0423 Form 15417-E (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f15417e.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

403(b) Plan

Required Minimum Distributions¶

Worksheet 9A – Determination of 403(b) Status

Instructions - All items must be completed. A “Yes” answer generally indicates a favorable conclusion is warranted, while a “No” answer indicates a problem exists. Use the space on the worksheet to explain any “No” answer.

All plans are required to include some form of the minimum distribution requirements of 401(a)(9). The following are the acceptable forms:

For Incorporation By Reference, go to Section I.
For Alternative 401(a)(9) Language, go to Section II.
For Governmental Plans, go to Section III.

The technical principles in this worksheet may be changed by future regulations or guidelines

Name of plan

Explain any "No" answers in this section

Form 15417-E (4-2023) Catalog Number 94033Z publish.no.irs.gov Department of the Treasury - Internal Revenue Service

Exceptions & meaning →