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  • (hsa) Contribution Election Change Form - Human Resources ...

Get (hsa) Contribution Election Change Form - Human Resources ...

Requested Effective Date for the Deduction Change: (Enter the first day of the requested month.) Requested Annual Election Pledge: $ (Total amount you want to elect for this calendar year. To stop deductions, enter $0) Requested Bi-Weekly HSA Pre-tax Deduction Amount: $ (Divide the annual amount you wish to contribute by number of remaining pay periods, to calculate your bi-weekly deductions.) Is this a One-time Deduction: Yes No ACS Mell.

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Usually, your HSA contribution is reported in box 12 of your W-2 with the code W (Company Contributions to Health Savings Account). TurboTax automatically records this amount in the 1099-SA, HSA, MSA section. Code W reports the combined HSA contributions from you and your employer.

Health Savings Accounts: An HSA election change can occur at any time, for any reason. An employer may limit changes to once per month for administrative purposes. However, there are no other restrictions on changing your pre-tax HSA elections.

The 5498-SA form reports all contributions to your HSA for the prior year, including those contributed between Jan. 1 and the tax filing deadline of the current year. It also reports your HSA balance as of Dec. 31 of the prior year.

You can check your HSA balance by visiting the Member Website, where you will have secure, 24/7 access to your account balances and transaction history.

Health Savings Account (HSA) You will receive the IRS Form 1099-SA and IRS Form 5498-SA either by mail or electronically (based upon your elected delivery preference). These IRS tax forms are also available in the Member Website. IRS Form 1099-SA is provided for each HSA distribution you made in the current tax year.

Employer contributions to your Health Savings Account are reported on Form W-2 Wage and Tax Statement, Box 12 with a code "W." An amount entered here will flow to Line 7, Column C of California Schedule CA. The amount is then added to the income total on Line 16 of California Form 540.

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© Copyright 1997-2025
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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