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Get 2001 Form 8853 (Fill-in Version). Archer MSAs And Long-Term Care Insurance Contracts

Attachment Sequence No. See separate instructions. 39 Social security number of MSA account holder. If both spouses have MSAs, see page 1 Section A. Archer MSAs. If you have only a Medicare+Choice MSA, skip Section A and complete Section B. Part I General Information. See page 1 of the instructions. Yes No 1a b c 2a b c Did you or your employer make contributions to your Archer MSA for 2001? If Yes, were you uninsured when the MSA was established (see page 2 of the instructions)?.

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