HSA, Archer MSA, or Medicare Advantage MSA Information

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1518 can be found here:

Documents and Forms

Document Name Document Type
Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information Form
08 Draft 1099 General Instructions.pdf Instruction
5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information 08 Draft Form 5498-SA.pdf Form
brdn_spec.pdf Burden Computation IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HSA, Archer MSA, or Medicare Advantage MSA Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5498-SA	HSA, Archer MSA, or Medicare Advantage MSA Information	08 Draft Form 5498-SA.pdf		Yes	Yes	Fillable Fileable
Instruction			08 Draft 1099 General Instructions.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,442	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	41,105	41,105
Annual IC Time Burden (Hours)	6,988	6,988
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Computation	brdn_spec.pdf	08/19/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.