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Health Savings Account Distribution Request/Account Closure Form Uses this form to request a distribution from your HSA. If you have any questions about Has or completing this form, please contact

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How to fill out hsa-distribution-request-account-closure-form

01

Obtain the HSA distribution request account closure form from your HSA provider.

02

Fill out your personal information accurately, including your name, address, and account number.

03

Indicate the reason for the closure of your HSA account.

04

Specify how you would like to receive the remaining balance in your account (e.g. check, direct deposit).

05

Sign and date the form to authorize the closure of your HSA account.

Who needs hsa-distribution-request-account-closure-form?

01

Individuals who have a Health Savings Account (HSA) and wish to close their account.

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What is hsa-distribution-request-account-closure-form?

The hsa-distribution-request-account-closure-form is a form used to request the closure of an HSA account and distribute the funds.

Who is required to file hsa-distribution-request-account-closure-form?

Account holders who wish to close their HSA account and withdraw the funds are required to file the hsa-distribution-request-account-closure-form.

How to fill out hsa-distribution-request-account-closure-form?

The hsa-distribution-request-account-closure-form should be completed with accurate account information and signed by the account holder before submitting it to the financial institution.

What is the purpose of hsa-distribution-request-account-closure-form?

The purpose of the hsa-distribution-request-account-closure-form is to formally request the closure of an HSA account and initiate the process of distributing the funds to the account holder.

What information must be reported on hsa-distribution-request-account-closure-form?

The hsa-distribution-request-account-closure-form must include the account holder's personal information, account details, distribution amount, and instructions for fund disbursement.

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