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This designation revokes and supercedes all earlier beneficiary designations which may apply to this HSA. If this HSA is being established with a rollover or transfer contribution I certify that the rollover or transfer assets are from another HSA or Archer Medical Savings Account MSA. Primary Beneficiary ies Name Address SSN Relationship DOB Percentage // Information for spouse I am the spouse of the HSA owner. First MI Last SSN-- Additional debit card YES NO Signature of additional signer...
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What is hsa new account form?
The hsa new account form is a document used to open a Health Savings Account (HSA).
Who is required to file hsa new account form?
Individuals who want to open a Health Savings Account (HSA) are required to file the hsa new account form.
How to fill out hsa new account form?
To fill out the hsa new account form, individuals need to provide their personal information, employment details, and designate a beneficiary.
What is the purpose of hsa new account form?
The purpose of the hsa new account form is to establish a Health Savings Account (HSA) for individuals to save money for medical expenses.
What information must be reported on hsa new account form?
The hsa new account form typically requires personal information, employment details, and beneficiary information.
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