Get the free HSA ROLLOVER CERTIFICATION

This form is used to certify the eligibility and requirements for rolling over funds from an HSA, Archer MSA, Health FSA, or HRA to an HSA. It outlines the necessary conditions and questions that

How to fill out hsa rollover certification

How to fill out HSA ROLLOVER CERTIFICATION

1. Obtain the HSA Rollover Certification form from your HSA provider or download it from their website.
2. Fill in your personal information, including your name, address, and HSA account number.
3. Indicate the amount you wish to roll over from your previous HSA.
4. Provide details of your previous HSA provider, including the account number and the institution's name.
5. Sign and date the form to confirm your request for the rollover.
6. Submit the completed form to your HSA provider, either by mail or electronically, as per their instructions.

Who needs HSA ROLLOVER CERTIFICATION?

1. Individuals who wish to transfer funds from one Health Savings Account (HSA) to another HSA.
2. Those who have recently changed HSA providers and want to consolidate their savings.
3. Beneficiaries of deceased individuals who need to move HSA funds to their own account.

People Also Ask about

What happens if I don't use my HSA by the end of the year?

HSA money is yours to keep. Unlike a flexible spending account (FSA), unused money in your HSA isn't forfeited at the end of the year; it continues to grow, tax-deferred.

What is the 12 month rule for HSA?

HSA: Eligibility You must participate in a High Deductible Health Plan, have no other insurance coverage other than those specifically allowed, and not be claimed as a dependent on someone else's tax return in order to be eligible for an HSA.

Is it worth rolling over HSA?

The advantages of rolling over your HSA from a previous employer: Simplicity: By consolidating your HSAs into one account, you don't have to keep track of balances in multiple accounts, and you won't have multiple sets of tax documents after the rollover year.

What is the 13 month rule for HSA contributions?

The annual HSA contribution limit for new HSAs is prorated for every month you weren't covered by an HDHP. But under the 13-month rule, you can still contribute the full amount to your HSA, even if you didn't have an HSA-eligible HDHP for the entire year.

Are HSA limits based on calendar year or plan year?

HSA contribution limits are based upon a calendar year starting January 1.

What are the rules for HSA rollover?

HSA rollover Your provider can send you a check or deposit the funds in your bank account. Then, you'll deposit the money into your new account. Any rollover funds aren't counted toward your contribution limit. The Internal Revenue Service (IRS) requires that you reinvest the funds into your new account within 60 days.

How do you calculate the last month rule?

Here's the “Last Month” rule for HSA accounts, quoted directly from IRS Publication 969: “Under the last-month rule, you are considered to be an eligible individual for the entire year if you are an eligible individual on the first day of the last month of your tax year (December 1 for most taxpayers).

For pdfFiller’s FAQs

What is HSA ROLLOVER CERTIFICATION?

HSA ROLLOVER CERTIFICATION is a document that certifies the transfer of funds from one Health Savings Account (HSA) to another without incurring taxes or penalties, ensuring compliance with IRS regulations.

Who is required to file HSA ROLLOVER CERTIFICATION?

Individuals who are transferring funds from one HSA to another and wish to report this rollover to the IRS are required to file the HSA ROLLOVER CERTIFICATION.

How to fill out HSA ROLLOVER CERTIFICATION?

To fill out HSA ROLLOVER CERTIFICATION, individuals need to provide information such as their personal details, the amount being rolled over, the details of the original HSA, and the receiving HSA.

What is the purpose of HSA ROLLOVER CERTIFICATION?

The purpose of HSA ROLLOVER CERTIFICATION is to ensure that the rollover transaction is properly documented to avoid any tax implications and to confirm that the funds are moving between qualified accounts.

What information must be reported on HSA ROLLOVER CERTIFICATION?

The information that must be reported includes the routing and account numbers of both the sending and receiving HSAs, the amount of the rollover, the date of the transaction, and the account holder's information.