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This form is used to request the distribution of funds from a Health Savings Account (HSA) upon the death of the accountholder, requiring submission of a death certificate and specific beneficiary
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How to fill out health savings account death
How to fill out Health Savings Account Death Distribution Form
01
Obtain the Health Savings Account Death Distribution Form from the financial institution managing the HSA.
02
Fill out the decedent's personal information, including name, address, and Social Security number.
03
Provide the date of death of the account holder.
04
Identify the beneficiary or beneficiaries of the HSA funds, including their names and Social Security numbers.
05
Indicate the relationship of the beneficiaries to the decedent.
06
Complete any additional required sections, such as payment instructions or transfer options.
07
Sign and date the form to verify the information provided is accurate.
08
Submit the completed form to the HSA custodian or trustee, along with any required documentation.
Who needs Health Savings Account Death Distribution Form?
01
Beneficiaries of a deceased individual who had a Health Savings Account and need to claim or distribute the funds.
02
Executors or administrators of the estate managing the decedent's financial affairs.
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What is Health Savings Account Death Distribution Form?
The Health Savings Account Death Distribution Form is a specific form used to report the distribution of funds from a Health Savings Account (HSA) following the account holder's death.
Who is required to file Health Savings Account Death Distribution Form?
The executor or administrator of the deceased account holder's estate is typically required to file the Health Savings Account Death Distribution Form.
How to fill out Health Savings Account Death Distribution Form?
To fill out the form, the filer must provide information such as the deceased account holder's details, the beneficiary's information, and the amount distributed from the HSA, along with other relevant financial details.
What is the purpose of Health Savings Account Death Distribution Form?
The purpose of the form is to ensure the correct reporting of HSA distributions for tax purposes after the account holder's death and to facilitate the proper transfer of assets to the beneficiaries.
What information must be reported on Health Savings Account Death Distribution Form?
The form must report the name and Social Security number of the deceased account holder, the name and Social Security number of the beneficiary, the date of death, and the total value of the HSA accounts at the time of death, among other details.
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