Opening note
Says all plans are required to include some form of the 401(a)(9) minimum distribution requirements and sends each of the three acceptable forms to its own section.
15417-E
403(b) Plan Required Minimum Distributions Worksheet 9A – Determination of 403(b) Status
- Agency
- IRS
- Revision
- 4-2023
- Fillable fields
- 20
- Pages
- 1
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 15417-E: 403(b) Plan Required Minimum Distributions Worksheet 9A
Form 15417-E (4-2023) is a one-page IRS worksheet titled 403(b) Plan Required Minimum Distributions. Its title also calls it Worksheet 9A, Determination of 403(b) Status. It asks how a named 403(b) plan includes the minimum distribution requirements of 401(a)(9). Each question has a Plan Reference column and Yes, No and N/A boxes.
The form says all plans are required to include some form of the minimum distribution requirements of 401(a)(9), and it lists three acceptable forms: incorporation by reference (Section I), alternative 401(a)(9) language (Section II) and governmental plans (Section III). The instructions at the top say "All items must be completed." A "Yes" answer generally indicates a favorable conclusion is warranted, while a "No" answer indicates a problem exists.
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.
What's on Form 15417-E
Section I: Incorporation By Reference
Item a covers compliance with 401(a)(9) under each investment arrangement's terms. Item b asks whether each investment arrangement is treated as an IRA, with distributions made in accordance with 1.408-8, except as provided in 1.403(b)-6(e).
Section II: Alternative 401(a)(9) Language
One item on plan language that complies with 401(a)(9), regulations 1.401(a)(9)-1 through 9 and 1.408-8, except as provided in 1.403(b)-6(e).
Section III: Governmental Plans
One item asking whether the plan provides a reasonable and good faith interpretation of 401(a)(9).
Explanation spaces
Each of the three sections ends with a space headed Explain any "No" answers in this section.
How to fill out Form 15417-E
- 1
Name of plan
Enter the name of the 403(b) plan in the box above Section I.
- 2
Pick the section
The opening note sends incorporation by reference to Section I, alternative 401(a)(9) language to Section II and governmental plans to Section III.
- 3
Check Yes, No or N/A
Check one box for each item. Each row also has a Plan Reference column; the form gives no further directions for it.
- 4
Section II reference
Item II(a) says to see Worksheet 9, Publication 7004, for detailed 401(a)(9) plan requirements.
- 5
Explain any No answers
Use the space at the end of each section for any "No" answer, as the instructions at the top ask.
Why fill Form 15417-E on indox
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Where it goes and related worksheets
No address or deadline
The worksheet prints no mailing address, filing method, recipient or deadline, and it has no signature line.
No separate instructions
No IRS About page or instructions are linked to it. The directions are the paragraph and the list of acceptable forms at the top of the page.
Edition
The page footer prints Form 15417-E (4-2023), Catalog Number 94033Z, Department of the Treasury, Internal Revenue Service.
Part of a series
The title calls it Worksheet 9A in the Determination of 403(b) Status series. Item II(a) refers to Worksheet 9 in Publication 7004 for detailed 401(a)(9) plan requirements.
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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-G
403(b) Plan Elective Deferrals Worksheet 12A – Determination of 403(b) Status
88 fields, 2 pages
15417-D
403(b) Plan, Plan Limitation on Contribution and Benefits Worksheet Number 6A – Determination of 403(b) Status
105 fields, 3 pages
Who completes Form 15417-E?
The worksheet does not name who completes it or who receives it. Its questions ask what a 403(b) plan document provides, not about a person's own taxes.
Official sources and the blank
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Questions about Form 15417-E
Who fills out Form 15417-E?
The worksheet does not say. It asks about the minimum distribution provisions of a named 403(b) plan and has no preparer, signature or recipient lines.
What does the form say about minimum distribution rules?
The form says all plans are required to include some form of the minimum distribution requirements of 401(a)(9), and it lists three acceptable forms.
Which section covers a governmental plan?
Section III. It asks whether a plan that does not incorporate by reference provides a reasonable and good faith interpretation of 401(a)(9).
What does a No answer mean on this worksheet?
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.
Where are the detailed 401(a)(9) requirements?
Item II(a) says to see Worksheet 9, Publication 7004, for detailed 401(a)(9) plan requirements.
Are there separate instructions for Form 15417-E?
No separate instructions are linked to it. The directions are the paragraph and the list of acceptable forms at the top of the page.