Get the free HSA Distribution Request Form

This form is used to request a distribution from the Health Savings Account (HSA). It includes sections for HSA owner information, distribution details, payment instructions, and acknowledgment. It

How to fill out hsa distribution request form

How to fill out HSA Distribution Request Form

1. Obtain the HSA Distribution Request Form from your HSA provider or their website.
2. Fill in your personal information, including your name, address, and account number.
3. Specify the type of distribution you are requesting.
4. Indicate the amount to be withdrawn.
5. Provide details of the expenses for which the distribution is being requested, including receipts if applicable.
6. Sign and date the form to authorize the distribution.
7. Submit the completed form to your HSA provider as instructed.

Who needs HSA Distribution Request Form?

1. Individuals who wish to withdraw funds from their Health Savings Account (HSA).
2. Account holders seeking reimbursement for qualified medical expenses.
3. Employees whose employers sponsor HSAs and wish to access their funds.

People Also Ask about

What is considered a distribution from an HSA?

The taxpayer can receive tax-free distributions from an HSA to pay or be reimbursed for qualified medical expenses incurred after the taxpayer establishes the HSA. Qualified medical expenses include the medical expenses of the taxpayer, their spouse, or a dependent at the time the expense was incurred.

Where can I find HSA distribution form?

The 1099-SA form will be available mid-to-late January in your online account if you had distributions in the prior year. If you chose to get paper documents, you'll get your 1099-SA in the mail in late January/early February.

What is a distribution form an HSA?

When the taxpayer pays these medical expenses that are not reimbursed, the taxpayer can request a distribution from the HSA trustee. The taxpayer can receive tax-free distributions from an HSA to pay or be reimbursed for qualified medical expenses incurred after the taxpayer establishes the HSA.

Is a 1099-SA distribution from HSA?

Form 1099-SA reports distributions from health savings accounts and medical savings accounts. Withdrawals from these accounts are tax-free if used for qualified expenses. Nonqualified expenses are subject to income tax plus additional tax.

How do I document an HSA withdrawal?

You must report distributions from your HSA on IRS Form 8889. You will receive a separate 1099-SA for each type of distribution made during the tax year. The five distribution types are 1) normal; 2) excess contribution removal; 3) death; 4) disability; and 5) prohibited transaction.

For pdfFiller’s FAQs

What is HSA Distribution Request Form?

The HSA Distribution Request Form is a document used by account holders to request a distribution from their Health Savings Account (HSA).

Who is required to file HSA Distribution Request Form?

Account holders of Health Savings Accounts (HSAs) who wish to withdraw funds from their accounts are required to file the HSA Distribution Request Form.

How to fill out HSA Distribution Request Form?

To fill out the HSA Distribution Request Form, provide the account holder's information, specify the amount to be withdrawn, state the purpose of the distribution, and sign the form.

What is the purpose of HSA Distribution Request Form?

The purpose of the HSA Distribution Request Form is to formally document the request for distribution of funds from an HSA, ensuring compliance with IRS regulations.

What information must be reported on HSA Distribution Request Form?

The information that must be reported includes the account holder's personal details, the amount of the distribution, the reason for the request, and a signature authorizing the transaction.