Form 1099-SA - Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

Documents and Forms

Document Name Document Type
Form 1099-SA Form 1099-SA - Distributions From an HSA, Archer MSA, or Medicare Advantage MSA Form
Instr for Form 1099-SA_and_5498_SA--2021-00-00.pdf Instruction
Instr for Form 1099-SA_and_5498_SA--2021-00-00.pdf Instruction
1099-SA Distributions From an HSA, Archer MSA or Medical Advanta Form 1099-SA--2019-11-00.pdf Form
1099-SA Distributions From an HSA, Archer MSA or Medical Advanta Form 1099-SA--2019-11-00.pdf Form

Information Collection (IC) Details

IC Title:	Form 1099-SA - Distributions From an HSA, Archer MSA, or Medicare Advantage MSA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1099-SA	Distributions From an HSA, Archer MSA or Medical Advantage MSA	Form 1099-SA--2019-11-00.pdf		Yes	Yes	Fillable Fileable
Instruction			Instr for Form 1099-SA_and_5498_SA--2021-00-00.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,336	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Previously Approved
Annual Number of Responses for this IC	25,839	25,839
Annual IC Time Burden (Hours)	3,618	3,618
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.