2026 Intake & Census Form

1. General Information

(A) Company Name

Years in business

(B) Owners / Partners Names

Federal Tax ID #

(C) Company Address

Tax Year End

(D) Company Phone #

(E) Owner(s) Mobile #

(F) Owner(s) Email Address

(H) Do you own any other company(ies)?

YesNo

If yes, what is % owned in each?

Company Names

Share the same employees in other company(ies)?

YesNo

Control / Affiliated Service Group?

YesNo

Any employees covered by a collectively bargained agreement?

YesNo

2. CPA / Accountant

CPA, Accountant's Name

Email Address

Phone #

3. Existing Company Retirement Plan Data (important)

Do you have an existing retirement plan?

YesNo

If yes, what type of plan or plans?

What is the custodian of the existing plan(s)?

How much in assets do you have in the plan(s)?

If you have a Defined Benefit, Cash Balance, or Profit Sharing plan, you must provide:

Summary Plan Description (SPD) or an Adoption Agreement for each plan.
If a pension, the latest actuarial valuation.
The latest Form 5500 for each plan.
If not a 401(k) safe-harbor profit sharing plan, the latest testing (ADP/ACP, top heavy, etc.) and account information.

Upload your plan documentsOpens in a new tab. You can send these before or after submitting this form.

4. Plan Design Objectives

A. In your own words, please describe your goals.For example: "Maximum deduction for the owner", "Minimum contribution for employees".

B. Three highest consecutive years of income for each owner and key employee

A key employee is any owner with 5% or more ownership, a 1% owner with $150K+ in compensation, or an officer with $170K+ in compensation.

Year 2024 — Net Business Profit

Year 2024 — W2 Income, Owner 1

Year 2024 — W2 Income, Owner 2 (if any)

Year 2025 — Net Business Profit

Year 2025 — W2 Income, Owner 1

Year 2025 — W2 Income, Owner 2 (if any)

Year 2026 — Estimated Net Business Profit

Year 2026 — Estimated W2 Income, Owner 1

Year 2026 — Estimated W2 Income, Owner 2 (if any)

Personal tax filing status

5. Employee Census

Include all active employees plus former employees who terminated after the beginning of the year. Add a row for every employee — there is no page limit here.

Company Name

As of

Show the Social Security Number column

No.	Social SecurityNumber	LastName	FirstName	GenderM/F	Self-Empl	OfficerY/N	Ownership%	Date of BirthMM/DD/YY	Date of HireMM/DD/YY	AnnualCompensation	Hrs(A)	Date of TerminationMM/DD/YY	(B) Class & Job TitleJob description with detail	Remove
1
		T O T A L								$0.00

Columns marked * are needed for every person you list, and at least 1 must be completed. Leave rows you do not need completely blank.The Social Security Number is not required for new proposals.

Who to include

All part-time employees, with the hours they worked.
All family members, including the spouse and children of owners, with dates of birth (note as family member).
Parents and in-laws of key employees.
All business addresses if there are employees at multiple locations (i.e. address A, B, C).

(A) Hrs codes

F = Full-time (over 1,000 hours/yr)
P = Part-time (500–1,000 hours/yr)
B = Break in service (< 500 hours)
H = Hourly S = Salaried U = Collective bargaining

(B) Class codes

A = Active participant
T = Terminated
N = Nonresident alien

Job description

Please give as much detail as possible about the job and responsibilities.
Example: Owner, Executive, Manager, Supervisor, Assistant, Clerical, Intern.
Department: Sales, Marketing, Administrative, IT, etc.
Enter address 1, 2, 3 if there are multiple locations.

Privacy sensitive. Employee census information is for official use only. Any misuse or unauthorized disclosure of this data may result in both civil and criminal penalties.