5498 IRA Contribution Information

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website,
is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
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See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

VOID

2828

CORRECTED

TRUSTEE’S or ISSUER'S name, street address, city or town, province or
state, country, and ZIP or foreign postal code

1 IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, and 14a)

$

OMB No. 1545-0747

2013

2 Rollover contributions
Form 5498

$
3 Roth IRA conversion
amount
TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

PARTICIPANT’S name

4 Recharacterized
contributions

Copy A

$

$

5 Fair market value of account

6 Life insurance cost included in
box 1

For
Internal Revenue
Service Center

$

$

File with Form 1096.

7 IRA
SEP
8 SEP contributions

$
10 Roth IRA contributions

Street address (including apt. no.)

IRA
Contribution
Information

SIMPLE
Roth IRA
9 SIMPLE contributions

$
11 Check if RMD for 2014

$
12a RMD date

12b RMD amount

13a Postponed contribution

13b Year

$

City or town, province or state, country, and ZIP or foreign postal code

$
14a Repayments

14b Code

13c Code

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2013 General
Instructions for
Certain
Information
Returns.

$
Account number (see instructions)

Form 5498

Cat. No. 50010C

www.irs.gov/form5498

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
TRUSTEE’S or ISSUER'S name, street address, city or town, province or
state, country, and ZIP or foreign postal code

1 IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, and 14a)

$

OMB No. 1545-0747

2013

2 Rollover contributions
Form 5498

$
3 Roth IRA conversion
amount
TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

$

$
6 Life insurance cost included in
box 1

$
$
Street address (including apt. no.)

4 Recharacterized
contributions

5 Fair market value of account

7 IRA
SEP
8 SEP contributions

PARTICIPANT’S name

10 Roth IRA contributions

$

IRA
Contribution
Information
Copy B
For
Participant

$
SIMPLE
Roth IRA
9 SIMPLE contributions

$
11 If checked, required minimum
distribution for 2014

12a RMD date

12b RMD amount

13a Postponed contribution

13b Year

This information
is being
furnished to
the Internal
Revenue
Service.

$

City or town, province or state, country, and ZIP or foreign postal code

13c Code

$
14a Repayments

14b Code

$
Account number (see instructions)

Form 5498

(keep for your records)

www.irs.gov/form5498

Department of the Treasury - Internal Revenue Service

Instructions for Participant
The information on Form 5498 is submitted to the Internal Revenue Service by
the trustee or issuer of your individual retirement arrangement (IRA) to report
contributions, including any catch-up contributions, required minimum
distributions (RMDs), and the fair market value (FMV) of the account. For
information about IRAs, see Pubs. 590 and 560.
Account number. May show an account or other unique number the trustee
assigned to distinguish your account.
Box 1. Shows traditional IRA contributions for 2013 you made in 2013 and
through April 15, 2014. These contributions may be deductible on your Form
1040 or 1040A. However, if you or your spouse was an active participant in an
employer’s pension plan, these contributions may not be deductible. This box
does not include amounts in boxes 2–4, 8–10, 13a, and 14a.
Box 2. Shows any rollover, including a direct rollover to a traditional IRA or Roth
IRA, or a qualified rollover contribution (including a military death gratuity, SGLI
payment, or qualified settlement income) to a Roth IRA you made in 2013. It
does not show any amounts you converted from your traditional IRA, SEP IRA,
or SIMPLE IRA to a Roth IRA. They are shown in box 3. See the Form 1040 or
1040A instructions for information on how to report rollovers. If you have ever
made any nondeductible contributions to your traditional IRA or SEP IRA and
you did not roll over the total distribution, use Form 8606 to figure the taxable
amount. If property was rolled over, see Pub. 590. For a qualified rollover to a
Roth IRA, also see Pub. 590. For information on airline payments, see
www.irs.gov/form5498.
Box 3. Shows the amount converted from a traditional IRA, SEP IRA, or SIMPLE
IRA to a Roth IRA in 2013. Use Form 8606 to figure the taxable amount.
Box 4. Shows amounts recharacterized from transferring any part of the
contribution (plus earnings) from one type of IRA to another. See Pub. 590.
Box 5. Shows the FMV of all investments in your account at year end. However,
if a decedent’s name is shown, the amount reported may be the FMV on the
date of death. If the FMV shown is zero for a decedent, the executor or
administrator of the estate may request a date-of-death value from the financial
institution.
Box 6. Shows for endowment contracts only the amount allocable to the cost of
life insurance. Subtract this amount from your allowable IRA contribution
included in box 1 to compute your IRA deduction.
Box 7. May show the kind of IRA reported on this Form 5498.
Box 8. Shows SEP contributions made in 2013, including contributions made in
2013 for 2012, but not including contributions made in 2014 for 2013. If made
by your employer, do not deduct on your income tax return. If you made the
contributions as a self-employed person (or partner), they may be deductible.
See Pub. 560.

Box 9. Shows SIMPLE contributions made in 2013. If made by your employer,
do not deduct on your income tax return. If you made the contributions as a
self-employed person (or partner), they may be deductible. See Pub. 560.
Box 10. Shows Roth IRA contributions you made in 2013 and through April 15,
2014. Do not deduct on your income tax return.
Box 11. If the box is checked, you must take an RMD for 2014. An RMD may be
required even if the box is not checked. If you do not take the RMD for 2014,
you are subject to a 50% excise tax on the amount not distributed. See Pub.
590 for details.
Box 12a. Shows the date by which the RMD amount in box 12b must be
distributed to avoid the 50% excise tax on the undistributed amount for 2014.
Box 12b. Shows the amount of the RMD for 2014. If box 11 is checked and
there is no amount in this box, the trustee or issuer must provide you the
amount or offer to calculate the amount in a separate statement by January 31,
2014.
Box 13a. Shows the amount of any postponed contribution made in 2013 for a
prior year.
Box 13b. Shows the year to which the postponed contribution in box 13a was
credited.
Box 13c. For participants who made a postponed contribution due to an
extension of the contribution due date because of a federally designated
disaster, shows the code FD.
For participants who served in designated combat zones, qualified hazardous
duty areas, or in direct support areas, shows the appropriate code. The codes
are: EO13239 for Afghanistan and associated direct support areas, EO12744 for
the Arabian peninsula areas, and EO13119 (or PL106-21) for the Yugoslavia
operations areas. For additional information, including a list of locations within
the designated combat zones, qualified hazardous duty areas, and direct
support areas, see Pub. 3, Armed Forces' Tax Guide. For updates to the list of
locations, go to www.irs.gov/form5498.
Box 14a. Shows the amount of any repayment of a qualified reservist
distribution or federally designated disaster withdrawal repayment. See Pub.
590 for reporting repayments.
Box 14b. Shows the code QR for the repayment of a qualified reservist
distribution or code DD for repayment of a federally designated disaster
distribution.
Future developments. For the latest information about developments related to
Form 5498 and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/form5498.

VOID

CORRECTED

TRUSTEE’S or ISSUER'S name, street address, city or town, province or
state, country, and ZIP or foreign postal code

1 IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, and 14a)

$

OMB No. 1545-0747

2013

2 Rollover contributions
Form 5498

$
3 Roth IRA conversion
amount
TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

$

$
6 Life insurance cost included in
box 1

7 IRA
SEP
8 SEP contributions

$
Street address (including apt. no.)

4 Recharacterized
contributions

5 Fair market value of account

$
PARTICIPANT’S name

10 Roth IRA contributions

$
11 Check if RMD for 2014

$
12b RMD amount

13a Postponed contribution

13b Year

$
$
14a Repayments

Copy C
For
Trustee or Issuer

$
SIMPLE
Roth IRA
9 SIMPLE contributions

12a RMD date
City or town, province or state, country, and ZIP or foreign postal code

IRA
Contribution
Information

14b Code

13c Code

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2013 General
Instructions for
Certain
Information
Returns.

$
Account number (see instructions)

Form 5498

www.irs.gov/form5498

Department of the Treasury - Internal Revenue Service

Instructions for Trustee or Issuer

We provide general and specific form instructions
separately. You should use the 2013 General
Instructions for Certain Information Returns and
the 2013 Instructions for Forms 1099-R and 5498
to complete Form 5498. To order these
instructions and additional forms, go to
www.irs.gov/form5498 or call 1-800-TAX-FORM
(1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file with the IRS Forms
1096, 1097, 1098, 1099, 3921, 3922, or 5498 that
you print from the IRS website.
Due dates. Furnish Copy B of this form to the
participant by June 2, 2014, but furnish fair market
value information and RMD if applicable by
January 31, 2014.

File Copy A of this form with the IRS by
June 2, 2014. If you file electronically, you must
have software that generates a file according to
the specifications in Pub. 1220, Specifications for
Filing Forms 1097, 1098, 1099, 3921, 3922, 5498,
8935, and W-2G Electronically. The IRS does not
provide a fill-in form option.
Need help? If you have questions about reporting
on Form 5498, call the information reporting
customer service site toll free at 1-866-455-7438
or 304-263-8700 (not toll free). Persons with a
hearing or speech disability with access to TTY/
TDD equipment can call 304-579-4827 (not toll
free). The hours of operation are Monday through
Friday from 8:30 a.m. to 4:30 p.m., Eastern time.