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Page 3 of 8 3500 (Rev. 5/2012) (2/2015) 2015 As census, Inc. The account owner named on the application is establishing this health savings account (HSA) exclusively ...
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Read the 3500 HSA custodial application thoroughly to understand the requirements and instructions.
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Gather all the necessary information and documents needed to fill out the application.
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Start by entering your personal information such as your name, address, and contact details.
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Provide information about your employment status and employer.
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Fill out the sections related to your health insurance coverage and contributions.
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Submit the completed 3500 HSA custodial application to the designated authority.

Who needs 3500 hsa custodial application?

01
Individuals who want to open a Health Savings Account (HSA) and need a custodial application should use the 3500 HSA custodial application form.
02
Employers who offer HSA plans as part of their employee benefits package may also need the 3500 HSA custodial application for their employees.
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Any individual or organization that acts as a custodian for HSA funds and accounts may require the 3500 HSA custodial application for new account openings.
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3500 HSA custodial application is a form used by custodians of Health Savings Accounts (HSAs) to report information about the account and the transactions carried out within it.
Custodians of Health Savings Accounts (HSAs) are required to file the 3500 HSA custodial application.
The 3500 HSA custodial application can be filled out electronically or on paper, following the instructions provided by the IRS and ensuring that all required information is accurately reported.
The purpose of the 3500 HSA custodial application is to provide the IRS with information about the HSA account and transactions to ensure compliance with tax laws.
Information such as account holder details, contributions, distributions, and any other relevant account activity must be reported on the 3500 HSA custodial application.
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