Get the free A-1228-0614 - Individual HSA Application

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Medical Plan H requires an HSA account 2000 N. Classes Blvd., 7E Oklahoma City, OK 731066013 Toll Free: (866) 3263600 Local: (405) 5235699 Fax: (844) 5606754 Website: www.afhsa.com Email: AFSSA receipts

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How to fill out a-1228-0614 - individual hsa

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Step 1: Gather all necessary information such as personal details, employment information, and insurance details.

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Step 2: Read the instructions on the A-1228-0614 form carefully to understand the requirements for filling it out.

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Step 3: Start filling out the form by providing your full name, address, and contact information.

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Step 4: Enter your Social Security Number or Tax ID number as required.

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Step 5: Provide details about your employer, including their name, address, and contact information.

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Step 6: Fill in the necessary information about your high deductible health plan (HDHP) and the coverage dates.

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Step 7: Calculate and enter the total contribution you make to your HSA for the tax year.

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Step 8: Sign and date the form after carefully reviewing all the information provided.

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Step 9: Submit the completed A-1228-0614 form to the appropriate authority as instructed on the form or by your employer.

Who needs a-1228-0614 - individual hsa?

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Individuals who have a high deductible health plan (HDHP) and want to contribute to a Health Savings Account (HSA) need A-1228-0614 - individual HSA form.

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Employees who have opted for a HDHP through their employer's health insurance plan and wish to contribute to an HSA should fill out A-1228-0614 form.

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Self-employed individuals who have a HDHP and want to take advantage of the tax-advantaged benefits of an HSA should fill out A-1228-0614 form.

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