Get the free 3500 HSA Custodial Application, Plan Agreement and Disclosure Statement(4/2015)

HEALTH SAVINGS ACCOUNT MEMBERSHIP APPLICATION AND ELIGIBILITY FORM All fields must be completed. For assistance, call 8003588228. Return this application with a check to: Patel co CU, Department #25,

How to fill out 3500 hsa custodial application

How to fill out 3500 hsa custodial application

1. Start by downloading the 3500 HSA custodial application form from the official website.
2. Read the instructions carefully before filling out the form.
3. Provide your personal information, such as your name, address, and Social Security number, in the designated fields.
4. Indicate whether you are applying for an individual HSA or a family HSA by selecting the appropriate option.
5. Fill out the section for your employer information if applicable.
6. Specify the type of HSA custodian you are choosing, whether it's a bank, insurance company, or another type of custodian.
7. Enter the details of your HSA funding, including how much you plan to contribute and the source of the funds.
8. Sign and date the application form.
9. Review your completed application for any errors or missing information before submitting it.
10. Submit the application by mail or electronically as instructed in the application guidelines.

Who needs 3500 hsa custodial application?

1. Anyone who wishes to open a Health Savings Account (HSA) and designate a custodian for their funds needs to fill out the 3500 HSA custodial application. This application is required if you want to establish an HSA and have a custodian hold and manage your HSA funds.

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What is 3500 hsa custodial application?

3500 HSA custodial application is a form used to establish a Health Savings Account (HSA) and is required by the Internal Revenue Service (IRS).

Who is required to file 3500 hsa custodial application?

Individuals who want to open a Health Savings Account (HSA) are required to file Form 3500 HSA custodial application.

How to fill out 3500 hsa custodial application?

Form 3500 HSA custodial application can be completed by providing personal information, HSA details, and signature as required by the instructions provided by the IRS.

What is the purpose of 3500 hsa custodial application?

The purpose of 3500 HSA custodial application is to establish a Health Savings Account (HSA) which allows individuals to save and pay for qualified medical expenses on a tax-free basis.

What information must be reported on 3500 hsa custodial application?

Information such as personal details, HSA account information, and beneficiary designation must be reported on Form 3500 HSA custodial application.