Get the free HSA Closure Request Form - HealthEquity

HSA Closure Request Form Mail or fax completed forms to: Address: HealthEquity, A n: Client Services 15 W Scenic Point Dr, Ste 400, Draper, UT 84020 Fax: 520.844.7090 Authorize on for Account Closure

How to fill out hsa closure request form

How to fill out hsa closure request form:

1. Gather all required information: Before starting the form, make sure you have all the necessary information at hand, including your personal details, HSA account number, and the reason for closing the account.
2. Obtain the closure request form: You can usually find the hsa closure request form on your HSA provider's website. Download or request a copy of the form.
3. Fill in your personal information: Start by entering your full name, address, contact details, and any other personal information as required by the form.
4. Provide your HSA details: Enter your HSA account number, which can usually be found on your account statements or in your online portal. This ensures that the closure request is linked to the correct account.
5. State the reason for closure: Explain why you want to close your HSA account. The reasons may vary, such as no longer being eligible for an HSA, changing HSA providers, or simply deciding not to continue with the account.
6. Review and sign: Carefully review all the information you have provided to ensure accuracy. Then, sign and date the closure request form as indicated.
7. Submit the form: Once you have filled out the form completely, follow the instructions provided to submit it. This may involve mailing it to your HSA provider or submitting it online through their secure portal.

Who needs hsa closure request form:

1. Individuals no longer eligible for an HSA: If your circumstances change and you become ineligible for an HSA, you may need to close your account.
2. Individuals changing HSA providers: If you decide to switch to a different HSA provider, you may need to close your current account before opening a new one.
3. Individuals not planning to continue with an HSA: If you no longer wish to maintain an HSA account, you may need to submit a closure request form to close the account and withdraw any remaining funds.

For pdfFiller’s FAQs

What is hsa closure request form?

The HSA closure request form is a document used to request the closure of a Health Savings Account (HSA).

Who is required to file hsa closure request form?

Any individual or account holder who wishes to close their Health Savings Account is required to file the HSA closure request form.

How to fill out hsa closure request form?

The HSA closure request form typically requires basic information such as the account holder's name, account number, and reasons for closing the account. It may also require a signature for authorization.

What is the purpose of hsa closure request form?

The purpose of the HSA closure request form is to officially notify the HSA administrator or provider about the account holder's decision to close their Health Savings Account.

What information must be reported on hsa closure request form?

The HSA closure request form usually requires the account holder to provide their personal details, such as name and contact information, as well as the account number and reasons for closure.

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