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SIMPLE-IRA Administrative Forms

SIMPLE Service Agreement (5305 version) Form # 919 Revised 11/02 
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Service Agreement

Purpose of Form: This service agreement is to be used to define the relationship between the IRA custodian or trustee and the business customer. A financial institution can limit its responsibility by using this document.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Service Agreement (5304 version) Form # 919-A Revised 9/02 
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Service Agreement

Purpose of Form: This service agreement is to be used to define the relationship between the IRA custodian or trustee and the business customer. A financial institution can limit its responsibility by using this document.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Worksheet Form # 920 Revised 4/97  
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Employee Eligibility Worsheet

Purpose of Form: This form is used each payroll by the employer to list and record the salary-reduction contributions made by each employee. The employer may also use this form to record the matching contributions they make.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Payroll Contribution Report Form # 921 Revised 4/97 
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Summary Worksheet of Employees' Salary-Reduction Contributions and Employer's Matching Contributions

Purpose of Form: This form is used each payroll by the employer to list and record the salary-reduction contributions made by each employee. The employer may also use this form to record the matching contributions they make.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Transfer Certification Form # 956 Revised 2/04 
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Transfer Certification Form for Transfers from one SIMPLE-IRA to Another SIMPLE-IRA

Purpose of Form: This form is used so a person may certify that he or she is satisfying the special transfer rules which apply to SIMPLE-IRAs.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Rollover Certification Form # 965 Revised 3/03 
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Rollover Certification for Rollovers from a SIMPLE-IRA to Another SIMPLE-IRA

Purpose of Form: This form is used so that a person certifies that he or she is satisfying the special rollover rules which apply to SIMPLE-IRAs.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2007 (5305 Version) Form # 970 Revised 2/07 
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Elective Contribution Instructions and Acknowledgment of Receipt of Notice of Withdrawal, Rollover and Transfer Rights

Purpose of Form: Each eligible employee will need to complete this form and furnish it to the employer. The employee uses this form to tell the employer what percentage of compensation he or she wants to defer.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2007 (5304 version) Form # 970-A Revised 2/07 
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Elective Contribution Instructions and Acknowledgment of Receipt of Notice of Withdrawal, Rollover and Transfer Rights

Purpose of Form: Each eligible employee will need to complete this form and furnish it to the employer. The employee uses this form to tell the employer what percentage of compensation he or she wants to defer.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
IRS Form 5304-SIMPLE Form # 917-A Revised 9/05 
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IRS Model Form 5304-SIMPLE

Purpose of Form: Employer uses to establish its SIMPLE-IRA plan when such plan will not have a designated financial institution.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
IRS Form 5305-SIMPLE Form # 917 Revised 9/05 
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IRS Model Form 5305-SIMPLE

Purpose of Form: Employer uses to establish its SIMPLE-IRA plan, and such plan will have a designated Financial Institution.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2007 (5304 version) Form # 918-A Revised 9/05 
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2007 Retirement Account Summary Description

Purpose of Form: Every custodian/trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2007 (5304 version) Alternate version Form # 918-B Revised 8/06 
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2007 Retirement Account Summary Description (Alternate Version)

Purpose of Form: Every custodian/trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25  forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2007 (5305 version) Form # 918 Revised 8/06 
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2007 Retirement Account Summary Description

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2008 (5305 version) Form # 918 Revised 8/07 
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SIMPLE Summary Description for 2008

Purpose of Form: SIMPLE— Summary Description for the 2008 Calendar Year (If Employer has Adopted IRS Model Form 5305-SIMPLE)

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2008 (5304 version) Form # 918-A Revised 8/07 
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2008 Retirement Account Summary Description

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Summary Description for 2008 (5304 version) Alternate version Form # 918-B Revised 8/07 
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2007 Retirement Account Summary Description (Alternate Version)

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2007 (5305 version) Form # 970 Revised 2/07 
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SIMPLE Elective Contribution for 2007 (5305 version)

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2007(5304 version) Form # 970-A Revised 2/07 
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SIMPLE Elective Contribution for 2007 (5304 version)

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2008 (5305 version) Form # 970 Revised 8/07 
   Add to basketBasketAdd to favorites

SIMPLE Elective Contribution for 2008 (5305 version)

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
SIMPLE Elective Contribution for 2008 (5304 version) Form # 970-A Revised 8/07 
   Add to basketBasketAdd to favorites

SIMPLE Elective Contribution for 2008 (5304 version)

Purpose of Form: Every trustee of a SIMPLE plan account must annually furnish the employer with this form. The employer must furnish this form to each eligible employee.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.
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