Get Hsa Closure/withdrawal Request - Umb.com

This guide provides clear instructions on how to effectively fill out the Health Savings Account (HSA) Closure/Withdrawal Request form online. Whether you are making a standard withdrawal or correcting a contribution, this step-by-step approach will ensure you complete the form accurately.

Follow the steps to successfully fill out the HSA Closure/Withdrawal Request form.

1. Press the ‘Get Form’ button to access the HSA Closure/Withdrawal Request form and open it in your preferred editor.
2. Locate the field for your UMB Health Savings Account Number. Enter the 10-digit account number found on your HSA statement to ensure proper identification.
3. Choose the action you want to take by checking one of the three options: 'Withdrawal Request — Standard Disbursement', 'Withdrawal Request — Excess Contribution Refund', or 'Withdrawal Request — Contribution/Deposit Correction'.
4. If selecting 'Standard Disbursement', enter the amount you wish to withdraw in the designated field. Make sure to review the implications of this action as it will be reported as a normal distribution to the IRS.
5. For 'Excess Contribution Refund', fill in the Excess Contribution Amount and the relevant Tax Year. Be aware that penalties may apply, and consult a tax advisor if necessary.
6. If correcting a contribution error, provide the withdrawal amount specifying the Tax Year of Correction. Verify that the contribution was indeed a mistake and acknowledge responsibility for any potential tax implications.
7. After filling out all necessary fields and checking the accuracy of the information provided, ensure you sign at the designated area at the bottom of Page 2 to validate the form.
8. Finally, choose to save your changes, download the completed form, print it, or share it via email as required. Ensure you send the completed form to the address or fax number provided for processing.

Complete your HSA Closure/Withdrawal Request online today to maintain efficient digital document management.