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1545-0074 2010 Attachment Sequence No. 39 separate instructions. Social security number of MSA account holder. If both spouses have MSAs, see page 1 of the instructions Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B. Part I Archer MSA Contributions and Deductions. See page 2 of the instructions before completing this part. If you are filing jointly and both you and your spouse have high deductible health plans with self-only cov.

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Go to .irs.gov/Form8853 for instructions and the latest information. Attach to Form 1040, 1040-SR, or 1040-NR. Section A.

When to use Form 8853. There are a few situations that require Form 8853: If you or your employer made contributions to an Archer MSA within a tax year. If you received distributions from an Archer MSA or Medicare Advantage MSA.

Note that MSA account withdrawals for qualified medical expenses are tax-free, while account withdrawals for non-medical expenses are subject to both income tax and a 50% tax penalty.

you must file Form 8853 with Form 1040, 1040-SR, or 1040-NR even if you have no taxable income or any other reason for filing Form 1040, 1040-SR, or 1040-NR. Name and social security number (SSN). Enter your name(s) and SSN as shown on your tax return.

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Keywords relevant to Form 8853

  • Unreimbursed
  • excludable
  • 2011
  • 13b
  • OMB
  • 13a
  • 1099-LTC
  • 14a
  • rollovers
  • 24091h
  • payees
  • reimbursements
  • policyholder
  • taxable
  • worksheet
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232