Get the free 3500 HSA Custodial Application, Plan Agreement and Disclosure Statement(10/2018)

Clear Formosa Simplifier10/2018Health Savings Account Application PART 1. HSA COUNTERPART 2. HSA CUSTODIANName (First/MI/Last) Mainstay Trust Name Address Line 1 214 W 9th St Address Line 1 Address

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 through the form and familiarize yourself with the instructions and requirements.
3. Fill in your personal details accurately, including your name, contact information, and Social Security number.
4. Provide information about your employer or self-employment status, including the name and address of your employer or business.
5. Fill out the sections related to your health plan, such as the type of plan, coverage period, and annual deductible.
6. Indicate whether you are eligible for Medicare or covered by any other health plan.
7. If applicable, provide details about your spouse's coverage and any dependent coverage.
8. Sign and date the application form.
9. Review your completed form to ensure all sections are filled out accurately and completely.
10. Submit the application by mail or through the designated online submission method as instructed.

Who needs 3500 hsa custodial application?

1. Any individual who wants to establish a Health Savings Account (HSA) and is eligible for one can use the 3500 HSA Custodial Application form. Eligible individuals typically include those who have a high-deductible health plan and meet other IRS guidelines for HSA eligibility. Employers may also use this form to establish HSAs for their employees.

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What is 3500 hsa custodial application?

3500 hsa custodial application is a form used to establish a custodial account for a Health Savings Account (HSA).

Who is required to file 3500 hsa custodial application?

Individuals who want to open a custodial account for their HSA are required to file the 3500 hsa custodial application.

How to fill out 3500 hsa custodial application?

To fill out the 3500 hsa custodial application, you will need to provide personal information, select a custodian, and designate beneficiaries.

What is the purpose of 3500 hsa custodial application?

The purpose of the 3500 hsa custodial application is to establish a custodial account for an HSA, which allows individuals to save money for medical expenses.

What information must be reported on 3500 hsa custodial application?

The 3500 hsa custodial application requires personal information, custodian selection, beneficiary designation, and agreement to the custodial terms.