U.S. Individual Income Tax Return

2011

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
What’s New

The IRS has created a page on IRS.gov
for information about Form 8930 and its
instructions, at www.irs.gov/form8930.
Information about any future
developments affecting Form 8930 (such
as legislation enacted after we release it)
will be posted on that page.

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,
later, 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 made a repayment of a qualified
disaster recovery assistance distribution
in 2011.

When and Where To File

File Form 8930 with your 2011 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.
Nov 04, 2011

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.
You cannot take a qualified
disaster recovery assistance
CAUTION 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, later) 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,
later).
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
Cat. No. 52382T

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
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.
Include on Form 8930 any repayments
you make before filing your 2011 return.
Any repayments you make will reduce the
amount of qualified disaster recovery
assistance distributions reported on your
return for 2011. Do not include on your
2011 Form 8930 any repayments you
make later than the due date (including
extensions) for filing your 2011 return. If
you make a repayment in 2012 after you
file your 2011 return, you may be eligible
to amend your 2009, 2010, or 2011
return. See Amending Form 8930 below.
Also, any excess repayments you make
for 2011 can be carried back to your
2008, 2009, or 2010 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 2009 or 2010 Form 8930, do not
include those repayments on your 2011
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 2011 Form 8930.
If you make a repayment after the due
date of your original return (including
extensions), include the repayment on
your 2012 Form 8930. However, you can
file an amended Form 8930 for 2009,
2010, or 2011 if either of the following
applies.
• You elected to include all of your
qualified disaster recovery assistance
distributions in income for 2009 (instead
of over 3 years) on your original return.
• You received a qualified disaster
recovery assistance distribution in 2009
and included it in income over 3 years.
You can amend your 2009, 2010, or 2011
return, if applicable, to carry the
repayment back. See the example below.
Example. You received a qualified
disaster recovery assistance distribution
in the amount of $90,000 on June 15,
2009. You chose to spread the $90,000
over 3 years ($30,000 in income for 2009,
2010, and 2011). On November 19, 2011,
you make a repayment of $45,000. For
2011, 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 2010.
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 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 5

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

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the original distribution. See Repayment
of a Qualified Disaster Recovery
Assistance Distribution, earlier, for details.
Enter on line 5 the amount of any
repayments you made before filing your
2011 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
1 (including any excess repayments from
2010 on line 4), the excess can be carried
back. Repayments made after the due
date of your 2011 return (including
extensions) generally will be reported on
your 2012 tax return. However, you may
have to file an amended return in certain
situations. See Amending Form 8930,
earlier.
Do not include on line 5
repayments of qualified disaster
CAUTION recovery assistance distributions
made after 2010 that were included on
your 2010 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, 2012, you repay $30,000 to an IRA.
You file your return on April 10, 2012.
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 5.

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 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 12

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, earlier, for details.
Enter on line 12 the amount of any
repayments you made before filing your
2011 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
8 (including any excess repayments from
2010 on line 11), the excess can be
carried back. Repayments made after the
due date of your 2011 return (including
extensions) generally will be reported on
your 2012 tax return. However, you may
have to file an amended return in certain
situations. See Amending Form 8930,
earlier.
Instructions for Form 8930 (2011)

Do not include on line 12
repayments of qualified disaster
CAUTION recovery assistance distributions
made after 2010 that were included on
your 2010 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,
2012, you repay $30,000 to your Roth
IRA. You file your return on April 10,
2012. 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 12.

!

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need this information to ensure that you
are complying with these laws and to
allow us to figure and collect the right

Instructions for Form 8930 (2011)

amount of tax. You are required to give us
this information if you made certain
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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.

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Instructions for Form 8930 (2011)