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  • Withdrawal Bformb - Umb Bank

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R08.15 Health Savings Account (HSA) or Medical Savings Account (MSA) Withdrawal Form 9 UMB Health Savings Account Number (10digit number found on your HSA statement) 8 As owner of the Health Savings.

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How to fill out the Withdrawal BFormb - UMB Bank online

Filling out the Withdrawal BFormb for UMB Bank can be straightforward if you follow the right steps. This guide provides clear instructions to help you complete the form accurately, ensuring a smoother processing of your request.

Follow the steps to complete your Withdrawal BFormb online.

  1. Click the 'Get Form' button to acquire the Withdrawal BFormb and open it in your preferred editing platform.
  2. Input your UMB Health Savings Account number, which is the 10-digit number located on your HSA statement.
  3. Select the appropriate withdrawal request option by checking one of the boxes provided: 'Withdrawal Request — Standard Disbursement', 'Withdrawal Request — Excess Contribution Refund', or 'Withdrawal Request — Contribution/Deposit Correction'. Include the amount you wish to withdraw next to the selected option.
  4. If you chose 'Excess Contribution Refund', fill out the excess contribution amount and the corresponding tax year.
  5. Signature and date: As the account owner, sign the form at the designated area, affirming your request and understanding of its implications.
  6. Ensure to double-check all information for accuracy. Save your changes and decide whether to download, print, or share the completed form as necessary.

Complete your Withdrawal BFormb online to manage your health savings account effectively.

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In order for the withdrawal to be accurately reported, you may not withdraw the excess directly. Instead, you must request an excess contributions refund by faxing or mailing this signed and completed form to UMB, using the address or fax number listed below.

You may withdraw any portion or all of the funds from one HSA or Archer MSA and roll them into an HSA with another custodian or trustee. However, you are required to roll the funds into a new HSA within 60 calendar days of your receipt of the funds.

You can submit a withdrawal request form to receive funds (cash) from your HSA. If the cash is used to pay for ineligible purchases, it must be reported when you're filing your taxes. Once it's reported, it's subject to an income tax and treated as though it had never been in your tax-free HSA.

The HSA debit card can be used to pay for qualified medical expenses for the accountholder and their dependents. When using their debit card at a merchant location (other than an ATM), they will enter “credit” into the merchant's keypad at checkout, or let the cashier know that the purchase is a “credit” transaction.

You will receive a signature-based debit card with ATM access for your HSA. There is no charge to use the card at merchants and health care providers, but fees apply if it is used at an ATM. UMB charges a monthly service fee for HSA custodial services.

Return completed form to: UMB Bank, n.a. Mailstop 1020502 — HCS Department. P.O. Box 419226. Kansas City, MO 64141-6226. Or Fax to: 816.843.2247. Or e-mail scanned document to: HSA.Administration@umb.com.

Online Transfer – On HSA Bank's Member Website, you can transfer funds from your HSA to an external bank account, such as a personal checking or savings account. There is a daily transfer limit of $2,500 to safeguard against fraudulent activity.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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