HSA, Archer MSA, or Medicare Advantage MSA Information

HSA, Archer MSA, or Medicare Advantage MSA Information

OMB: 1545-1518

IC ID: 18582

Information Collection (IC) Details

View Information Collection (IC)

HSA, Archer MSA, or Medicare Advantage MSA Information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 5498-SA HSA, ARCHER MSA OR MEDICARE ADVANTAGE MSA INFORMATION Form 5498-SA (2018).pdf Yes Yes Fillable Fileable
Instruction Form 5498-SA (Instructions) (2018).pdf Yes No Printable Only
Instruction General Instruction for Certain Info Returns (2018).pdf Yes No Printable Only

General Government Taxation Management

 

9,167 0
   
Private Sector Businesses or other for-profits
 
   95 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 9,167 0 0 0 0 9,167
Annual IC Time Burden (Hours) 1,559 0 0 0 0 1,559
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2014 Burden Burden-F5498-SA-2014.PDF 11/21/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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