Get the free Health Savings Account (HSA) Distribution Form

This form is designed to assist HSA owners in selecting the reason and method for HSA distributions, including transfers and distributions due to death or disability.

How to fill out health savings account hsa

How to fill out Health Savings Account (HSA) Distribution Form

1. Obtain the HSA Distribution Form from your HSA provider or their website.
2. Fill out your personal information including your name, address, and HSA account number.
3. Indicate the distribution amount you wish to withdraw from your HSA.
4. Select the reason for the distribution, such as medical expenses or other qualified uses.
5. Attach any necessary documentation supporting your reason for the distribution, if required.
6. Review the form for accuracy and completeness.
7. Sign and date the form to authorize the distribution.
8. Submit the completed form to your HSA provider either through mail or electronically, as directed.

Who needs Health Savings Account (HSA) Distribution Form?

1. Individuals who have an HSA and need to withdraw funds for qualified medical expenses.
2. Those who have incurred medical expenses and wish to reimburse themselves from their HSA.
3. Account holders intending to use HSA funds for non-medical expenses and meet applicable tax obligations.

People Also Ask about

What is a distribution form in HSA?

When the taxpayer pays these medical expenses that are not reimbursed, the taxpayer can request a distribution from the HSA trustee. The taxpayer can receive tax-free distributions from an HSA to pay or be reimbursed for qualified medical expenses incurred after the taxpayer establishes the HSA.

Where can I find HSA distribution form?

Visit the 'Account Statements' page in your online account to access your HSA tax documents. File Form 1099-SA to report distributions from an HSA. File Form 5498-SA to report contributions to an HSA. File Form 8889 to report your HSA contributions. and distributions. Refer to Form W-2 for your HSA contributions.

Do you have to report HSA withdrawals?

Distributions from HSAs and MSAs that are not used for qualified medical expenses are subject to income tax and an additional 20% tax. When filing taxes, you must report taxable distributions from HSAs and MSAs on your tax return and calculate the additional 20% tax on the taxable portion of your distributions.

How do I withdraw money from my HSA account?

Report as Income: Income taxes must be paid on the withdrawn amounts (contributions and earnings). Withdrawn excess contributions should be reported as “Other Income” on the tax return.

What is the form for HSA withdrawal?

You must report distributions from your HSA on IRS Form 8889. You will receive a separate 1099-SA for each type of distribution made during the tax year.

Where can I download my HSA tax form?

How do I find my HSA tax forms? Log in to your account and select Manage My Reimbursement Account. Click the red menu on the top left, click My Accounts, then select Benefit Account Summary. Select the Tax Forms link in the Account Resources section. You may be prompted to complete a PDF verification step.

How do I document an HSA withdrawal?

You may get both a 1099-SA and 5498-SA from us. IMPORTANT: You won't receive this form if you didn't take a distribution from your HSA in the prior year. The 1099-SA is used to report any distribution of funds from your HSA during the prior year. You must report distributions from your HSA on IRS Form 8889.

For pdfFiller’s FAQs

What is Health Savings Account (HSA) Distribution Form?

The Health Savings Account (HSA) Distribution Form is a document used to report distributions taken from an HSA account. It includes information about the amount withdrawn and its purpose, ensuring compliance with IRS regulations.

Who is required to file Health Savings Account (HSA) Distribution Form?

Individuals who take distributions from their Health Savings Account (HSA) are required to file the HSA Distribution Form. This includes both account holders and custodians who manage HSAs.

How to fill out Health Savings Account (HSA) Distribution Form?

To fill out the HSA Distribution Form, you need to provide your personal information, the HSA account number, the amount of the distribution, and the purpose of the distribution. Ensure all required fields are completed accurately.

What is the purpose of Health Savings Account (HSA) Distribution Form?

The purpose of the HSA Distribution Form is to document distributions from an HSA for tax reporting and compliance purposes. It helps in tracking eligible medical expenses and ensures that funds are used appropriately.

What information must be reported on Health Savings Account (HSA) Distribution Form?

The information that must be reported includes the account holder's name and Social Security number, the HSA account number, the amount of the distribution, the date of the distribution, and the purpose of the distribution.