Plan name and answer columns
A line for the name of the plan, then every item has a Plan Reference column and Yes, No and N/A boxes. Each section ends with space to explain any "No" answers.
15417-D
403(b) Plan, Plan Limitation on Contribution and Benefits Worksheet Number 6A – Determination of 403(b) Status
- Agency
- IRS
- Revision
- 4-2023
- Fillable fields
- 105
- Pages
- 3
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 15417-D: 403(b) Plan Limitation on Contribution and Benefits, Worksheet 6A
Form 15417-D is titled "403(b) Plan, Plan Limitation on Contribution and Benefits, Worksheet 6A, Determination of 403(b) Status." It is a checklist that walks through the written terms of a 403(b) plan, item by item, against the limits on contributions and benefits.
Each item is a question about the plan document, with a column for the plan reference and boxes for Yes, No or N/A. The form says a "Yes" answer indicates a favorable conclusion is warranted while a "No" answer indicates a problem exists, and that the space on the worksheet is used to explain any "No" answer. It covers four sections: definitions, limits on elective deferrals, limitations on annual additions, and the 401(a)(17) limitation.
The worksheet does not say who completes it and prints no filing address or deadline. It also says its technical principles may be changed by future regulations or guidelines. You can fill out Form 15417-D free in your browser on this page and download the result without an account.
What's on Form 15417-D
Section I: Definitions
Items a to d: the limitation year, compensation defined as Includible Compensation, the meaning of Year of Service, and the special rule for church employees.
Section II: Limits on Elective Deferrals
Items a to e: the section 402(g) limit, aggregation with other plans, the age 50 catch-up, the special section 403(b) catch-up and the order in which the two catch-ups apply.
Section III: Limitations on Annual Additions
Items a to g: the annual additions definition and limit, excess annual additions held in a separate account, former employees, disabled participants and the rule when a participant controls an employer.
Section IV: 401(a)(17) Limitation
One item on the limit on compensation taken into account in determining contributions, with notes on churches, QCCOs and elective deferrals.
How to fill out Form 15417-D
- 1
Name the plan
Enter the name of the plan at the top. The form says all items are completed unless the contrary is specifically provided.
- 2
Answer each item
For each question, enter where the plan document addresses it in the Plan Reference column and check Yes, No or N/A.
- 3
Use the skip rules in Section II
If the plan does not offer elective deferrals, skip to Section III. Item II(d) also says to skip the rest of the section when the special 403(b) catch-up does not apply.
- 4
Check the printed limits
Item III(b) asks about the lesser of $61,000 (for 2022), as adjusted for cost-of-living, or 100 percent of Includible Compensation. Item IV(a) asks about the $305,000 (for 2022) compensation limit, as adjusted.
- 5
Explain each No answer
Use the space at the end of each section to explain any "No" answer, which the form says indicates a problem exists.
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Notes printed on the worksheet
No filing details
The worksheet prints no filing address, deadline or instructions about where it goes. Its footer gives the catalog number 94032O.
What the answers mean
The form says a "Yes" answer indicates a favorable conclusion is warranted while a "No" answer indicates a problem exists.
Limits as printed
The dollar limits on the form are shown for 2022, as adjusted for cost-of-living. The form also says its technical principles may be changed by future regulations or guidelines.
Other worksheets
Item I(b) says to see WS 5B for contributions to former employees. The IRS listing titles Form 15417-C as Worksheet 5B.
Related forms
15417-C
403(b) Plan Coverage and Nondiscrimination Requirements for Employer Contributions (Other than Matching Contributions) Worksheet 5B – Determination of 403(b) Status
104 fields, 3 pages
15417-G
403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status
88 fields, 2 pages
15417
403(b) Plan Eligibility and Participation Worksheet 1A – Determination of 403(b) Status
81 fields, 2 pages
15417-A
403(b) Plan Minimum Vesting Standards Worksheet 2B – Determination of 403(b) Status
26 fields, 1 page
15417-B
403(b) Plan Miscellaneous Provisions Worksheet 4A – Determination of 403(b) Status
133 fields, 3 pages
15417-E
403(b) Plan Required Minimum Distributions Worksheet 9A – Determination of 403(b) Status
20 fields, 1 page
Which plans Form 15417-D covers
The worksheet does not name who fills it out. It reviews the terms of a 403(b) plan, and several items apply only to certain plans or employers.
Official sources and the blank
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Questions about Form 15417-D
What does a No answer on Form 15417-D mean?
The form says a "No" answer indicates a problem exists, and each section has space to explain any "No" answer.
Does every item need an answer?
The form says all items are to be completed unless the contrary is specifically provided, such as the skip notes in Section II.
What dollar limits does the worksheet print?
$61,000 (for 2022) for annual additions and $305,000 (for 2022) for compensation under section 401(a)(17), each as adjusted for cost-of-living.
Does the 401(a)(17) item apply to church plans?
The form notes that this requirement does not apply to churches and QCCOs, and does not apply to elective deferrals.
Where is Form 15417-D sent?
The worksheet does not say. It prints no filing address, deadline or separate instructions.