U.S. Individual Income Tax Return Forms

2019

Department of the Treasury
Internal Revenue Service

Instructions for Form 8915-A

Qualified 2016 Disaster Retirement Plan Distributions and Repayments
Section references are to the Internal Revenue
Code unless otherwise noted.

General Instructions
Future Developments

For the latest information about
developments related to Form 8915-A and
its instructions, such as legislation
enacted after they were published, go to
IRS.gov/Form8915A.

What’s New
Hyphens added to form numbers.
Beginning in 2019, hyphens have been
added to certain form numbers. Form
8915A is now Form 8915-A. Forms
8915B, 1040NR, and 1040X are now
Forms 8915-B, 1040-NR, and 1040-X,
respectively.

Purpose of Form

Use 2019 Form 8915-A if you were
adversely affected by a 2016 disaster
listed in Table 1. 2016 Disaster Areas and
you received a distribution that qualifies
for favorable tax treatment. For
distributions for qualified 2017 disasters,
see Form 8915-B and its instructions.
Qualified 2016 disaster distributions
can't be made in 2019. Only repayments
of qualified 2016 disaster distributions can
be made in 2019.
Repayments of distributions from
retirement plans (other than IRAs) are
reported in Part I, and repayments of
distributions from IRAs are reported in Part
II.

Who Must File

File 2019 Form 8915-A if either of the
following applies.
• You received a qualified 2016 disaster
distribution in 2017 that you are including
in income in equal amounts over 3 years.
• You made a repayment of a qualified
2016 disaster distribution in 2019.

When and Where To File

File 2019 Form 8915-A with your 2019
Form 1040, 1040-SR, or 1040-NR. If you
are not required to file an income tax
return but are required to file 2019 Form
8915-A, sign Form 8915-A and send it to
the IRS at the same time and place you
would otherwise file 2019 Form 1040,
1040-SR, or 1040-NR.
Oct 29, 2019

The timing of your repayments will
determine whether you need to file an
amended return to claim them. See
Amending Form 8915-A, later.

Qualified 2016 Disaster
Distribution
What 2016 Disasters Are
Covered?

In order to have had a qualified 2016
disaster distribution, you must have been
adversely affected by a disaster declared
by the President in 2016. See Table 1.

How Is a Qualified 2016
Disaster Distribution Taxed?

Generally, a qualified 2016 disaster
distribution is included in your income in
equal amounts over 3 years. However, if
you elected, you could have included the
entire distribution in your income in the
year of the distribution. If you received
more than one distribution during 2016 or
2017, you must have treated all the
distributions for that year the same way.
Any repayments made before you file your
2019 return and by the due date (including
extensions) reduce the amount of the
distribution included in your income.
Qualified 2016 disaster distributions aren't
subject to the additional 10% tax (or the
25% additional tax for certain distributions
from SIMPLE IRAs) on early distributions.

Repayment of a Qualified 2016
Disaster Distribution

If you choose, you can generally repay to
an eligible retirement plan any portion of a
qualified 2016 disaster distribution that is
eligible for tax-free rollover treatment.
Also, you can repay a qualified 2016
disaster distribution from a retirement plan
made on account of hardship. However,
see Exceptions below for qualified 2016
disaster distributions you can’t repay.
You have 3 years from the day after the
date you received the distribution to make
a repayment. The amount of your
repayment cannot be more than the
amount of the original distribution.
Amounts that are repaid are treated as a
trustee-to-trustee transfer and are not
included in income. Also, for purposes of
the one-rollover-per-year limitation for
IRAs, a repayment to an IRA is not
considered a rollover.
Include on 2019 Form 8915-A any
repayments you make before filing your
Cat. No. 71195C

2019 return. Do not include on your 2019
Form 8915-A any repayments you make
later than the due date (including
extensions) for filing your 2019 return. See
Amending Form 8915-A, later. Also, any
excess repayments you make for 2019 will
be carried back to your 2017 or 2018
return; or back to your 2016 return if you
are repaying a distribution reported on
your 2016 Form 8915A.
An amount paid more than 3 years
and 1 day after the distribution
CAUTION was received cannot be treated as
a repayment on your 2019 tax return. For
example, if your qualified 2016 disaster
distribution was received on October 4,
2016, and you choose to repay the
distribution, the repayment for your 2019
tax return must be made before October 5,
2019.

!

Exceptions. You cannot repay the
following types of distributions.
1. Qualified 2016 disaster
distributions received as a beneficiary
(other than a surviving spouse).
2. Required minimum distributions.
3. Any distribution (other than from an
IRA) that is one of a series of substantially
equal periodic payments made (at least
annually) for:
a. A period of 10 years or more,
b. Your life or life expectancy, or
c. The joint lives or joint life
expectancies of you and your beneficiary.

Amending Form 8915-A

If, after filing your original return, you make
a repayment, the repayment may reduce
the amount of your qualified 2016 disaster
distributions reported on that return.
Depending on when a repayment is made,
you may need to file an amended tax
return to refigure your taxable income.
If you make a repayment after timely
filing your 2019 tax return but by the due
date of your 2019 return (including
extensions), include the repayment on
your amended 2019 Form 8915-A.
If you make a repayment after the due
date of your 2019 return (including
extensions), but before you timely file your
2020 return, include the repayment on
your 2020 Form 8915-A. However, you
may file an amended 2017 or 2018 Form
8915A or an amended 2019 Form 8915-A,
if either of the following applies. (But see

the example below. Also see the caution
under Repayment of a Qualified 2016
Disaster Distribution, earlier, for
limitations.)
• You elected to include all of your
qualified 2016 disaster distributions in
income (instead of over 3 years) on your
original 2017 return.
• You received a qualified 2016 disaster
distribution in 2017 and included it in
income over 3 years. You can amend your
2017, 2018, or 2019 tax return, if
applicable.
Example. You received a qualified
2016 disaster distribution in the amount of
$90,000 on January 15, 2017. You choose
to spread the $90,000 over 3 years
($30,000 in income for 2017, 2018, and
2019). On November 19, 2019, you make
a repayment of $40,000. For 2019, none
of the qualified 2016 disaster distribution
is included in income. The excess
repayment of $10,000 ($40,000 - $30,000)
can be carried back to 2017 or 2018.
File Form 1040-X, Amended U.S.
Individual Income Tax Return, to amend a
return you have already filed. Generally,
Form 1040-X must be filed within 3 years
after the date the original return was filed,
or within 2 years after the date the tax was
paid, whichever is later.

Specific Instructions
Married filers. If both you and your
spouse are required to file 2019 Form
8915-A, file a separate Form 8915-A for
each of you.
Name and social security number
(SSN). If you file a joint return, enter only
the name and SSN of the spouse whose
information is being reported on the 2019
Form 8915-A.
Foreign address. If you have a foreign
address, enter the city name on the
appropriate line. Do not enter any other
information on that line, but also complete
the spaces below that line. Do not
abbreviate the country name. Follow the
country's practice for entering the postal
code and the name of the province,
county, or state.

Part I—Qualified 2016
Disaster Distributions
From Retirement Plans
(Other Than IRAs)

Complete Part I if any of the following
apply.
• You had an amount on your 2017 Form
8915A, line 11, and you did not check the
box on that line.
• You made a repayment in 2019 of
qualified 2016 disaster distribution
amounts from line 10 of 2017 Form
8915A; or line 8 of 2016 Form 8915A. See

the example below. Also see the caution
under Repayment of a Qualified 2016
Disaster Distribution, earlier, for
limitations.
Line 5. At any time during the 3-year
period beginning 1 day after the date you
received a qualified 2016 disaster
distribution, you can repay any portion of
the distribution to an eligible retirement
plan that is permitted to accept rollover
contributions. You cannot, however, repay
more than the amount of the original
distribution. See Repayment of a Qualified
2016 Disaster Distribution, earlier, for
details.
Enter on line 5 the amount of any
repayments you made before filing your
2019 return. Do not include any
repayments made later than the due date
(including extensions) for that return nor
any repayments of nontaxable amounts. If
you repaid more than the amount on line 1
(including any excess repayments from
2018 on line 4), the excess can be carried
back. Repayments made after the due
date of your 2018 return (including
extensions) but before the due date of
your 2019 return (including extensions)
generally will be reported on your 2019 tax
return. Repayments made after the due
date of your 2019 return (including
extensions) but before the due date of
your 2020 return (including extensions)
generally will be reported on your 2020 tax
return. However, you may have to file an
amended return in certain situations. See
Amending Form 8915-A, earlier. For a
discussion of repayments made more than
3 years and 1 day after the qualified 2016
disaster distribution to which the
repayment relates was received, see the
caution under Repayment of a Qualified
2016 Disaster Distribution, earlier.
Example. You received a $90,000
qualified 2016 disaster distribution on May
7, 2017, from your 401(k) plan. You had
an economic loss in the Kansas Severe
Storms and Flooding. On April 1, 2020,
you repay $30,000 to your 401(k) plan.
You file your return on April 10, 2020.
Since the repayment was made before
you filed your return, not later than the due
date (including extensions) and within the
3-year period beginning 1 day after the
distribution was received, you would enter
the $30,000 repayment on line 5.

Part II—Qualified 2016
Disaster Distributions
From Traditional, SEP,
SIMPLE, and Roth IRAs

Complete Part II if any of the following
apply.
• You had an amount on your 2017 Form
8915A, line 26, and you did not check the
box on that line.

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• You made a repayment in 2019 of
qualified 2016 disaster distribution
amounts from line 25 of 2017 Form
8915A; or line 16 of 2016 Form 8915A.
See the example below. Also see the
caution under Repayment of a Qualified
2016 Disaster Distribution, earlier, for
limitations.
Line 12. At any time during the 3-year
period beginning 1 day after the date you
received a qualified 2016 disaster
distribution, you can repay any portion of
the distribution to an eligible retirement
plan that is permitted to accept rollover
contributions. You cannot, however, repay
more than the amount of the original
distribution. See Repayment of a Qualified
2016 Disaster Distribution, earlier, for
details.
Enter on line 12 the amount of any
repayments you made before filing your
2019 return. Do not include any
repayments made later than the due date
(including extensions) for that return nor
any repayments of nontaxable amounts. If
you repaid more than the amount on line 8
(including any excess repayments from
2018 on line 11), the excess can be
carried back. Repayments made after the
due date of your 2018 return (including
extensions) but before the due date of
your 2019 return (including extensions)
generally will be reported on your 2019 tax
return. Repayments made after the due
date of your 2019 return (including
extensions) but before the due date of
your 2020 return (including extensions)
generally will be reported on your 2020 tax
return. However, you may have to file an
amended return in certain situations. See
Amending Form 8915-A, earlier. For a
discussion of repayments made more than
3 years and 1 day after the qualified 2016
disaster distribution to which the
repayment relates was received, see the
caution under Repayment of a Qualified
2016 Disaster Distribution, earlier.
Example. You received a $60,000
qualified 2016 disaster distribution on May
1, 2017, from your traditional IRA. You had
an economic loss due to the Tennessee
wildfires. On April 1, 2020, you repay
$30,000 to your traditional IRA. You file
your return on April 10, 2020. Since the
repayment was made before you filed your
return, not later than the due date
(including extensions) and within the
3-year period beginning 1 day after the
distribution was received, you would enter
the $30,000 repayment on line 12.
If, in 2019, you made a repayment
of a qualified 2017 disaster
CAUTION distribution that you opted to claim
on Part III of 2017 Form 8915A, any
repayments of that distribution in 2019
must be claimed on 2019 Form 8915-A,
Part II. They can't be claimed on 2019
Form 8915-B, Qualified 2017 Disaster

!

Instructions for Form 8915-A (2019)

Retirement Plan Distributions and
Repayments.
Example. In 2017, you reported
qualified 2016 disaster distributions on
2017 Form 8915A and qualified 2017
disaster distributions on 2017 Form
8915B. You elected to spread the
repayments over 3 years on both forms.
You had to complete 2017 Form 8606;
you chose to enter the amounts from 2017
Form 8606, lines 15b and 25b, on 2017
Form 8915A, lines 22 and 23; and you
entered -0- on 2017 Form 8915B, lines 13
and 14. You make a repayment of those
qualified 2017 disaster distributions in
November 2019. That repayment should
be entered on your 2019 Form 8915-A,
line 12, and not on 2019 Form 8915-B.
Privacy Act and Paperwork Reduction
Act Notice. We ask for the information on
this form to carry out the Internal Revenue
laws of the United States. We need this

Instructions for Form 8915-A (2019)

information to ensure that you are
complying with these laws and to allow us
to figure and collect the right amount of
tax. You are required to give us this
information if you made certain
contributions or received certain
distributions from qualified plans, including
IRAs, and other tax-favored accounts. Our
legal right to ask for the information
requested on this form is sections 6001,
6011, 6012(a), and 6109 and their
regulations. If you don’t provide this
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retained as long as their contents may
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any Internal Revenue law. Generally, tax
returns and return information are

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income tax return.

Table 1. 2016 Disaster Areas — Disasters Declared by the President in 2016
By State

Type

Date of Declaration

Incident Period

Alabama

Severe Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4251)

1/21/2016

December 23, 2015 – December 31, 2015

Alaska

Severe Storm (DR-4257)

2/17/2016

December 12, 2015 – December 15, 2015

Arkansas

Severe Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4254)

2/5/2016

December 26, 2015 – January 22, 2016

Arkansas

Severe Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4270)

5/6/2016

March 08, 2016 – March 13, 2016

Delaware

Severe Winter Storm and Flooding (DR-4265)

3/16/2016

January 22, 2016 – January 23, 2016

District of Columbia (DC)

Snowstorm (DR-4260)

3/4/2016

January 22, 2016 – January 23, 2016

Florida

Hurricane Matthew (DR-4283)

10/8/2016

October 03, 2016 – October 19, 2016

Florida

Hurricane Hermine (DR-4280)

9/28/2016

August 31, 2016 – September 11, 2016

Georgia

Severe Storms and Flooding (DR-4259)

2/26/2016

December 22, 2015 – January 13, 2016

Georgia

Hurricane Matthew (DR-4284)

10/8/2016

October 04, 2016 – October 15, 2016

Hawaii

Severe Storms, Flooding, Landslides, and Mudslides (DR-4282)

10/6/2016

September 11, 2016 – September 14, 2016

Idaho

Severe Winter Storms (DR-4252)

2/1/2016

December 16, 2015 – December 27, 2015

Iowa

Severe Storms, Straight-line Winds, and Flooding (DR-4281)

9/29/2016

August 23, 2016 – August 27, 2016

Iowa

Severe Storms and Flooding (DR-4289)

10/31/2016

September 21, 2016 – October 03, 2016

Kansas

Severe Storms and Flooding (DR-4287)

10/20/2016

September 02, 2016 – September 12, 2016

Kentucky

Severe Storms, Tornadoes, Flooding, Landslides, and Mudslides (DR-4278)

8/26/2016

July 02, 2016 – July 09, 2016

Louisiana

Severe Storms and Flooding (DR-4263)

3/13/2016

March 08, 2016 – April 08, 2016

Louisiana

Severe Storms and Flooding (DR-4277)

8/14/2016

August 11, 2016 – October 02, 2016

Maryland

Severe Winter Storm and Snowstorm (DR-4261)

3/4/2016

January 22, 2016 – January 23, 2016

Maryland

Severe Storm and Flooding (DR-4279)

9/16/2016

July 30, 2016 – July 31, 2016

Mississippi

Severe Storms and Flooding (DR-4268)

3/25/2016

March 09, 2016 – March 29, 2016

Mississippi

Severe Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4248)

1/4/2016

December 23, 2015 – December 28, 2015

Missouri

Severe Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4250)

1/21/2016

December 23, 2015 – January 09, 2016

Montana

Severe Winter Storm and Straight-line Winds (DR- 4271)

5/24/2016

April 15, 2016 – April 16, 2016

Montana

Tornado (DR-4275)

8/3/2016

June 11, 2016

New Jersey

Severe Winter Storm and Snowstorm (DR-4264)

3/14/2016

January 22, 2016 – January 24, 2016

North Carolina

Hurricane Matthew (DR-4285)

10/9/2016

October 04, 2016 – October 25, 2016

Oklahoma

Severe Storms and Flooding (DR-4274)

7/15/2016

June 11, 2016 – June 13, 2016

Oklahoma

Severe Winter Storms and Flooding (DR-4256)

2/10/2016

December 26, 2015 – January 05, 2016

Oregon

Severe Winter Storms, Straight-line Winds, Flooding, Landslides, and Mudslides (DR-4258)

2/17/2016

December 06, 2015 – December 23, 2015

Pennsylvania

Severe Winter Storm and Snowstorm (DR-4267)

3/23/2016

January 22, 2016 – January 23, 2016

Pennsylvania

Severe Storms and Flooding (DR-4292)

12/2/2016

October 20, 2016 – October 21, 2016

South Carolina

Hurricane Matthew (DR-4286)

10/11/2016

October 04, 2016 – October 30, 2016

Tennessee

Wildfires (DR-4293)

12/15/2016

November 28, 2016 – December 09, 2016

Texas

Severe Storms and Flooding (DR-4269)

4/25/2016

April 17, 2016 – April 30, 2016

Texas

Severe Storms and Flooding (DR-4272)

6/11/2016

May 22, 2016 – June 24, 2016

Texas

Severe Storms, Tornadoes, and Flooding (DR-4266)

3/19/2016

March 07, 2016 – March 29, 2016

Texas

Severe Winter Storms, Tornadoes, Straight-line Winds, and Flooding (DR-4255)

2/9/2016

December 26, 2015 – January 22, 2016

Virginia

Severe Winter Storm and Snowstorm (DR-4262)

3/7/2016

January 22, 2016 – January 23, 2016

Virginia

Hurricane Matthew (DR-4291)

11/2/2016

October 07, 2016 – October 15, 2016

Washington

Severe Storms, Straight-line Winds, Flooding, Landslides, and Mudslides (DR-4249)

1/15/2016

November 12, 2015 – November 21, 2015

Washington

Severe Winter Storm, Straight-line Winds, Flooding, Landslides, Mudslides, and a Tornado
(DR-4253)

2/2/2016

December 01, 2015 – December 14, 2015

West Virginia

Severe Storms, Flooding, Landslides, and Mudslides (DR-4273)

6/25/2016

June 22, 2016 – June 29, 2016

Wisconsin

Severe Storms and Flooding (DR-4276)

8/9/2016

July 11, 2016 – July 12, 2016

Wisconsin

Severe Storms, Flooding, and Mudslides (DR-4288)

10/20/2016

September 21, 2016 – September 22, 2016

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Instructions for Form 8915-A (2019)