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

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

G your debit card, checking or ACH access. This may include: normal distributions, death distributions, disability distributions, prohibited transaction distributions and transfers to a spouse due to death or divorce. Also use this form if you are closing your account. 1. Personal Information Name Soc. Sec # Date of Birth HSA Account # Phone # 2. Distribution Information A. Amount: $.

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Related content

Instructions for Form 8889 (2023)
Enter your name(s) as shown on your tax return and the SSN of the HSA account beneficiary...
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HSA Tax Resources and Information
This form reports HSA contributions made by you and the university, as well as any...
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2014 Instructions for Form 1040NR
Apr 15, 2015 — If you enrolled someone who is not claimed as a dependent on your tax...
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You can withdraw funds from your HSA anytime. But keep in mind that if you use HSA funds for any reason other than to pay for a qualified medical expense, those funds will be taxed as ordinary income, and the IRS will impose a 20% penalty.

File Form 1099-SA to report distributions made from a: Health savings account (HSA).

A 1099-SA is a U.S. tax form that reports distributions made from a health savings account (HSA), Archer medical savings account (Archer MSA), or Medicare Advantage medical savings account (MA MSA). Its purpose is to show you (and the Internal Revenue Service) how much money you spent from your account.

An HSA distribution is a withdrawal from your health savings account. HSA distributions taken to pay for eligible medical expenses are not taxable, but they still must be reported to the Internal Revenue Service (IRS).

The account owner then repays the mistaken distribution to the HSA no later than April 15 following the first year the account owner knew or should have known the distribution was a mistake.

Verification of expenses is not required for HSAs. However, total withdrawals from your HSA are reported to the IRS on Form 1099-SA. You are responsible for reporting qualified and non-qualified withdrawals when completing your taxes.

The purpose of Form 5498-SA is to report how much money is contributed to an HSA, Archer MSA or MA MSA over the course of a tax year. In the case of HSAs and Archer MSAs, the tax year extends to April 15 of the following year.

Save: Prepare for health care needs in the future If you don't spend the money in your account, it will carryover year after year.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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