Get the free HSA Authorized User Form
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Please complete this form to request Authorized User changes to your HSA account. Fax completed form to:
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How to fill out hsa authorized user form
How to fill out hsa authorized user form
01
Obtain the HSA authorized user form from your financial institution or employer.
02
Fill out your personal information including your name, address, and contact details.
03
Provide the information of the authorized user including their name, relationship to you, and contact information.
04
Sign and date the form to confirm your consent for the authorized user to access your HSA account.
Who needs hsa authorized user form?
01
Anyone who wants to designate someone else to have access to their HSA account may need to fill out the HSA authorized user form.
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What is hsa authorized user form?
The HSA authorized user form is a document that designates an individual who is authorized to use funds in a Health Savings Account.
Who is required to file hsa authorized user form?
The primary account holder of the Health Savings Account is required to file the HSA authorized user form.
How to fill out hsa authorized user form?
To fill out the HSA authorized user form, the primary account holder must provide their personal information and the information of the authorized user.
What is the purpose of hsa authorized user form?
The purpose of the HSA authorized user form is to authorize an individual to use funds in the Health Savings Account.
What information must be reported on hsa authorized user form?
The HSA authorized user form must include the name, address, and Social Security number of the authorized user.
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