Get Purpose: Use This Form For Distributions From Your Hsa In Cases When You Want A Check From Us (or A

Understanding how to properly fill out the HSA distribution form is crucial for people seeking check distributions from their health savings accounts. This guide will provide clear and detailed instructions to ensure a smooth and efficient process when completing the form online.

Follow the steps to ensure your distribution request is processed correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your personal information in the designated fields: provide your name, social security number, date of birth, HSA account number, and phone number.
3. In the distribution information section, specify the amount you wish to withdraw. Additionally, take note that a check will be mailed to the address registered on your account.
4. Select the reason for the distribution by checking the appropriate box. Options include normal distribution, excess return of excess contribution, death distribution, transfer to spouse, disability, prohibited transaction, or return of HSA contribution to employer.
5. If applicable, complete the required details for the selected distribution reason, such as beneficiary information or reasons for closing your HSA.
6. Sign and date the form in the certification section, confirming your understanding of the tax consequences and your responsibilities regarding the distribution.
7. Finally, review the completed form for accuracy. You can save your changes, download, print, or share the form as needed.

Complete your HSA distribution form online today for prompt processing.