filer  
must electronically file the 2023 Form 8955-SSA if the filer is  
required to file 250 returns of any type during the calendar  
year that includes the first day of the plan year. “Returns” for  
this purpose include information returns (for example, Forms  
W-2 and 1099), income tax returns, employment tax returns  
(including quarterly Forms 941), and excise tax returns. If a  
filer is required to file a Form 8955-SSA electronically but  
does not, the filer is considered not to have filed the form  
even if a paper return is submitted.  
Complete all applicable lines on the form unless otherwise  
specified.  
Print all information necessary in the specific fields  
provided on the form.  
Do not mark on or near any barcode.  
Do not use glue or other sticky substances on the paper  
form.  
Do not staple the form pages. Use binder clips or other  
fasteners that do not perforate the paper.  
Do not submit extraneous material or information, such as  
arrows used to indicate where to sign, notes between  
preparers of the report, or notations on the form.  
File Form 8955-SSA using the address specified in the  
instructions under Where To File, earlier.  
Note. On February 23, 2023, the Department of the Treasury  
published final regulations, Electronic-Filing Requirements for  
reduced mandatory electronic filing threshold under section  
2301 of the Taxpayer First Act of 2019 (the “TFA”). Under the  
final regulations, a filer who is required to file at least 10  
returns with the IRS during the calendar year must file Form  
8955-SSA electronically for plan years beginning on or after  
January 1, 2024. The mandatory electronic filing threshold for  
e-filing Form 8955-SSA remains 250 returns for the 2023  
plan year. The instructions will be updated next year for  
changes.  
The requirement to file the 2023 Form 8955-SSA  
electronically does not apply to filers filing for relief under  
Notice 2014-35, 2014-23 I.R.B. 1072 (relating to filers who  
qualify for relief under the Department of Labor’s Delinquent  
Filer Voluntary Compliance Program). See Regulations  
section 301.6057-3 for more information on the mandatory  
electronic filing of Form 8955-SSA.  
Use only whole dollars. Round off cents to whole dollars.  
Drop any amount less than 50 cents and increase any  
amount from 50 to 99 cents to the next higher dollar.  
Penalties  
Section 6652(d)(1) imposes a penalty for failure to file a  
registration statement (including failure to include all required  
participants). The penalty is $10 for each participant not  
reported and for each day multiplied by the number of days  
the failure continues. The penalty, up to a maximum of  
$50,000, is imposed on the person failing to properly file  
unless it is shown the failure is due to reasonable cause.  
In the case of a failure to file a notification of a change in  
the status of the plan (such as a change in the plan name or a  
termination of the plan), or a change in the name or address  
of the plan administrator, section 6652(d)(2) imposes a  
penalty of $10 for each day during which such failure occurs.  
The penalty, up to a maximum of $10,000, is imposed on the  
person failing to so file unless it is shown the failure is due to  
reasonable cause.  
The Code provides that each plan administrator required  
to file a registration statement must, before the expiration of  
the time prescribed for the filing of the form, also furnish to  
each affected participant an individual statement setting forth  
the information required to be contained in the form. Section  
6690 imposes a penalty of $50 on the person required to  
furnish the individual statement to each affected participant  
for each willful failure to furnish the statement or a willful  
furnishing of a false statement.  
The IRS may waive the requirements to file Form  
8955-SSA electronically in cases of undue economic  
hardship. For information on filing a request for a hardship  
waiver, see Rev. Proc. 2015-47, 2015-39 I.R.B. 419, available  
Electronic and paper filing. You can:  
Use SSA-approved software to complete and  
electronically file a Form 8955-SSA. For more information, go  
to IRS.gov, search for and select “Form 8955-SSA  
Resources,and then select “Approved Software Vendors  
Form 8955-SSA.”  
Use a personal computer to complete the online fillable  
Specific Instructions  
Form 8955-SSA on the IRS website at IRS.gov/FormsPubs  
before printing, signing, and mailing it to the IRS. A barcode  
capturing the data you entered on the form will appear on the  
completed pages when printed. A form partially completed  
online and partially completed (other than the signature) on  
printed paper will cause processing delays and may result in  
correspondence from the IRS.  
PART I  
Enter the calendar or fiscal year beginning and ending dates  
of the plan year (not to exceed 12 months in length) for which  
you are reporting information. Express the dates in numerical  
month, day, and year in the following order: (MMDDYYYY).  
Use a printed Form 8955-SSA ordered from the IRS  
For a plan year of less than 12 months (short plan year),  
enter the short plan year beginning and ending dates on the  
line provided at the top of the form. For purposes of this form,  
the short plan year ends on the date of a change in  
accounting period or the complete distribution of the plan's  
assets.  
website at IRS.gov/OrderForms. When completing the form,  
use as many pages 2 of the Form 8955-SSA as necessary to  
list separated participants and number the pages in  
sequential order.  
4
Instructions for Form 8955-SSA (2023)  
By mailing or faxing Form SS-4, Application for Employer  
Line A. Check this box if you are electing to file this form  
voluntarily. The plan administrators of plans, such as  
governmental plans and non-electing church plans, not  
subject to the vesting standards of section 203 of ERISA are  
not required to file this form but may elect to do so. If such a  
plan administrator so elects, the plan administrator is  
encouraged to provide as much information as possible, but  
no specific requirements are imposed.  
Identification Number.  
A multiple-employer plan or plan of a controlled group of  
corporations should use the EIN of the sponsor identified on  
line 2a. The EIN must be used in all subsequent filings of  
Form 8955-SSA. (See the instructions for line 5 about  
changes in EIN.)  
If the plan sponsor is a group of individuals, get a single  
EIN for the group (providing the group name).  
Note. Only the plan administrators of plans subject to the  
vesting standards of section 203 of ERISA must file the Form  
8955-SSA.  
Line B. Check this box if this Form 8955-SSA amends a  
previously filed Schedule SSA (Form 5500) or Form  
8955-SSA.  
Line C. Check the appropriate box if an extension of time  
has been filed using Form 5558, or if an automatic or special  
extension has been granted. If a special extension has been  
granted, enter the description of the special extension exactly  
as it is listed in the announcement. See Other Extensions of  
Time To File, earlier, for additional information regarding  
special extensions.  
Line 2c. Enter the plan sponsor's trade name if that trade  
name is different from the plan sponsor's name entered on  
line 2a.  
Line 2e. If you want a third party to receive mail for the plan,  
enter “C/O” followed by the third party's name and complete  
the applicable mailing address on lines 2f through 2l.  
Line 2f. Enter the plan sponsor's street address. A post  
office box may be entered if the Post Office does not deliver  
mail to the plan sponsor's street address.  
Line 2g. Enter the name of the city.  
Line 2h. Enter the two-character abbreviation for the U.S.  
state or territory.  
PART II  
Line 2j. Enter the foreign province or state, if applicable.  
Line 2k. Enter the foreign country, if applicable.  
Line 2l. Enter the foreign postal code, if applicable. Leave  
the U.S. state and ZIP code blank if completing line 2k or  
line 2l.  
Please verify that the employer identification number (EIN)  
and plan number (PN) being used on this Form 8955-SSA  
are correct for this plan.  
Line 1a. Enter the formal name of the plan or enough  
information to identify the plan. Abbreviate if necessary.  
Line 3a. Enter the plan administrator's name. Enter “Same”  
if the plan administrator identified on line 3a is the same as  
the plan sponsor identified on line 2a and leave lines 3b  
through 3k blank.  
Line 1b. Enter the three-digit number that the employer or  
plan administrator assigned to the plan and uses to file the  
plan's Form 5500 return/report.  
Line 2a. Enter the name of the plan sponsor. The term “plan  
“Plan administrator” for this purpose means:  
sponsor” means:  
The person or group of persons specified as the  
The employer, for a plan that a single employer established  
administrator by the instrument under which the plan is  
operated,  
or maintains;  
The employee organization in the case of a plan of an  
The plan sponsor/employer if an administrator is not so  
employee organization; or  
The association, committee, joint board of trustees, or  
designated, or  
Any other person prescribed by regulations if an  
other similar group or representatives of the parties who  
established or maintain the plan (in the case of a plan  
established or maintained jointly by one or more employers  
and one or more employee organizations, or by two or more  
employers).  
administrator is not designated and a plan sponsor cannot be  
identified.  
Note. Employees of the plan sponsor who perform  
administrative functions for the plan are generally not plan  
administrators unless specifically designated in the plan  
document. If an employee of the plan sponsor is designated  
as the plan administrator, that employee must obtain an EIN.  
Note. In the case of a multiple-employer plan, if an  
association or similar entity is not the sponsor, enter the  
name of a participating employer as sponsor. The plan  
administrator of a plan maintained by a controlled group of  
corporations should enter the name of the member of the  
controlled group that is entered on the Form 5500 return/  
report as the plan sponsor. The same name must be used in  
all subsequent filings of the Form 8955-SSA for the  
multiple-employer plan or controlled group. (See the  
instructions for line 5 about changes in sponsorship.)  
Line 3b. Enter the plan administrator's nine-digit EIN. Plan  
administrators who do not have an EIN must apply for one as  
described in the instructions for line 2b.  
Line 3c. If you want a third party to receive mail for the plan  
administrator, enter “C/O” followed by the third party's name  
and complete the applicable mailing address on lines 3e  
through 3k.  
Line 3e. Enter the plan administrator's street address. A  
post office box may be entered if the Post Office does not  
deliver mail to the sponsor's street address.  
Line 2b. Enter the sponsor's nine-digit EIN. Do not use a  
social security number (SSN). Sponsors without an EIN must  
apply for one as soon as possible.  
EINs are issued by the IRS. You can apply for an EIN:  
Line 3f. Enter the name of the city.  
Online — Go to the IRS website at IRS.gov/EIN. The EIN is  
issued immediately once the application information is  
validated. (The online application process is not yet available  
for corporations with addresses in foreign countries.)  
Line 3g. Enter the two-character abbreviation for the U.S.  
state or territory.  
Line 3i. Enter the foreign province or state, if applicable.  
5
Instructions for Form 8955-SSA (2023)  
Line 3j. Enter the foreign country, if applicable.  
PART III  
Enter the name of the plan, the plan number, and the plan  
sponsor's EIN at the top of each page 2.  
Line 3k. Enter the foreign postal code, if applicable. Leave  
the U.S. state and ZIP code blank if completing line 3j or  
line 3k.  
Line 4. If the plan administrator's name and/or EIN have  
changed since the most recent Schedule SSA (Form 5500)  
or Form 8955-SSA was filed for this plan, enter the plan  
administrator's name and EIN as they appeared on the most  
recently filed Schedule SSA (Form 5500) or Form 8955-SSA.  
Line 9, column (a). Enter the appropriate code from the  
following list.  
Code Use this code for a participant not previously  
A
reported. Also, complete columns (b) through  
(g), as applicable.  
Code Use this code for a participant previously  
B
Failure to indicate on line 4 that a plan administrator  
was previously identified by a different name or EIN  
reported under the plan number shown on this  
form to modify some of the previously reported  
information. Enter all the current information for  
columns (b) through (g), as applicable. You do  
not need to report a change in the value of a  
participant's account since that is likely to  
change. However, you may report such a  
change if you want.  
!
CAUTION  
could result in correspondence from the IRS.  
Line 5. If the plan sponsor's name and/or EIN have changed  
since the most recently filed Schedule SSA (Form 5500) or  
Form 8955-SSA for this plan, enter the plan sponsor's name,  
EIN, and the three-digit plan number as they appeared on the  
most recently filed Schedule SSA (Form 5500) or Form  
8955-SSA.  
Code Use this code for a participant previously  
C
Failure to indicate on line 5 that a plan sponsor was  
reported under the plan of a different plan  
sponsor and who will now be receiving a future  
benefit from the plan reported on this form.  
Also, complete columns (b), (c), (h), and (i).  
previously identified by a different name or EIN could  
!
CAUTION  
result in correspondence from the IRS.  
Line 6a. For a plan to which only one employer contributes,  
provide the total number of participants entitled to a deferred  
vested benefit who separated from service in the 2022 plan  
year and who were not previously reported. For a plan to  
which more than one employer contributes, provide the total  
number of participants entitled to a deferred vested benefit  
who completed the second of two consecutive 1-year breaks  
in service in the 2023 plan year and who were not previously  
reported.  
Line 6b. For a plan to which only one employer contributes,  
provide the total number of participants entitled to a deferred  
vested benefit who separated from service under the plan in  
the 2023 plan year and who are reported in Part III of this  
form. For a plan to which more than one employer  
contributes, provide the total number of participants entitled  
to a deferred vested benefit who separated from service  
under the plan in 2023 or who completed the first 1-year  
break in service in the 2023 plan year and who are reported  
in Part III of this form. See When To Report a Separated  
Participant.  
Code Use this code for a participant previously  
D
reported under the plan number shown on this  
form who is no longer entitled to those deferred  
vested benefits. This includes a participant who  
has begun receiving benefits, has received a  
lump-sum payout, or has been transferred to  
another plan (for example, in the case of a plan  
termination). Also, complete columns (b) and  
(c). Participants should not be reported under  
Code D merely because they return to the  
service of the plan sponsor.  
Line 9, column (b). Enter the full nine-digit SSN of each  
participant listed. Please do not enter only the last four digits  
of the SSN. If the participant is a foreign national employed  
outside the United States who does not have an SSN, enter  
the word “FOREIGN”.  
Line 9, column (c). Enter each participant's name exactly  
as it appears on the participant's social security card. Do not  
enter periods; however, initials, if on the social security card,  
are permitted.  
Do not include any participants on line 6a or 6b who  
were previously reported on a Form 8955-SSA or a  
!
CAUTION  
Schedule SSA (Form 5500). Accordingly, only those  
participants who are listed with an Entry Code A on page 2  
should be included on line 6a or 6b.  
After the last name column, there is a checkmark column.  
Check the box for each participant whose information is  
based on incomplete records. Information for a participant  
may be based on incomplete records where more than one  
employer contributes to the plan and the records at the end  
of the plan year are incomplete regarding the participant's  
service. Check the box next to a participant's name if:  
1. The amount of the participant's vested benefit is based  
on records that are incomplete as to the participant's covered  
service (or other relevant service), or  
Line 7. The sum of lines 6a and 6b should equal the number  
on line 7.  
Line 8. Check the appropriate box as to whether the plan  
administrator provided the individual statement to each  
participant required to receive one. See Penalties.  
Signature. Form 8955-SSA must be signed and dated by  
the plan sponsor and by the plan administrator. If the plan  
administrator and the plan sponsor are the same person,  
include only the signature as plan administrator on the form.  
If more than one page 2 of the form is filed for one plan, only  
one page 1 of Form 8955-SSA should be signed and filed  
with the pages 2 for the plan.  
2. The plan administrator is unable to determine from the  
records of the participant's service if the participant is vested  
in any deferred retirement benefit but there is a significant  
6
Instructions for Form 8955-SSA (2023)  
likelihood that the participant is vested in such a benefit. See  
Regulations section 1.6057-1(b)(3).  
Line 9, column (g). For defined contribution plans, enter  
the value (in whole dollars) of the participant's account.  
Line 9, columns (h) and (i). Show the EIN and plan  
number of the plan under which the participant was  
previously reported.  
Line 9, column (d). From the following list, select the code  
that describes the type of annuity that will be provided for the  
participant. Enter the code that describes the type of annuity  
that normally accrues under the plan at the time of the  
participant's separation from service covered by the plan (or,  
for a plan to which more than one employer contributes, at  
the time the participant incurs the second consecutive 1-year  
break in service under the plan).  
Privacy Act and Paperwork Reduction Act Notice. We  
ask for the information on this form to carry out the Internal  
Revenue laws of the United States. Sections 6057 and 6109  
require you to provide the information requested on this form.  
We need it to determine whether the plan properly accounts  
for the deferred vested retirement benefits of separated  
participants. Failure to provide this information, or providing  
false or fraudulent information, may subject you to penalties.  
Type of Annuity Code  
A A single sum  
B Annuity payable over fixed number of years  
C Life annuity  
You are not required to provide the information requested  
on a form that is subject to the Paperwork Reduction Act  
unless the form displays a valid OMB control number. Books  
or records relating to a form or its instructions must be  
retained as long as their contents may become material in the  
administration of any Internal Revenue law. Generally, tax  
returns and return information are confidential, as required by  
section 6103.  
D Life annuity with period certain  
E Cash refund life annuity  
F Modified cash refund life annuity  
G Joint and last survivor life annuity  
M Other  
Line 9, column (e). From the following list, select the code  
that describes the benefit payment frequency during a  
12-month period.  
However, section 6103 authorizes disclosure of the  
information to others. Pursuant to section 6057(d), we will  
disclose this information to the Social Security Administration  
for use in administering the Social Security Act. This  
Type of Payment Code  
A Lump sum  
B Annually  
C Semiannually  
D Quarterly  
E Monthly  
information may also be disclosed to the Department of  
Justice for civil or criminal litigation, to the Department of  
Labor or the Pension Benefit Guarantee Corporation for use  
in administering ERISA, and to cities, states, the District of  
Columbia, and U.S. commonwealths and territories for use in  
administering their tax laws. It may also be disclosed to other  
countries under a tax treaty, to federal and state agencies to  
enforce federal nontax criminal laws, or to federal law  
enforcement and intelligence agencies to combat terrorism.  
M Other  
Line 9, column (f). For a defined benefit plan, enter the  
amount (in whole dollars) of the periodic payment that a  
participant is entitled to receive.  
In general, a deferred vested benefit under a defined  
benefit plan would be reported under line 9, column (f), as the  
periodic payment that the participant is entitled to receive.  
The plan administrator may, however, report a different form  
of benefit if the plan administrator considers it more  
appropriate. For example, the plan administrator of a cash  
balance plan may report a participant's benefit as the  
participant's hypothetical account balance. In that case, the  
plan administrator may enter Code A (a single sum) in  
column (d) and Code A (a lump sum) in column (e).  
For a multiemployer plan, if the amount of the periodic  
payment cannot be accurately determined because the plan  
administrator does not maintain complete records of covered  
service, enter an estimated amount.  
The time needed to complete and file this form will vary  
depending on individual circumstances. The estimated  
average time is 49 minutes.  
If you have suggestions for making this form simpler, we  
would be happy to hear from you. You can send us  
comments from IRS.gov/FormComments. Or you can write to  
the Internal Revenue Service, Tax Forms and Publications  
Division, 1111 Constitution Ave. NW, IR-6526, Washington,  
DC 20224. Do not send Form 8955-SSA to this address.  
Instead, see Where To File, earlier.  
7
Instructions for Form 8955-SSA (2023)