U.S. Individual Income Tax Return

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Instructions for Form 8915 (2009)

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2009

Department of the Treasury
Internal Revenue Service

Instructions for Form 8915
Qualified Hurricane Retirement Plan Distributions and Repayments
Section references are to the Internal
Revenue Code unless otherwise noted.

General Instructions
Purpose of Form
Use Form 8915 to report repayments of
qualified hurricane distributions made in
2009 that were not included on your 2008
Form 8915.

Parts I and II
Use Part I to report any repayments of
qualified hurricane distributions from
retirement plans (other than IRAs).
Use Part II to report any repayments of
qualified hurricane distributions from
IRAs.

Additional Information
See Pub. 4492, Information for Taxpayers
Affected by Hurricanes Katrina, Rita, and
Wilma, for more details.

Who Must File
File Form 8915 if you made a repayment
of a qualified hurricane distribution in
2009 that was not included on your 2008
Form 8915.
If you were affected by the Kansas

TIP storms and tornadoes that began
on May 4, 2007, see Pub. 4492-A
to determine what version of Form 8915
you must file.

When and Where to File
File Form 8915 with your 2009 Form
1040, 1040A, or 1040NR. If you are not
required to file an income tax return but
are required to file Form 8915, sign Form
8915 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
Hurricane Distribution
Taxed?
Generally, a qualified hurricane
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.
Also, qualified hurricane distributions
are not subject to the 10% additional tax
on early distributions.

!

CAUTION

You cannot repay a qualified
hurricane distribution after 2009.

Qualified Hurricane
Distribution
A qualified hurricane distribution is any
distribution you received in 2005 or 2006
from an eligible retirement plan if both of
the following conditions were met.
1. Your main home was located in a
hurricane disaster area listed below on
the date shown for that area.
a. August 28, 2005, for the Hurricane
Katrina disaster area. For this purpose,
that area includes the states of Alabama,
Florida, Louisiana, and Mississippi.
b. September 23, 2005, for the
Hurricane Rita disaster area. For this
purpose, that area includes the states of
Louisiana and Texas.
c. October 23, 2005, for the Hurricane
Wilma disaster area. For this purpose,
that area includes the state of Florida.
2. You sustained an economic loss
because of Hurricane Katrina, Rita, or
Wilma, on the date in (1) above for that
hurricane. 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
2005 or 2006 (including periodic
payments and required minimum
distributions) from an eligible retirement
plan as a qualified hurricane distribution,
regardless of whether the distribution was
made on account of Hurricane Katrina,
Rita, or Wilma. Qualified hurricane
distributions were permitted without
regard to your need or the actual amount
of your economic loss.
A reduction or offset in 2005 or 2006 of
your account balance in an eligible
retirement plan in order to repay a loan
also could have been designated as a
qualified hurricane distribution. See
Distribution of plan loan offsets later.
Limit. The total of your qualified
hurricane distributions for 2005 and 2006
from all plans was limited to $100,000. If
you had distributions in 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.
Cat. No. 48411X

• 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 hurricane
distributions were not subject to the 10%
additional 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
hurricane distribution limit may have been
subject to the additional tax.
Note. If you chose to treat a distribution
as a qualified hurricane 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
Hurricane Distribution
If you choose, you can generally repay
any portion of a qualified hurricane
distribution that is eligible for tax-free
rollover treatment to an eligible retirement
plan. Also, you can repay a qualified
hurricane distribution made on account of
hardship from a retirement plan.
However, see Exceptions on page 2 for
qualified hurricane 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

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Instructions for Form 8915 (2009)

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

qualified rollover and are not included in
income. Also, for purposes of the
one-rollover-per-year limitation for IRAs, a
repayment to an IRA is not considered a
qualified rollover.
Include on Form 8915 any repayments
you make during 2009 that were not
included on your 2008 Form 8915. If you
make a repayment in 2009, you may be
eligible to amend your 2006, 2007, or
2008 return. See Amending Form 8915
below.
Also file Form 8606 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 hurricane 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.

!

CAUTION

2009 is the last year you can
repay a qualified hurricane
distribution.

Amending Form 8915
If you make any repayments during 2009,
include the repayments on your 2009
Form 8915 if they were not included on
your 2008 Form 8915. You may be able
to file an amended return for 2006, 2007,
or 2008 if either of the following applies.
• You elected to include all of your
qualified hurricane distributions in income
for 2006 (instead of over 3 years) on your
original return.
• You received a qualified hurricane
distribution in 2006 and included it in
income over 3 years. See the examples
below.
Example 1. You received a qualified
hurricane distribution in the amount of
$90,000 on January 15, 2006. You
choose to spread the $90,000 over 3
years ($30,000 in income for 2006, 2007,
and 2008). On January 10, 2009, you
make a repayment of $45,000. The
repayment of $45,000 can be carried
back to 2006, 2007, or 2008.
Example 2. The same facts as in
Example 1, except you also want to make
a repayment of $10,000 on February 20,
2009. In this case, you cannot make a
repayment of $10,000 since the 3-year
period for making a repayment has
passed.
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
8915. If both you and your spouse are
required to file Form 8915, file a separate
Form 8915 for each of you.

Part I—Qualified Hurricane
Distributions From
Retirement Plans (other
than IRAs)
Complete Part I if you made a repayment
of a qualified hurricane distribution.

Line 4
At any time during the 3-year period after
the date you received a qualified
hurricane 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 Hurricane Distribution
beginning on page 1 for details.
Enter on line 4 the amount of any
repayments you made during 2009. Do
not include any repayments you included
on your 2008 Form 8915.
Example. You received a $90,000
qualified hurricane distribution on August
7, 2006, from your 401(k) plan because of
Hurricane Wilma. On July 1, 2009, you
repay $30,000 to an IRA. You would enter
the $30,000 repayment on line 4.

Line 5
If you have an amount on line 5, you may
be able to carry this amount back to your
2006, 2007, or 2008 return and reduce
the amount of tax. For more information,
see Amending Form 8915 on this page.

Part II—Qualified
Hurricane Distributions
From Traditional, SEP,
SIMPLE, and Roth IRAs
Complete Part II if you made a repayment
of a qualified hurricane distribution.

Line 9
At any time during the 3-year period after
the date you received a qualified
hurricane 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 Hurricane Distribution
beginning on page 1 for details.

-2-

Enter on line 9 the amount of any
repayments you made during 2009. Do
not include any repayments you included
on your 2008 Form 8915.
Example. You received a $60,000
qualified hurricane distribution on July 1,
2006, from your Roth IRA because of
Hurricane Katrina. On June 1, 2009, you
repay $30,000 to your Roth IRA. You
would enter the $30,000 repayment on
line 9.

Line 10
If you have an amount on line 10, you
may be able to carry this amount back to
your 2006, 2007, or 2008 return and
reduce the amount of tax. For more
information, see Amending Form 8915 on
this page.
Privacy Act and Paperwork Reduction
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need this information to ensure that you
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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
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The average time and expenses
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Instructions for Form 8915 (2009)