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WITHDRAWAL AUTHORIZATION Refer to page 2 for reporting information. PART 1. HSA COUNTERPART 2. HSA CUSTODIAN To be completed by the HSA custodian Patel co Credit Uniondale (First/MI/Last)Asocial Security

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How to fill out 3500 hsa custodial application

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Download the 3500 HSA custodial application form from the designated website

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Fill out personal information such as name, address, and social security number

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04

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Who needs 3500 hsa custodial application?

01

Individuals who wish to open a Health Savings Account (HSA) and designate a custodian for managing their funds

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What is 3500 hsa custodial application?

It is a form used to apply for a custodial Health Savings Account (HSA) with a bank or financial institution.

Who is required to file 3500 hsa custodial application?

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

How to fill out 3500 hsa custodial application?

The form can be filled out online or in person by providing personal information, beneficiary details, and funding source for the HSA account.

What is the purpose of 3500 hsa custodial application?

The purpose is to establish a custodial HSA account for individuals who want to save for qualified medical expenses.

What information must be reported on 3500 hsa custodial application?

Personal information, beneficiary details, funding sources for the account, and any additional required documentation.

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