Get the free 3500 HSA Custodial Application, Plan Agreement and Disclosure Statement (5/2012)

Simplified HEALTH SAVINGS ACCOUNT APPLICATION PART 1. HSA OWNER PART 2. HSA CUSTODIAN Name (First/MI/Last) To be completed by the HSA custodian Delta Community Credit Union Name Attn: IRA Department

How to fill out 3500 hsa custodial application

How to fill out the 3500 HSA custodial application:

1. Gather necessary information: Before starting the application, make sure you have all the required information handy. This may include your personal details such as name, address, social security number, and contact information.
2. Complete the applicant information section: Begin by filling out the applicant information section. Provide accurate and up-to-date details about yourself, including your legal name, date of birth, gender, and contact information.
3. Choose the custodian: Select the desired custodian for your Health Savings Account (HSA). Research different custodian options available and consider factors such as fees, investment options, and customer service.
4. Provide beneficiary information: If desired, designate a beneficiary for your HSA. This is the person who would receive the funds in your account in the event of your death. Include their name, relationship to you, and their contact information.
5. Verify employer information (if applicable): If your HSA is sponsored by your employer, you may need to provide details about your employer, such as their name, address, and employer identification number (EIN).
6. Review terms and conditions: Carefully read and understand the terms and conditions of the custodial agreement. This section outlines the responsibilities of both the custodian and the account holder. Ensure you agree to the terms before proceeding.
7. Sign and date the application: After completing all the necessary sections, sign and date the application. This signifies your agreement to open an HSA and abide by the custodial agreement's terms.
8. Submit the application: Depending on the custodian, you may be able to submit the application online, through mail, or in-person. Follow the specified instructions provided by the custodian to submit your application successfully.

Who needs a 3500 HSA custodial application?

1. Individuals seeking to open a Health Savings Account (HSA): The 3500 HSA custodial application should be filled out by individuals who want to open and establish an HSA to save and invest funds for qualified medical expenses.
2. Employees with access to an HSA through their employer: Many employers offer HSAs as part of their employee benefits package. If you have access to an HSA through your employer, you will likely need to complete the 3500 HSA custodial application to open an account.
3. Self-employed individuals or those without employer-sponsored healthcare: If you are self-employed or don't have access to employer-sponsored healthcare, you can still open an HSA independently. The 3500 HSA custodial application is necessary for individuals in this situation as well.

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What is 3500 hsa custodial application?

The 3500 hsa custodial application is a form used by custodians to report information related to Health Savings Accounts (HSAs).

Who is required to file 3500 hsa custodial application?

Custodians of Health Savings Accounts (HSAs) are required to file the 3500 hsa custodial application.

How to fill out 3500 hsa custodial application?

The 3500 hsa custodial application can be filled out electronically or submitted by mail. Custodians must provide information about the HSA, contributions, distributions, and account holders.

What is the purpose of 3500 hsa custodial application?

The purpose of the 3500 hsa custodial application is to report information about Health Savings Accounts (HSAs) to the IRS.

What information must be reported on 3500 hsa custodial application?

Information such as the HSA custodian's name, address, Employer Identification Number (EIN), and details about contributions, distributions, and account holders must be reported on the 3500 hsa custodial application.