5498-QA ABLE Account Contribution Information

2A2A

VOID

CORRECTED

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

1 ABLE contributions

OMB No. 1545-2262

2021

$
2 ABLE to ABLE Rollovers

$

Form 5498-QA

3 Cumulative contributions

4 Fair market value

$

$

BENEFICIARY’S name

5 Check if account opened
in 2021

6 Basis of eligibility

Street address (including apt. no.)

7 Code

ISSUER’S TIN

BENEFICIARY’S TIN

ABLE Account
Contribution
Information
Copy A
For
Internal Revenue
Service Center
File with Form 1096.

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-QA

Cat. No. 67556T

www.irs.gov/Form5498QA

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2021 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
ISSUER’S name, street address, city or town, state or province, country,
and ZIP or foreign postal code

1 ABLE contributions

OMB No. 1545-2262

2021

$
2 ABLE to ABLE Rollovers

$
ISSUER’S TIN

BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

Form 5498-QA

3 Cumulative contributions

4 Fair market value

$

$

5 If checked, account was
opened in 2021

6 Basis of eligibility

7 Code

ABLE Account
Contribution
Information
Copy B
For Beneficiary
This information
is being furnished
to the IRS.

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-QA

(keep for your records)

www.irs.gov/Form5498QA

Department of the Treasury - Internal Revenue Service

Instructions for Beneficiary
The information on Form 5498-QA is furnished to you by the issuer of your
Achieving a Better Life Experience (ABLE) savings account. Form 5498QA reports contributions, rollovers, and program-to-program transfers to
this ABLE account for 2021. For more information, see Pub. 907.
Beneficiary’s taxpayer identification number (TIN). For your
protection, this form may show only the last four digits of your TIN
(social security number (SSN), individual taxpayer identification
number (ITIN), or adoption taxpayer identification number (ATIN)).
However, the issuer has reported your complete TIN to the IRS.
Account number. May show an account or other unique number the
issuer assigned to distinguish your account.
Box 1. Shows the amount of contributions made to this ABLE account
in 2021. Include all cash contributions and Qualified Tuition Plan (QTP)
to ABLE account rollovers, and QTP to ABLE program-to-program
transfers. Do not deduct these amounts on your income tax return.
If the total contributions (including any contributions from a section
529 program/QTP), but not including contributions of the designated
beneficiary’s compensation income made under section 529A(b)(2)(B)
(ii) made to your ABLE account for 2021 exceeded $15,000, or if the
contributions of an employed designated beneficiary’s compensation
income exceeded the applicable amount under section 529A(b)(2)(B)
(ii), the excess contributions, plus the earnings on them, must be
returned by the date your tax return is due (including extensions), or
you may owe a penalty. Check with your ABLE program to verify that
excess contributions and earnings are returned timely. You must keep
track of your ABLE account basis (contributions and distributions).

Box 2. Shows the amount of any rollover or program-to-program
transfer made to this ABLE account from another ABLE account in
2021. Generally, any amount rolled over from one ABLE account to
another ABLE account for the benefit of the named beneficiary or of
an eligible individual who is a member of the beneficiary’s family who
is described in section 152(d)(2)(B) is not taxable.
Box 3. May show the cumulative amount contributed since the
establishment of the ABLE account (or of an ABLE account of the same
designated beneficiary that was rolled over, or directly transferred (in a
program-to-program transfer), to the current ABLE account).
Box 4. Shows the FMV of the ABLE account as of the end of the year.
Box 5. The ABLE account was opened in 2021 if the box is checked.
Box 6. These codes show the basis for your ABLE account eligibility.
A—eligibility established under 529A(e)(1)(A), SSDI, Title II SSA.
B—eligibility established under 529A(e)(1)(A), SSI, Title XVI SSA.
C—eligibility established by disability certification under section
529A(e)(1)(B).
Box 7. These codes show the type of disability for which you are
receiving ABLE account qualifying benefits. 1—developmental
disorders (including autism); 2—intellectual disability; 3—psychiatric
disorders; 4—nervous disorders (including blindness and deafness);
5—congenital anomalies (including Down syndrome); 6—respiratory
disorders; 7—other.
Future developments. For the latest information about developments
related to Form 5498-QA and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/Form5498QA.
FreeFile. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online
federal tax preparation, e-filing, and direct deposit or payment options.

VOID

CORRECTED

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

1 ABLE contributions

OMB No. 1545-2262

2021

$
2 ABLE to ABLE Rollovers

$
ISSUER’S TIN

BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

4 Fair market value

$

$

5 Check if account opened
in 2021

6 Basis of eligibility

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-QA

Form 5498-QA

3 Cumulative contributions

7 Code

www.irs.gov/Form5498QA

ABLE Account
Contribution
Information
Copy C
For Issuer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2021 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Issuer
To complete Form 5498-QA, use:
• The 2021 General Instructions for Certain Information
Returns, and
• The 2021 Instructions for Form 5498-QA.
To get or to order these instructions, go to
www.irs.gov/Form5498QA.
Due dates. Furnish Copy B of this form to the
beneficiary (participant) by March 15, 2022.

File Copy A of this form with the IRS by May 31, 2022.
Need help? If you have questions about reporting on
Form 5498-QA, call the information reporting customer
service site toll free at 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).