Table of Contents
Section references are to the Internal Revenue Code, unless otherwise noted. ERISA refers to the Employee Retirement Income Security Act of 1974.
The Social Security Administration (SSA) will no longer process nonstandard pages 2. If additional space is needed, use additional pages 2 of the 2012 Form 8955-SSA for separated participants. Do not add spreadsheets or other non-standard formats.
Form 8955-SSA, the designated successor to Schedule SSA (Form 5500), is used to satisfy the reporting requirements of section 6057(a) for plan years beginning after December 31, 2008. Form 8955-SSA is a stand-alone reporting form filed with the Internal Revenue Service (IRS). See Where To File. Do not file Form 8955-SSA with the Form 5500, Annual Return/Report of Employee Benefit Plan, or Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.
Note. Report required information regarding 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.
The IRS and SSA encourage all filers to file Form 8955-SSA electronically. Filing electronically saves time and effort and helps ensure accuracy.
Reporting requirement. top 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 annual 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.
Telephone Assistance If you have questions and need assistance completing this form, call the IRS Help Line at 1-877-829-5500 and follow the directions as prompted. This toll-free telephone service is available Monday through Friday.
Internet. top You can access the IRS website 24 hours a day, 7 days a week at IRS.gov to:
By phone and in person. top You can order forms and IRS publications by calling 1-800-TAX-FORM (1-800-829-3676). You can also get most forms and publications at your local IRS office.
Photographs of Missing Children The Internal Revenue Service is a proud partner with the National Center for Missing and Exploited Children. 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 (1-800-843-5678) if you recognize a child.
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 must file a Form 8955-SSA with respect to the plan's deferred vested participants. Sponsors and administrators of government, church, and other plans which are not subject to the vesting standards of section 203 of ERISA (including plans that cover only owners and their spouses) may elect to file the Form 8955-SSA voluntarily. See the instructions for Part I, line A.
Note. If the 2012 Form 5500 annual return/report was the final return/report of the plan, the Form 8955-SSA filed for the 2012 plan year must report information on deferred vested participants, including reporting that previously reported deferred vested participants are no longer deferred vested participants.
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.
Using Form 5558
If filing 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 appropriate box on the Form 8955-SSA, Part I, line C. A one-time extension of time to file the Form 8955-SSA (up to 2 1/2 months) may be obtained by filing Form 5558 on or before the normal due date (not including any extensions) of the Form. See the instructions for Form 5558. You must file the Form 5558 with the Department of the Treasury, Internal Revenue Service Center, Ogden, UT 84201-0045. Because approved copies of the Form 5558 will not be returned to the filer, you should retain a copy of the Form 5558 that is filed.
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 both of the following conditions are met.
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 9 ½ months beyond the close of the plan year.
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."
File a 2012 Form 8955-SSA to correct errors and/or omissions in a previously filed statement for the 2012 plan year. 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.
In general, for a plan to which only one employer contributes, a participant must be reported on Form 8955-SSA if:
A participant 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 for filing), the participant:
Caution! top If payment of the deferred vested retirement benefit ceases before ALL of the participant's benefit is paid to the participant or beneficiary, information on 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.
When the benefit of a separated participant with deferred vested
benefits is transferred from one plan to the plan of a new employer,
Send the completed Form 8955-SSA to:
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. These delivery services include only the
Private delivery services should send Form 8955-SSA to:
Internal Revenue Service
1973 Rulon White Blvd.
Ogden, UT 84404
Follow the line-by-line instructions to complete the Form 8955-SSA. Answer all questions about the plan, unless otherwise specified.
Caution! The Form 8955-SSA must be filed with the IRS. The Form 8955-SSA and previous years' Schedules SSA (Form 5500) and any attachments with the form or schedules are NOT open to public inspection. DO NOT attach a Form 8955-SSA or a previous year's 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"). Because of privacy concerns, the inclusion of a social security number on the Form 5500, Form 5500-SF, or on a schedule or attachment that is filed with the DOL using EFAST2, may result in the return of the filing.
Electronic and paper filing. top You can:
Note. Remember to use additional pages 2 of the 2012 Form 8955-SSA only if additional pages are needed to add separated participants. Do not use nonstandard pages 2.
Processing tips. top To reduce the possibility of correspondence and penalties:
The Internal Revenue Code imposes a penalty for failure to file a registration statement (including failure to include all required participants). The penalty is $1 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 $5,000, is imposed on the person failing to so file unless it is shown the failure is due to reasonable cause.
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").
Line A. top 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.
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. top Check this box if this Form 8955-SSA amends a previously filed Schedule SSA (Form 5500) or Form 8955-SSA.
Line C. top 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 for additional information regarding special extensions.
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. top Enter the formal name of the plan or enough information to identify the plan. Abbreviate if necessary.
Line 1b. top Enter the three-digit plan number that the employer or plan administrator assigned to the plan uses for filing the Form 5500 series.
Line 2a. top Enter the name of the plan sponsor. The term "plan sponsor" means:
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 series 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 instructions for line 5 about changes in sponsorship).
Line 2b. top 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.
Line 2c. top 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. top 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 in lines 2f through 2l.
Line 2f. top Enter the sponsor'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 2g. top Enter the name of the city.
Line 2h. top Enter the two-character abbreviation for the U.S. state or possession.
Line 2j. top Enter the foreign province or state, if applicable.
Line 2k. top Enter the foreign country, if applicable.
Line 2l. top Enter the foreign routing code, if applicable. Leave the U.S. state and ZIP code blank if completing line 2k or line 2l.
Line 3a. top 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.
Note. Employees of the plan sponsor who perform administrative functions for the plan are generally not the plan administrator 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.
Line 3b. top 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. top 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 in lines 3e through 3k.
Line 3e. top 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 3f. top Enter the name of the city.
Line 3g. top Enter the two-character abbreviation for the U.S. state or possession.
Line 3i. top Enter the foreign province or state, if applicable.
Line 3j. top Enter the foreign country, if applicable.
Line 3k. top Enter the foreign routing code, if applicable. Leave the U.S. state and ZIP code blank if completing line 3j or line 3k.
Line 4. top 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.
Caution! Failure to indicate on line 4 that a plan administrator was previously identified by a different name or EIN could result in correspondence from the IRS.
Line 5. top 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.
Caution! Failure to indicate on line 5 that a plan sponsor was previously identified by a different name or EIN could result in correspondence from the IRS.
Line 6a. top 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 2011 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 one-year breaks in service in the 2012 plan year and who were not previously reported.
Line 6b. top 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 2012 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 2012 or who completed the first one-year break in service in the 2012 plan year, and who are reported in Part III of this form. See When To Report a Separated Participant.
Line 7. top The sum of lines 6a and 6b should equal the number on line 7.
Line 8. top Check the appropriate box as to whether the plan administrator provided the individual statement to each participant required to receive one. See Penalties.
Signature. The 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 the Form 8955-SSA should be signed and filed with the pages 2 for the plan.
Enter the name of the plan, the plan number, and the plan sponsor's EIN at the top of each page 2.
Line 9, column (a). top Enter the appropriate code from the following list:
|Code A||Use this code for a participant not previously reported. Also complete columns (b) through (g).|
|Code B||Use this code for a participant previously 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). 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.|
|Code C||Use this code for a participant previously 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).|
|Code D||Use this code for a participant previously 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). top Line 9, column (b). Enter the exact SSN of each participant listed. 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). top 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.
Line 9, column (d). top 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 one-year break in service under the plan).
|Type of Annuity Code|
|A||A single sum|
|B||Annuity payable over fixed number of years|
|D||Life annuity with period certain|
|E||Cash refund life annuity|
|F||Modified cash refund life annuity|
|G||Joint and last survivor life annuity|
Line 9, column (e). top From the following list, select the code that describes the benefit payment frequency during a 12-month period.
|Type of Payment Code|
Line 9, column (f). top For a defined benefit plan, enter the amount (in whole dollars) of the periodic payment that a participant is entitled to receive.
Line 9, column (g). top For defined contribution plans, enter the value (in whole dollars) of the participant's account.
Line 9, columns (h) and (i). top Show the EIN and plan number of the plan under which the participant was previously reported.