U.S. Individual Income Tax Return

2010

Instructions for Form 8930

Department of the Treasury
Internal Revenue Service

Qualified Disaster Recovery Assistance Retirement Plan
Distributions and Repayments
Section references are to the Internal
Revenue Code unless otherwise noted.

General Instructions
Purpose of Form

Use Form 8930 if you were adversely
affected by the Midwestern severe
storms, tornadoes, or flooding, and you
received a distribution that qualified for
favorable tax treatment. See Table 1 on
page 4 for the Midwestern disaster areas.

Parts I and II

Use Parts I and II to:
• Report any repayments of qualified
disaster recovery assistance distributions,
and
• Figure the taxable amount, if any, of
your qualified disaster recovery
assistance distributions.
Note. Distributions from retirement plans
(other than IRAs) are reported in Part I
and distributions from IRAs are reported
in Part II.

Additional Information

See Pub. 4492-B, Information for Affected
Taxpayers in the Midwestern Disaster
Areas, for more details.

Who Must File

File Form 8930 if any of the following
apply.
• You received a qualified disaster
recovery assistance distribution from an
eligible retirement plan in 2009 that you
are including in income in equal amounts
over 3 years.
• You received a qualified disaster
recovery assistance distribution from an
eligible retirement plan in 2008 that you
are including in income in equal amounts
over 3 years.
• You made a repayment of a qualified
disaster recovery assistance distribution
in 2010.

When and Where To File

File Form 8930 with your 2010 Form
1040, 1040A, or 1040NR. If you are not
required to file an income tax return but
are required to file Form 8930, sign Form
8930 and send it to the Internal Revenue
Service at the same time and place you
would otherwise file Form 1040, 1040A,
or 1040NR.

How Is a Qualified Disaster
Recovery Assistance
Distribution Taxed?
Generally, a qualified disaster recovery
assistance distribution is included in your
income in equal amounts over 3 years.
However, you could have elected to
include the entire distribution in your

income in the year of the distribution. Any
repayments made before you file your
return and by the due date (including
extensions) reduce the amount of the
distribution included in your income.
Also, qualified disaster recovery
assistance distributions are not subject to
the additional 10% tax on early
distributions.

!

CAUTION

You cannot take a qualified
disaster recovery assistance
distribution after 2009.

Qualified Disaster
Recovery Assistance
Distribution

A qualified disaster recovery assistance
distribution is any distribution you
received on or after the applicable
disaster date (see Table 1 on page 4) in
2008 or 2009 from an eligible retirement
plan if both of the following conditions
were met.
1. Your main home was located in a
Midwestern disaster area on an
applicable disaster date (see Table 1 on
page 4).
2. You sustained an economic loss
because of the severe storms, tornadoes,
or flooding in the disaster area in which
your main home was located. Examples
of an economic loss include, but are not
limited to (a) loss, damage to, or
destruction of real or personal property
from fire, flooding, looting, vandalism,
theft, wind, or other cause; (b) loss
related to displacement from your home;
or (c) loss of livelihood due to temporary
or permanent layoffs.
If (1) and (2) applied, you could have
generally designated any distribution in
2008 or 2009 (including periodic
payments and required minimum
distributions) from an eligible retirement
plan as a qualified disaster recovery
assistance distribution, regardless of
whether the distribution was made on
account of the severe storms, tornadoes,
or flooding in the Midwestern disaster
areas. Qualified disaster recovery
assistance distributions were permitted
without regard to your need or the actual
amount of your economic loss.
A reduction or offset on or after the
applicable disaster date in 2008 or 2009
of your account balance in an eligible
retirement plan in order to repay a loan
also could have been designated as a
qualified disaster recovery assistance
distribution. See Distribution of plan loan
offsets later.
Limit. The total of your qualified disaster
recovery assistance distributions for 2008
and 2009 from all plans was limited to
$100,000. If you had distributions in
Cat. No. 52382T

excess of $100,000 from more than one
type of plan, such as a 401(k) plan and an
IRA, you could have allocated the
$100,000 limit among the plans any way
you chose.
Eligible retirement plan. An eligible
retirement plan can be any of the
following.
• A qualified pension, profit-sharing, or
stock bonus plan (including a 401(k)
plan).
• A qualified annuity plan.
• A tax-sheltered annuity contract.
• A governmental section 457 deferred
compensation plan.
• A traditional, SEP, SIMPLE, or Roth
IRA.
Distribution of plan loan offsets. A
distribution of a plan loan offset is a
distribution that occurs when, under the
terms of a plan, the participant’s accrued
benefit is reduced (offset) in order to
repay a loan. A distribution of a plan loan
offset amount can occur for a variety of
reasons, such as when a participant
terminates employment or does not
comply with the terms of repayment. Plan
loan offsets are treated as actual
distributions and are reported on Form
1099-R, box 1.
Main home. Generally, your main home
is the home where you live most of the
time. A temporary absence due to special
circumstances, such as illness, education,
business, military service, evacuation, or
vacation, will not change your main home.
Additional tax. Qualified disaster
recovery assistance distributions were not
subject to the additional 10% tax (or the
25% additional tax for certain distributions
from SIMPLE IRAs) on early distributions
and are not required to be reported on
Form 5329. However, any distributions
you received in excess of the $100,000
qualified disaster recovery assistance
distribution limit may have been subject to
the additional tax.
Note. If you chose to treat a distribution
as a qualified disaster recovery
assistance distribution, it is not eligible for
the 20% Capital Gain Election or the
10-Year Tax Option. For information on
those options, see the instructions for
Form 4972.

Repayment of a Qualified
Disaster Recovery
Assistance Distribution

If you choose, you can generally repay
any portion of a qualified disaster
recovery assistance distribution that is
eligible for tax-free rollover treatment to
an eligible retirement plan. Also, you can
repay a qualified disaster recovery
assistance distribution made on account
of hardship from a retirement plan.

However, see Exceptions, below, for
qualified disaster recovery assistance
distributions you cannot repay.
You have 3 years from the day after
the date you received the distribution to
make a repayment. The amount of your
repayment cannot be more than the
amount of the original distribution.
Amounts that are repaid are treated as a
qualified rollover and are not included in
income. Also, for purposes of the
one-rollover-per-year limitation for IRAs, a
repayment of a qualified disaster recovery
assistance distribution to an IRA is not
considered a qualified rollover.
Note. If a taxpayer who had previously
received a qualified disaster recovery
assistance distribution died in 2010, the
distribution may no longer be spread over
3 years. The remainder of the distribution
must be reported on the return of the
deceased taxpayer.
Include on Form 8930 any repayments
you make before filing your 2010 return.
Any repayments you make will reduce the
amount of qualified disaster recovery
assistance distributions reported on your
return for 2010. Do not include on your
2010 Form 8930 any repayments you
make later than the due date (including
extensions) for filing your 2010 return. If
you make a repayment in 2011 after you
file your 2010 return, the repayment will
reduce the amount of your qualified
disaster recovery assistance distributions
included in income on your 2011 return,
unless you are eligible to amend your
2008, 2009, or 2010 return. See
Amending Form 8930 below. Also, any
excess repayments you make for 2010
will be carried forward to your 2011 return
or, if you choose, carried back to your
2008 or 2009 return if applicable.
Also file Form 8606, Nondeductible
IRAs, to report any repayment of a
nondeductible contribution to a traditional
IRA on line 1 of Form 8606. If you make a
repayment of a previously deductible
contribution to a traditional IRA, do not file
Form 8606 solely because of such
repayment. If you make a repayment to a
Roth IRA, see Pub. 590 to figure your
basis.
Exceptions. You cannot repay the
following types of distributions.
1. Qualified disaster recovery
assistance distributions received as a
beneficiary (other than a surviving
spouse).
2. Required minimum distributions.
3. Periodic payments (other than from
an IRA) that are for:
a. A period of 10 years or more,
b. Your life or life expectancy, or
c. The joint lives or life expectancies
of you and your beneficiary.
Note. If you included repayments on
your 2008 or 2009 Form 8930, do not
include those repayments on your 2010
Form 8930.

Amending Form 8930

If, after filing your original return, you
make a repayment, the repayment may
reduce the amount of your qualified
disaster recovery assistance distributions
reported on that return. Depending on
when a repayment is made, you may

need to file an amended tax return to
refigure your taxable income.
If you make a repayment by the due
date of your original return (including
extensions), include the repayment on
your amended 2010 Form 8930.
If you make a repayment after the due
date of your original return (including
extensions), include the repayment on
your 2011 Form 8930. However, you can
file an amended Form 8930 for 2008,
2009, or 2010 if either of the following
applies.
• You elected to include all of your
qualified disaster recovery assistance
distributions in income (instead of over 3
years) on your original return.
• The amount of the repayment exceeds
the amount of your qualified disaster
recovery assistance distributions that are
included in income for 2011 and you
choose to carry the excess back to your
2008, 2009, or 2010 tax return. See the
example below.
Example. You received a qualified
disaster recovery assistance distribution
in the amount of $90,000 on June 15,
2009. You choose to spread the $90,000
over 3 years ($30,000 in income for 2009,
2010, and 2011). On November 19, 2010,
you make a repayment of $45,000. For
2010, none of the qualified disaster
recovery assistance distribution is
included in income. The excess
repayment of $15,000 ($45,000 $30,000) could have been carried back to
2009 or you could have chosen to carry it
forward to 2011.
File Form 1040X, Amended U.S.
Individual Income Tax Return, to amend a
return you have already filed. Generally,
Form 1040X must be filed within 3 years
after the date the original return was filed,
or within 2 years after the date the tax
was paid, whichever is later.

Specific Instructions
Name and social security number
(SSN). If you file a joint return, enter only
the name and SSN of the spouse whose
information is being reported on Form
8930. If both you and your spouse are
required to file Form 8930, file a separate
Form 8930 for each of you.

Part I—Qualified Disaster
Recovery Assistance
Distributions From
Retirement Plans (other
than IRAs)

Complete Part I if any of the following
apply.
• You had an amount on your 2008 Form
8930, line 9, and you did not check the
box on that line.
• You had an amount on your 2009 Form
8930, line 11, and you did not check the
box on that line.
• You made a repayment of a qualified
disaster recovery assistance distribution.

Line 7

At any time during the 3-year period after
the date you received a qualified disaster
recovery assistance distribution, you can
repay any portion of the distribution to an

-2-

eligible retirement plan that is permitted to
accept rollover contributions. You cannot,
however, repay more than the amount of
the original distribution. See Repayment
of a Qualified Disaster Recovery
Assistance Distribution beginning on page
1 for details.
Enter on line 7 the amount of any
repayments you made before filing your
2010 return. Do not include any
repayments made later than the due date
(including extensions) for that return. If
you repaid more than the amount on line
3 (including any excess repayments from
2009 on line 6), the excess will be carried
forward to your 2011 tax return.
Repayments made after the due date of
your 2010 return (including extensions)
generally will be reported on your 2011
tax return. However, you may have to file
an amended return in certain situations.
See Amending Form 8930 on this page.
Do not include on line 7
repayments of qualified disaster
recovery assistance distributions
made after 2009 that were included on
your 2009 Form 8930.
Example. You received a $90,000
qualified disaster recovery assistance
distribution on June 9, 2009, from your
401(k) plan because of the severe storms
in the Midwestern disaster areas. On April
1, 2011, you repay $30,000 to an IRA.
You file your return on April 10, 2011.
Since the repayment was made before
you filed your return, and not later than
the due date (including extensions), you
would enter the $30,000 repayment on
line 7.

!

CAUTION

Part II—Qualified Disaster
Recovery Assistance
Distributions From
Traditional, SEP, SIMPLE,
and Roth IRAs

Complete Part II if any of the following
apply.
• You had an amount on your 2008 Form
8930, line 17, and you did not check the
box on that line.
• You had an amount on your 2009 Form
8930, line 26, and you did not check the
box on that line.
• You made a repayment of a qualified
disaster recovery assistance distribution.

Line 16

At any time during the 3-year period after
the date you received a qualified disaster
recovery assistance distribution, you can
repay any portion of the distribution to an
eligible retirement plan that is permitted to
accept rollover contributions. You cannot,
however, repay more than the amount of
the original distribution. See Repayment
of a Qualified Disaster Recovery
Assistance Distribution beginning on page
1 for details.
Enter on line 16 the amount of any
repayments you made before filing your
2010 return. Do not include any
repayments made later than the due date
(including extensions) for that return. If
you repaid more than the amount on line
12 (including any excess repayments
from 2009 on line 15), the excess will be
carried forward to your 2011 tax return.
Repayments made after the due date of
Instructions for Form 8930 (2010)

your 2010 return (including extensions)
generally will be reported on your 2011
tax return. However, you may have to file
an amended return in certain situations.
See Amending Form 8930 on page 2.
Do not include on line 16
repayments of qualified disaster
CAUTION
recovery assistance distributions
made after 2009 that were included on
your 2009 Form 8930.
Example. You received a $90,000
qualified disaster recovery assistance
distribution on October 1, 2009, from your
Roth IRA because of the severe storms in
the Midwestern disaster areas. On April 1,
2011, you repay $30,000 to your Roth
IRA. You file your return on April 10,
2011. Since the repayment was made
before you filed your return, and not later
than the due date (including extensions),
you would enter the $30,000 repayment
on line 16.

!

Privacy Act and Paperwork Reduction
Act Notice. We ask for the information
on this form to carry out the Internal

Instructions for Form 8930 (2010)

Revenue laws of the United States. We
need this information to ensure that you
are complying with these laws and to
allow us to figure and collect the right
amount of tax. You are required to give us
this information if you made certain
contributions or received certain
distributions from qualified plans,
including IRAs, and other tax-favored
accounts. Our legal right to ask for the
information requested on this form is
sections 6001, 6011, 6012(a), and 6109
and their regulations. If you do not
provide this information, or you provide
incomplete or false information, you may
be subject to penalties.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records relating
to a form or its instructions must be
retained as long as their contents may
become material in the administration of
any Internal Revenue law. Generally, tax

-3-

returns and return information are
confidential, as required by section 6103.
However, we may give this information to
the Department of Justice for civil and
criminal litigation, and to cities, states, the
District of Columbia, and U.S.
commonwealths and possessions to carry
out their tax laws. We may also disclose
this information to other countries under a
tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to
federal law enforcement and intelligence
agencies to combat terrorism.
The average time and expenses
required to complete and file this form will
vary depending on individual
circumstances. For the estimated
averages, see the instructions for your
income tax return.
If you have suggestions for making this
form simpler, we would be happy to hear
from you. See the instructions for your
income tax return.

Table 1. Midwestern Disaster Areas
The counties listed below are in the Midwestern disaster areas and are eligible for the special tax relief discussed in these instructions.
Applicable
Disaster Dates*

State

Affected Counties — Midwestern Disaster Areas

05/02/2008
through
05/12/2008

Arkansas

Arkansas, Benton, Cleburne, Conway, Crittenden, Grant, Lonoke, Mississippi, Phillips, Pulaski, Saline,
and Van Buren.

06/01/2008
through
07/22/2008

Illinois

Adams, Calhoun, Clark, Coles, Crawford, Cumberland, Douglas, Edgar, Greene, Hancock,
Henderson, Jasper, Jersey, Lake, Lawrence, Madison, Mercer, Monroe, Pike, Randolph, Rock Island,
St. Clair, Scott, Whiteside, and Winnebago.

05/30/2008
through
06/27/2008

Indiana

Adams, Bartholomew, Benton, Boone, Brown, Clay, Daviess, Dearborn, Decatur, Fountain, Franklin,
Gibson, Grant, Greene, Hamilton, Hancock, Hendricks, Henry, Huntington, Jackson, Jay, Jefferson,
Jennings, Johnson, Knox, Lawrence, Madison, Marion, Montgomery, Monroe, Morgan, Ohio, Owen,
Parke, Pike, Posey, Putnam, Randolph, Ripley, Rush, Shelby, Sullivan, Switzerland, Tippecanoe,
Union, Vermillion, Vigo, Wabash, Washington, and Wayne.

05/25/2008
through
08/13/2008

Iowa

Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan,
Butler, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clayton, Clinton, Crawford,
Dallas, Davis, Decatur, Delaware, Des Moines, Dubuque, Fayette, Floyd, Franklin, Fremont, Greene,
Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Henry, Howard, Humboldt, Iowa, Jackson,
Jasper, Johnson, Jones, Keokuk, Kossuth, Lee, Linn, Louisa, Lucas, Lyon, Madison, Mahaska,
Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, Page, Palo Alto,
Pocahontas, Polk, Pottawattamie, Poweshiek, Ringgold, Scott, Story, Tama, Taylor, Union, Van
Buren, Wapello, Warren, Washington, Wayne, Webster, Winnebago, Winneshiek, Worth, and Wright.

05/22/2008
through
06/16/2008

Kansas

Barber, Barton, Bourbon, Brown, Butler, Chautauqua, Cherokee, Clark, Clay, Comanche, Cowley,
Crawford, Decatur, Dickinson, Edwards, Elk, Ellis, Ellsworth, Franklin, Gove, Graham, Harper, Haskell,
Hodgeman, Jackson, Jewell, Kingman, Kiowa, Lane, Linn, Logan, Mitchell, Montgomery, Ness,
Norton, Osborne, Pawnee, Phillips, Pratt, Reno, Republic, Riley, Rooks, Rush, Saline, Seward,
Sheridan, Smith, Stafford, Sumner, Thomas, Trego, Wallace, and Wilson.

06/06/2008
through
06/13/2008

Michigan

Allegan, Barry, Eaton, Ingham, Lake, Manistee, Mason, Missaukee, Osceola, Ottawa, Saginaw, and
Wexford.

06/06/2008
through
06/12/2008

Minnesota Cook, Fillmore, Freeborn, Houston, Mower, and Nobles.

05/10/2008
through
05/11/2008

Missouri

Barry, Jasper, and Newton.

06/01/2008
through
08/13/2008

Missouri

Adair, Andrew, Atchison, Audrain, Bates, Buchanan, Callaway, Cape Girardeau, Carroll, Cass,
Chariton, Christian, Clark, Daviess, Gentry, Greene, Grundy, Harrison, Holt, Howard, Jefferson,
Johnson, Knox, Lewis, Lincoln, Linn, Livingston, Macon, Marion, Mercer, Miller, Mississippi, Monroe,
Morgan, New Madrid, Nodaway, Pemiscot, Perry, Pettis, Pike, Platte, Polk, Putnam, Ralls, Randolph,
Ray, Saline, Schuyler, Scotland, Shelby, St. Charles, St. Genevieve, St. Louis, the Independent City of
St. Louis, Scott, Stone, Sullivan, Taney, Vernon, Webster, and Worth.

04/23/2008
through
04/26/2008

Nebraska Gage, Johnson, Morrill, Nemaha, and Pawnee.

05/22/2008
through
06/24/2008

Nebraska Adams, Blaine, Boone, Boyd, Brown, Buffalo, Burt, Butler, Cass, Chase, Cherry, Colfax, Cuming,
Custer, Dawson, Douglas, Dundy, Fillmore, Frontier, Furnas, Gage, Garfield, Gosper, Greeley, Hall,
Hamilton, Hayes, Holt, Howard, Jefferson, Johnson, Kearney, Keya Paha, Lancaster, Lincoln, Logan,
Loup, Merrick, McPherson, Morrill, Nance, Nemaha, Otoe, Phelps, Platte, Polk, Red Willow,
Richardson, Rock, Saline, Sarpy, Saunders, Seward, Sherman, Stanton, Thayer, Thomas, Thurston,
Valley, Webster, Wheeler, and York.

06/27/2008

Nebraska Dodge, Douglas, Sarpy, and Saunders.

06/05/2008
through
07/25/2008

Wisconsin Adams, Calumet, Crawford, Columbia, Dane, Dodge, Fond du Lac, Grant, Green, Green Lake, Iowa,
Jefferson, Juneau, Kenosha, La Crosse, Lafayette, Manitowoc, Marquette, Milwaukee, Monroe,
Ozaukee, Racine, Richland, Rock, Sauk, Sheboygan, Vernon, Walworth, Washington, Waukesha, and
Winnebago.

*For more details, go to www.fema.gov.

-4-

Instructions for Form 8930 (2010)