Authorized Service Provider - Signing 5500 Filing?

Is there standard wording or a template to follow to obtain the required written authorization to sign the 5500 filing on behalf of the plan sponsor/administrator?  

There is, although I don't have a copy myself.  It basically parrots the language in question 33a of the EFAST FAQs.

Someone here should have a Word version or something readily shareable.

Filing Authorization

For the 2024 Form 5500

Name of Plan: 

EIN / PN:  

Plan Year Ending: December 31, 2024

PART I Authorization of Practitioner to Electronically Sign and File

I hereby authorize XXXXXX to electronically sign and file the above-named return/report through EFAST2.

I understand that in granting this authority:

•  I must manually sign and date page 1 of the Form 5500 and provide a scanned copy of that signature page to XXXXXXX before the electronic filing can be initiated;

•  XXXXXXX will retain a copy of this written authorization in its records;

•  XXXXXXX will notify the individual(s) signing below as plan administrator/employer about any inquiries and information it receives from EFAST2, DOL, IRS, or PBGC regarding this annual return/report; and

•  A copy of my signature, as it appears on page 1 of the Form 5500, will be included with the return/report posted by the Department of Labor on the Internet for public disclosure.

•  XXXXXXX shall not be deemed an administrator or other fiduciary with respect to any Plan solely on account of the services performed under this authorization.

This authorization is applicable only to the filing for the above-named Plan and applies only for Plan year end stated above.

Plan Administrator: ___________________________                      Date: ____________

PART II Acknowledgement of Receipt of Authorization

On behalf of XXXXXXXX I hereby certify that the firm will use the authority granted only for the express purposes described above; that the firm will not disclose confidential information to any parties other than the DOL, as required for EFAST filing; and that the firm will take reasonable steps to assure that confidential information provided by the Plan Administrator or Plan Sponsor is protected from unauthorized disclosure.

For XXXXXXXXXX: ________________­________Date: ____________

The designated service provider must retain this authorization.

5 hours ago, Belgarath said:

Filing Authorization

For the 2024 Form 5500

 

Name of Plan: 

     

EIN / PN:  

 

Plan Year Ending: December 31, 2024

 

PART I Authorization of Practitioner to Electronically Sign and File

 

I hereby authorize XXXXXX to electronically sign and file the above-named return/report through EFAST2.

 

I understand that in granting this authority:

•  I must manually sign and date page 1 of the Form 5500 and provide a scanned copy of that signature page to XXXXXXX before the electronic filing can be initiated;

•  XXXXXXX will retain a copy of this written authorization in its records;

•  XXXXXXX will notify the individual(s) signing below as plan administrator/employer about any inquiries and information it receives from EFAST2, DOL, IRS, or PBGC regarding this annual return/report; and

•  A copy of my signature, as it appears on page 1 of the Form 5500, will be included with the return/report posted by the Department of Labor on the Internet for public disclosure.

•  XXXXXXX shall not be deemed an administrator or other fiduciary with respect to any Plan solely on account of the services performed under this authorization.

 

This authorization is applicable only to the filing for the above-named Plan and applies only for Plan year end stated above.

 

Plan Administrator: ___________________________                      Date: ____________

 

PART II Acknowledgement of Receipt of Authorization

 

On behalf of XXXXXXXX I hereby certify that the firm will use the authority granted only for the express purposes described above; that the firm will not disclose confidential information to any parties other than the DOL, as required for EFAST filing; and that the firm will take reasonable steps to assure that confidential information provided by the Plan Administrator or Plan Sponsor is protected from unauthorized disclosure.

 

For XXXXXXXXXX: ________________­________Date: ____________

 

The designated service provider must retain this authorization.

Thank you!  Is this model language from the DOL, or is it a template created by a separate entity?  

The text seems adapted from Q33a in EBSA’s FAQs on EFAST2 Electronic Filing System https://www.dol.gov/agencies/EBSA/about-ebsa/our-activities/resource-center/faqs/efast2-form-5500-processing#signing.