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HSA Rollover Request Form
Instructions: Return completed form with a check to: NVIDIA Bank PO Box 370, Hudson MA 01749. Complete and return to NVIDIA Bank,
PO Box 370, Hudson, MA 01749. For assistance
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How to fill out hsa rollover request form
How to fill out hsa rollover request form
01
To fill out the HSA rollover request form, follow these steps:
02
Start by downloading the HSA rollover request form from the official website of your HSA provider.
03
Fill in your personal details, including your name, address, and contact information, in the designated fields.
04
Provide your HSA account information, such as your account number and the name of your HSA custodian.
05
Specify the amount you wish to rollover from your current HSA to another HSA or retirement account.
06
Indicate whether you want a direct rollover or an indirect rollover. A direct rollover involves transferring funds directly from one HSA to another without receiving the funds yourself, while an indirect rollover requires you to receive the funds yourself and deposit them into the new HSA or retirement account within 60 days.
07
Sign and date the form.
08
Submit the completed form to your HSA provider either by mail, fax, or online submission as per their instructions.
Who needs hsa rollover request form?
01
Anyone who wishes to transfer funds from their current HSA to another HSA or retirement account needs the HSA rollover request form.
02
This form is typically required by HSA providers or custodians to process the rollover request and ensure the accurate transfer of funds.
03
It is important to consult with your current HSA provider and the receiving HSA or retirement account institution to determine their specific requirements for initiating the rollover.
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