1099-QA Distributions from ABLE Accounts

Caution: DRAFT—NOT FOR FILING
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VOID

1A1A

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.

1 Gross distribution

$
2 Earnings

PAYER’S TIN

RECIPIENT’S TIN

OMB No. 1545-2262

2018

$

Form 1099-QA

3 Basis

4 Program-to-program
transfer

Distributions
From ABLE
Accounts

DRAFT AS OF
May 8, 2017
DO NOT FILE
$

5 Check if ABLE account
terminated in 2018

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 1099-QA

Cat. No. 67554X

www.irs.gov/Form1099QA

6 Check if the recipient is
not the designated
beneficiary

Copy A

For
Internal Revenue
Service Center

File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2018 General
Instructions for
Certain Information
Returns.

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)
PAYER’S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.

1 Gross distribution

$
2 Earnings

PAYER’S TIN

RECIPIENT’S TIN

OMB No. 1545-2262

2018

$

Form 1099-QA

3 Basis

4 Program-to-program
transfer

Distributions
From ABLE
Accounts

DRAFT AS OF
May 8, 2017
DO NOT FILE
$

5 If checked, ABLE account
terminated in 2018

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 1099-QA

(keep for your records)

www.irs.gov/Form1099QA

6 If this box is checked, the
recipient is not the
designated beneficiary

Copy B
For Recipient

This is important tax
information and is
being furnished to the
Internal Revenue
Service. If you are
required to file a return,
a negligence penalty or
other sanction may be
imposed on you if this
income is taxable and
the IRS determines that
it has not been
reported.

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Recipient's taxpayer identification number (TIN). For your protection, this
form may show only the last four digits of your social security number (SSN),
individual taxpayer identification number (ITIN), or adoption taxpayer
identification number (ATIN). However, the payer has reported your complete
TIN to the IRS.
Account number. May show an account or other unique number the payer has
assigned to distinguish your account.
Box 1. Shows the gross distribution paid to you this year from an Achieving a
Better Life Experience (ABLE) savings account in 2018. Gross distribution
includes distributions from the ABLE account for both qualified and
nonqualified disability expenses. The gross distribution also includes amounts
distributed that the designated beneficiary intends to roll over to another ABLE
account, but does not include program-to-program transfers. A gross
distribution also includes a return of excess contributions plus earnings.
Box 2. Shows the earnings part of the gross distribution shown in box 1.
Generally, amounts distributed that are used to pay for qualified disability

expenses, or rolled over to another ABLE account within 60 days, are not
included in income. Report taxable amounts as “Other income” on Form 1040.
Also see Form 5329 and its separate instructions.
Box 3. Shows your basis in the gross distribution reported in box 1.
Box 4. This box is checked if a program-to-program transfer was made from
this ABLE account to another ABLE account.
Box 5. This box is checked if the ABLE account was terminated in 2018.
Box 6. The designated beneficiary is the individual named in the document
creating the ABLE account to receive the benefit of the funds in the account. If
this box is checked, you are not the designated beneficiary of this ABLE
account. You and/or the designated beneficiary may be subject to additional
taxes and/or penalties on the box 1 gross distribution. See Form 5329 and its
separate instructions and the Instructions for Form 1040 (line 21, “Other
income”).
Future developments. For the latest information about developments related to
Form 1099-QA and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1099QA.

DRAFT AS OF
May 8, 2017
DO NOT FILE

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP or
foreign postal code, and telephone no.

1 Gross distribution

$
2 Earnings

PAYER’S TIN

RECIPIENT’S TIN

OMB No. 1545-2262

2018

$

Form 1099-QA

3 Basis

4 Program-to-program
transfer

Distributions
From ABLE
Accounts

DRAFT AS OF
May 8, 2017
DO NOT FILE
$

RECIPIENT’S name

5 Check if ABLE account
terminated in 2018

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 1099-QA

www.irs.gov/Form1099QA

6 Check if the recipient is
not the designated
beneficiary

Copy C
For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2018 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1099-QA, use:
• the 2018 General Instructions for Certain Information
Returns, and
• the 2018 Instructions for Form 1099-QA.
To get or to order these instructions, go to
www.irs.gov/Form1099QA.
Due dates. Furnish Copy B of this form to the recipient
by January 31, 2019.

File Copy A of this form with the IRS by February 28,
2019.
Need help? If you have questions about reporting on
Form 1099-QA, 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).

DRAFT AS OF
May 8, 2017
DO NOT FILE