Get Hsa Division Request Form - Fifth Third Bank

Filling out the HSA Division Request Form from Fifth Third Bank online is a straightforward process that requires attention to detail. This guide will assist you in accurately completing the form to ensure your requested changes are processed efficiently.

Follow the steps to complete your form accurately

1. Press the ‘Get Form’ button to access the HSA Division Request Form and open it for editing.
2. Begin filling out the company name, division name, and effective date of division. Ensure all entered information is accurate.
3. Provide the bank name, bank routing and transit number, and bank account number. Indicate whether the account is a checking or savings account.
4. Specify the intended use of the bank account by selecting one or more options: HSA funding, fee funding, or both.
5. List the employees associated with the division. You may choose to include a separate document with the employee listing attached to the request.
6. Read and acknowledge the certification statement, ensuring you understand your responsibilities and the accuracy of the information provided.
7. Complete the form by signing and dating it in the designated areas.
8. Once the form is completed, save any changes, and prepare to fax the document to Fifth Third Bank HSA Support at 513-358-3588 for processing.

Start completing your documents online today to ensure timely processing.