Get the free Distribution Reversal Form

This form is used to request the reversal of a distribution from a Health Savings Account (HSA). It allows account holders to return funds to their HSA due to overpayment or incorrect withdrawal. Completed forms must be submitted to Avidia Health by mail.

How to fill out distribution reversal form

How to fill out distribution reversal form

1. Obtain the distribution reversal form from the official website or your financial institution.
2. Fill in your personal details including name, address, and account number.
3. Specify the reason for the distribution reversal clearly.
4. Indicate the amount to be reversed.
5. Provide any necessary supporting documentation if required.
6. Review the form to ensure all information is accurate.
7. Sign and date the form.
8. Submit the completed form to the appropriate department of your financial institution.

Who needs distribution reversal form?

1. Individuals who have received a distribution from their retirement accounts or similar funds and wish to reverse that transaction.
2. Financial advisors or representatives managing client accounts who need to process reversal requests.
3. Account holders who have mistakenly received funds or need to rectify a distribution error.

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What is distribution reversal form?

A distribution reversal form is a document used to reverse a previously executed distribution or withdrawal from a retirement account, allowing the account holder to reclassify the transaction.

Who is required to file distribution reversal form?

Individuals who have made a distribution from their retirement accounts and wish to reverse that transaction are required to file a distribution reversal form.

How to fill out distribution reversal form?

To fill out a distribution reversal form, one must provide their personal information, details of the original distribution, the reason for reversal, and sign the form to certify the request.

What is the purpose of distribution reversal form?

The purpose of the distribution reversal form is to correct a mistake or unintentional early withdrawal from a retirement account, thereby restoring the account to its pre-distribution state.

What information must be reported on distribution reversal form?

The distribution reversal form must report the account holder's details, the date of the original distribution, the amount distributed, and the reason for the reversal.