Get the free HSA Transfer Request Form - Kereon HSA

HSA Transfer Request Form To request an HSA Transfer or Rollover, please complete this Form and Submit it to: Database Financial Services co Farmers & Merchants State Bank. P.O. Box 55068 Little Rock,

How to fill out hsa transfer request form

How to fill out HSA transfer request form:

1. Start by obtaining the HSA transfer request form from your current HSA custodian or employer. This form is typically available on their website or can be requested directly from them.
2. Fill out the personal information section of the form, including your full name, address, contact number, and Social Security number. Ensure that the information provided is accurate and up to date.
3. Provide details about your current HSA custodian, including their name, address, and contact information. This information is necessary for initiating the transfer process.
4. Indicate the reason for the transfer. Common reasons include changing jobs, dissatisfaction with the current custodian, or seeking better investment options. Be sure to select the appropriate reason for your transfer.
5. Specify the transfer method you prefer. You can typically choose between a direct transfer, where the funds are transferred directly from one custodian to another, or an indirect rollover, where you receive the funds and have 60 days to deposit them into another HSA to avoid penalties.
6. Decide whether you want to transfer the entire HSA balance or just a specific amount. If transferring only a portion, specify the desired amount.
7. Sign and date the form. Some forms may require a witness or notary signature, so make sure to follow any additional instructions provided.
8. Submit the completed form to your current HSA custodian by mail or through their electronic submission process. It's recommended to keep a copy of the form for your records.

Who needs an HSA transfer request form?

Individuals who have an existing Health Savings Account (HSA) and want to transfer their funds to a new custodian or employer typically need an HSA transfer request form. This form is necessary when moving one's HSA funds from one financial institution to another. Whether you are changing jobs, dissatisfied with your current custodian, or seeking better investment options, filling out this form is an essential step in initiating the transfer process. It allows you to provide the required information and specify your transfer preferences to ensure a smooth and efficient transfer of your HSA funds.

For pdfFiller’s FAQs

What is hsa transfer request form?

The HSA transfer request form is a document used to transfer funds from one Health Savings Account (HSA) to another.

Who is required to file hsa transfer request form?

Individuals who want to transfer funds from one HSA to another are required to file the HSA transfer request form.

How to fill out hsa transfer request form?

To fill out the HSA transfer request form, you need to provide information about the current HSA account and the receiving HSA account.

What is the purpose of hsa transfer request form?

The purpose of the HSA transfer request form is to facilitate the transfer of funds between HSAs without incurring tax penalties.

What information must be reported on hsa transfer request form?

The HSA transfer request form must include details such as the account numbers of the current and receiving HSAs, the amount to be transferred, and the reason for the transfer.

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