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Form 1099-SA (Rev. 11-2019)

ICR 202107-1545-012 · OMB 1545-1517 · Object 113292601.

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Document Metadata

Record metadata
application/octet-stream
Form 1099-SA (Rev. 11-2019)
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
SE:W:CAR:MP
2019-10-21
2019-10-21
complete