U.S. Individual Income Tax Return Forms

2019

Department of the Treasury
Internal Revenue Service

Instructions for Form 8915-C

Qualified 2018 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-C and
its instructions, such as legislation enacted
after they were published, go to IRS.gov/
Form8915C.

Purpose of Form

Use 2019 Form 8915-C if you were
adversely affected by a qualified disaster
listed in Table 1 at the end of these
instructions, and you received a distribution
described in Qualified 2018 Disaster
Distribution Requirements or Qualified
Distribution Requirements, later, that
qualifies for favorable tax treatment.
Both qualified 2018 disaster distributions
and repayments of qualified 2018 disaster
distributions can be made in 2019.

Part I. Use Part I to figure your:
• Total distributions from all retirement
plans (including IRAs),
• Qualified 2018 disaster distributions, and
• Distributions other than qualified 2018
disaster distributions.
Parts II and III. Use Parts II and III to:
• Report your qualified 2018 disaster
distributions;
• Report any repayments of qualified 2018
disaster distributions; and
• Figure the taxable amount, if any, of your
qualified 2018 disaster distributions.
Note. Distributions and repayments from
retirement plans (other than IRAs) are
reported in Part II and distributions and
repayments from IRAs are reported in Part
III.
Part IV. Use Part IV of Form 8915-C to:
• Report that you received qualified
distributions for the purchase or construction
of a main home in qualified 2018 disaster
areas that you repaid, in whole or in part, no
later than June 17, 2020;
• Report any repayments of qualified
distributions (not reported on 2019 Form
8606, Nondeductible IRAs); and
• Figure the taxable amount, if any, of your
qualified distributions (not reported on 2019
Form 8606).
See Qualified Distribution for the Purchase or
Construction of a Main Home in Qualified
2018 Disaster Areas, and Part IV, later, for
more information.

Jul 01, 2020

Who Must File

File 2019 Form 8915-C if any of the following
applies.
• You received a qualified 2018 disaster
distribution from an eligible retirement plan,
and the distribution was made in 2019.
• You received a qualified distribution in
2019 for the purchase or construction of a
main home in 2018 disaster areas that you
repaid, in whole or in part, no later than June
17, 2020.
• You received a qualified 2018 disaster
distribution in 2018 that you are including in
income in equal amounts over 3 years.
• You made a repayment of a qualified
2018 disaster distribution in 2019.

When and Where To File

File 2019 Form 8915-C 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 Form 8915-C, fill in the
address information on page 1 of Form
8915-C, sign the Form 8915-C, and send it
to the Internal Revenue Service at the same
time and place you would otherwise file Form
1040, 1040-SR, or 1040-NR.
The timing of your distributions and
repayments will determine whether you need
to file an amended return to claim them. If
you need to amend your Form 8915-C, see
Amending Form 8915-C, later.
If you have already filed your 2019
return, you may need to amend your
CAUTION 2019 return in order to claim
qualified 2018 disaster distributions or
qualified distributions on 2019 Form 8915-C.
You will do so by filing a Form 1040-X.
Check the 2019 box at the top of page 1 of
that form.

!

What Is a Qualified
Disaster Distribution?

For 2019, qualified disaster distributions are
the qualified 2018 disaster distributions
described in 2019 Form 8915-C and these
instructions; and the qualified 2019 disaster
distributions described in 2019 Form 8915–D
and its instructions.

Qualified 2018 Disaster
Distribution
What 2018 Disasters Are
Covered?

In order to have a qualified 2018 disaster
distribution, you must have been adversely
affected by a qualified 2018 disaster: that is,
a disaster that occurred in 2018 that was
declared as a major disaster by the
Cat. No. 72464Q

President no earlier than January 1, 2018,
and no later than February 18, 2020. See
Table 1 at the end of these instructions for
the list of qualified 2018 disasters. The
California wildfire disasters declared by the
President as major disasters on January 2,
2018, are not treated as 2018 disasters.
Distributions with respect to those disasters
are reported on Form 8915B. See Table 1 for
the California wildfire disasters covered by
Form 8915-C.

How Is a Qualified 2018
Disaster Distribution Taxed?

Generally, a qualified 2018 disaster
distribution is included in your income in
equal amounts over 3 years. However, if you
elect, you can include the entire distribution
in your income in the year of the distribution.
If more than one distribution was made
during the year, you must treat all
distributions for that year the same way. Any
repayments made before you file your return
and by the due date (including extensions)
reduce the amount of the distribution
included in your income.
Also, qualified 2018 disaster distributions
aren’t subject to the additional 10% tax on
early distributions.
If a taxpayer who received a
qualified 2018 disaster distribution
CAUTION dies in 2019, the distribution may no
longer be spread over 3 years. The
remainder of the distribution must be
reported on the return of the deceased
taxpayer.

!

Qualified 2018 Disaster
Distribution Requirements
Made in 2019. For 2019, a qualified 2018
disaster distribution is any distribution you
received from an eligible retirement plan if all
of the following conditions are met. You must
meet these requirements separately for each
of your disasters that occurred in 2018.
1. The distribution was made in 2019.
2. Your main home was located in a
2018 disaster area listed in Table 1 at any
time during the disaster period shown for that
area in Table 1. The disaster area is the
state, territory, or tribal government in which
the disaster occurs.
3. You sustained an economic loss
because of the disaster(s) in (2) above.
Examples of an economic loss include, but
aren’t limited to, (a) loss, damage to, or
destruction of real or personal property from
fire, flooding, looting, vandalism, theft, wind,
or other cause; (b) loss related to
displacement from your home; or (c) loss of

livelihood due to temporary or permanent
layoffs.
If (1) through (3) apply, you can generally
designate any distribution (including periodic
payments and required minimum
distributions) from an eligible retirement plan
as a qualified 2018 disaster distribution,
regardless of whether the distribution was
made on account of a qualified 2018
disaster. Qualified 2018 disaster distributions
are permitted without regard to your need or
the actual amount of your economic loss.
A reduction or offset in 2019 of your
account balance in an eligible retirement
plan in order to repay a loan can also be
designated as a qualified 2018 disaster
distribution. See Distribution of plan loan
offsets, later.
Made in 2018. See 2018 Form 8915-C and
its instructions for guidance on the reporting
of qualified 2018 disaster distributions made
in 2018.
Limit. For each qualified 2018 disaster, the
total of your qualified 2018 disaster
distributions from all plans is limited to
$100,000. If you have distributions from
more than one type of plan, such as a 401(k)
plan and an IRA, and the total exceeds
$100,000 for a qualified 2018 disaster, you
may allocate the $100,000 limit among the
plans by any reasonable method.
Eligible retirement plan. An eligible
retirement plan can be any of the following.
• A qualified pension, profit-sharing, or
stock bonus plan (including a 401(k) plan).
• A qualified annuity plan.
• A tax-sheltered annuity contract.
• A governmental section 457 deferred
compensation plan.
• A traditional, SEP, SIMPLE, or Roth IRA.
Distribution of plan loan offsets. A
distribution of a plan loan offset is a
distribution that occurs when, under the
terms of a plan, the participant’s accrued
benefit is reduced (offset) in order to repay a
loan. A distribution of a plan loan offset
amount can occur for a variety of reasons,
such as when a participant terminates
employment or doesn’t comply with the
terms of repayment. Plan loan offsets are
treated as actual distributions and are
reported in Form 1099-R, box 1.
Main home. Generally, your main home is
the home where you live most of the time. A
temporary absence due to special
circumstances, such as illness, education,
business, military service, evacuation, or
vacation, won’t change your main home.
Additional tax. Qualified 2018 disaster
distributions aren’t subject to the additional
10% tax (or the 25% additional tax for certain
distributions from SIMPLE IRAs) on early
distributions and aren’t required to be
reported on Form 5329. However, any
distributions you received in excess of the
$100,000 qualified 2018 disaster distribution
limit for a qualified 2018 disaster may be
subject to the additional tax.

Note. If you choose to treat a distribution as
a qualified 2018 disaster distribution, it is not
eligible for the 20% Capital Gain Election or
the 10-Year Tax Option. For information on
those options, see the instructions for Form
4972.

Repayment of a Qualified 2018
Disaster Distribution
Do not use this form to report
repayments of qualified 2016, 2017,
CAUTION or 2019 disaster distributions.
Instead see Forms 8915-A, 8915-B, or
8915-D, respectively, and their instructions.

!

If you choose, you can generally repay any
portion of a qualified 2018 disaster
distribution that is eligible for tax-free rollover
treatment to an eligible retirement plan. Also,
you can repay a qualified 2018 disaster
distribution made on account of hardship
from a retirement plan. However, see
Exceptions, later, for qualified 2018 disaster
distributions you can’t repay.
Your repayment can't be made any earlier
than the day after the date you received the
qualified 2018 disaster distribution. 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-C any
repayments you made before filing your
2019 return. Any repayments you made will
reduce the amount of qualified 2018 disaster
distributions reported on your return for
2019. Do not include on your 2019 Form
8915-C any repayments you made later than
the due date (including extensions) for filing
your 2019 return. If you made a repayment in
2020 after you filed your 2019 return, the
repayment will reduce the amount of your
qualified 2018 disaster distributions included
in income on your 2020 return if you have
spread the income over 3 years, unless you
are eligible to amend your 2019 return (or
your 2018 return, if applicable). See
Amending Form 8915-C, later. Also, if you
have spread the income over 3 years, any
excess repayments you made for 2019 will
be carried forward to your 2020 return or
back to your 2018 return, if applicable.
Example. You suffered economic losses
in Hawaii as the result of a disaster there.
You received a qualified 2018 disaster
distribution in the amount of $75,000 on April
30, 2019, and $15,000 on September 30,
2019. You wish to treat a contribution of
$90,000 you made on June 19, 2019, as a
repayment of both distributions. Only
$75,000 can be reported as a qualified 2018
disaster distribution repayment. Repayments
can only be made after the date on which the
distribution was received.

-2-

Exceptions. You cannot repay the
following types of distributions.
1. Qualified 2018 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.

Qualified Distribution for
the Purchase or
Construction of a Main
Home in Qualified 2018
Disaster Areas
Qualified Distribution
Requirements

To be a qualified distribution in 2019 for the
purchase or construction of a main home in a
qualified 2018 disaster area, the distribution
must meet all of the following requirements.
1. The distribution is a hardship
distribution from a 401(k) plan, a hardship
distribution from a tax-sheltered annuity
contract, or a qualified first-time homebuyer
distribution from an IRA.
2. The distribution was received in 2019
no later than 30 days after the last day of the
qualified 2018 disaster. Table 1 at the end of
these instructions lists the qualified 2018
disasters and their beginning and ending
dates.
Distributions for only two disasters
can meet the criteria in this
CAUTION paragraph (2): Mississippi Severe
Storms, Flooding, And Tornado (ending date
December 28, 2018) and Washington
Severe Winter Storms, Straight-line Winds,
Flooding, Landslides, Mudslides, Tornado
(ending date December 24, 2018).

!

3. The distribution was to be used to
purchase or construct a main home in the
qualified 2018 disaster area and the main
home was not purchased or constructed
because of the disaster. The disaster area is
the state, territory, or tribal government in
which the disaster occurs.
If the distribution was received in

TIP 2017, see Qualified distributions

under Amending Form 8915-C, later.

Repayment of a Qualified
Distribution for the Purchase or
Construction of a Main Home

If you received a qualified distribution, in
2019, to purchase or construct a main home,
you can choose to repay that distribution to
an eligible retirement plan no later than June
17, 2020. For this purpose, an eligible

Instructions for Form 8915-C (2019)

retirement plan is any plan, annuity, or IRA to
which a rollover can be made.
Amounts that are repaid no later than
June 17, 2020, are treated as a
trustee-to-trustee transfer and are not
included in income. For purposes of the
one-rollover-per-year limitation for IRAs, a
repayment to an IRA is not considered a
rollover.
A qualified distribution (or any portion
thereof) not repaid before June 18, 2020,
may be taxable in the year of the distribution,
which may be 2018 or 2019 (or even 2017,
see Qualified distributions under Amending
Form 8915-C, later) and may be subject to
the additional 10% tax (or the additional 25%
tax for certain SIMPLE IRAs) on early
distributions.
You may be able to designate a qualified
distribution as a qualified 2018 disaster
distribution if all of the following apply.
1. The distribution was made in 2019.
2. The distribution (or any portion
thereof) is not repaid before June 18, 2020.
3. The distribution can otherwise be
treated as a qualified 2018 disaster
distribution. See Qualified 2018 Disaster
Distribution Requirements, earlier.
If the distribution was received in

TIP 2017, see Qualified distributions

under Amending Form 8915-C, later.

Amending Form 8915-C

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.
Qualified 2018 disaster distributions. If,
after filing your 2019 return, you make a
repayment, the repayment may reduce the
amount of your qualified 2018 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 made the repayment by the due
date of your 2019 return (including
extensions), include the repayment on your
amended 2019 Form 8915-C.
If you made the repayment after the due
date of your 2019 return (including
extensions) but before the due date of your
2020 return (including extensions) and you
have spread the income over 3 years,
include the repayment on your 2020 Form
8915-C. However, you may file an amended
Form 8915-C for 2019 if either of the
following applies.
• You elected on 2019 Form 8915-C, lines
11 and 26, as applicable, to include all of
your qualified 2018 disaster distributions in
income in 2019 (instead of over 3 years).
• You have spread the income over 3 years,
the amount of the repayment exceeds the
amount of your qualified 2018 disaster

Instructions for Form 8915-C (2019)

distributions that are included in income on
your 2020 Form 8915-C, and you choose to
carry the excess back to your 2019 tax
return. See the example below.
Example. You received a qualified 2018
disaster distribution in the amount of $90,000
in 2019. You choose to spread the $90,000
over 3 years ($30,000 in income for 2019,
2020, and 2021). On November 19, 2020,
you make a repayment of $45,000. For 2020,
none of the qualified 2018 disaster
distribution is included in income. The
excess repayment of $15,000 ($45,000 $30,000) can be carried back to 2019. Also,
instead of carrying the excess repayment
back to 2019, you can choose to carry it
forward to 2021.
Qualified distributions. You may reduce
the amount of a qualified distribution
included in income in 2017 by the amount of
a repayment made in 2019. Because a
qualified distribution can be received up to
180 days before the disaster began and
repayments for that distribution can be made
from the beginning date of the disaster and
up to June 17, 2020, you may have a
qualified distribution received in 2017 for
which you are making repayments in 2019. If
you have already filed your 2017 return on
which you reported the distribution, you
should file an amended 2017 return to report
the repayment. On your amended return
(Form 1040-X), you will check the 2017 box
at the top of page 1 and enter, in
parentheses in column B of line 1, the
amount of the repayment. If the distribution
was from an IRA, in Part III of your amended
return, say: "The amount I reported on [2017
Form 1040, line 15b; 2017 Form 1040A,
line 11b; or 2017 Form 1040NR, line 16b, as
applicable] is being reduced by a
contribution made mm/dd/2019 to an eligible
retirement plan in repayment of a qualified
distribution made mm/dd/2017 under PL
116-94, sec. 202(b). The disaster was the
[name of the qualified 2018 disaster from
Table 1] disaster." If the distribution was from
a retirement plan (other than an IRA), in Part
III of your amended return, say: "The amount
I reported on [2017 Form 1040, line 16b;
2017 Form 1040A, line 12b; or 2017 Form
1040NR, line 17b, as applicable] is being
reduced by a contribution made mm/dd/2019
to an eligible retirement plan in repayment of
a qualified distribution made mm/dd/2017
under PL 116-94, sec. 202(b). The disaster
was the [name of the qualified 2018 disaster
from Table 1] disaster."
Example. You received a distribution
from a traditional IRA on December 14,
2017, to construct a home in the Alabama
Severe Storms And Tornadoes disaster area
which you did not construct because of that
disaster. The disaster began March 19,
2018, and the distribution now qualifies as a
qualified distribution. On April 14, 2019, you
made a contribution that qualifies as a
repayment of the distribution. You have
already filed your 2017 return: a Form 1040.
You will need to file a Form 1040-X for 2017
to claim the repayment. On your Form
1040-X, you check the 2017 box at the top of
-3-

page 1 and, in parentheses in column B of
line 1, you enter the amount of the
repayment. In Part III of your amended
return, say: "The amount I reported on 2017
Form 1040, line 15b, is being reduced by a
contribution made 04/14/2019 to an eligible
retirement plan in repayment of a qualified
distribution made 12/14/2017 under PL
116-94, sec. 202(b). The disaster was the
Alabama Severe Storms And Tornadoes
disaster."

Specific Instructions
Married filers. If both you and your spouse
are required to file Form 8915-C, file a
separate Form 8915-C for each of you. If you
and your spouse are both filing Forms
8915-C, the $100,000 limits on qualified
2018 disaster distributions and the election
on lines 11 and 26 to include all qualified
2018 disaster distributions in income in 2019
(and not spread them over 3 years) are
determined separately for each spouse.
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 Form 8915-C.
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.
Names of disasters. Use the name(s) of
the disaster(s) in Table 1 at the end of these
instructions. Include the name of the state,
territory, or tribal government. If you are
reporting only one qualified 2018 disaster for
your qualified 2018 disaster distribution(s),
enter the name of the disaster on the line
provided in Part I of Form 8915-C.
Worksheet 2. If you use Worksheet 2, at
the top of page 1 of Form 8915-C write the
name of each disaster for which you are
reporting a qualified 2018 disaster
distribution.
Part IV. Enter the name of the disaster(s)
for which you are reporting qualified
distributions on the line provided on Form
8915-C.

Part I—Total Distributions
From All Retirement Plans
(Including IRAs)
Column (a). If you received a distribution
from a retirement plan (including an IRA),
you should receive a Form 1099-R. The
amount of the distribution should be shown
in Form 1099-R, box 1. Enter the amounts
from all your Forms 1099-R, box 1, on the
appropriate lines in column (a). Because
qualified 2018 disasters occurred in 2018,
the date of the disaster, unlike in 2018, is not
a factor in determining whether a distribution
is an available distribution in 2019.

If you are reporting distributions in

TIP Part I of both 2019 Form 8915-C and

2019 Form 8915-D, complete
column (a) of 2019 Form 8915-C first. See
the 2019 Instructions for Form 8915-D.

Use if Reporting Only One 2018
Disaster
Column (b). Follow the instructions in this
section to complete, Part I, column (b), if you
have qualified 2018 disaster distributions for
only one disaster in 2019. If your qualified
2018 disaster distributions for 2018 and
2019 for that disaster total $100,000 or less,
use the entire total for the earliest disaster
and follow this section of the instructions
even if you were impacted by more than one
disaster.
If you have qualified 2018 disaster
distributions for more than one
CAUTION disaster, you must use Worksheet 2,
later, to figure your column (b) amounts
unless your distributions available for 2018
and 2019 qualified 2018 disaster
distributions total $100,000 or less. See the
paragraph immediately above and the
following examples.

!

Example 1. In 2019, you received
qualified 2018 disaster distributions totaling
$90,000. These were your only distributions
made in 2019. You had no distributions in
2018. You suffered economic losses as a
result of these two qualified 2018 disasters.
Disaster 1: Typhoon Mangkhut. Disaster 2:
Super Typhoon Yutu. Your main home was
in the Northern Mariana Islands during the
disaster periods in Table 1 for those
disasters. On your 2019 Form 8915-C, you
report the entire $90,000 distribution under
one disaster: Disaster 1. You do not use
Worksheet 2. You follow the steps under Use
if Reporting Only One 2018 Disaster.
Example 2. The facts are the same as in
Example 1, except in December 2018, you
received an $8,000 qualified 2018 disaster
distribution that you assigned to Disaster 1.
This was your only distribution made in 2018.
On your 2019 Form 8915-C, you report the
entire $98,000 in 2018 and 2019
distributions under one disaster: Disaster 1.
You do not use Worksheet 2. You follow the
steps under Use if Reporting Only One 2018
Disaster.
Enter on the appropriate lines, in column
(b), any qualified 2018 disaster distributions
(including periodic payments and required
minimum distributions) made in 2019.
Include only those distributions you wish
to designate as qualified 2018 disaster
distributions. See Qualified 2018 disaster
distributions, earlier.
Also include in column (b), if you choose,
any qualified distribution that is eligible to be
designated as a qualified 2018 disaster
distribution (see Qualified Distribution for the
Purchase or Construction of a Main Home in
Qualified 2018 Disaster Areas, earlier).
Column (c). Complete column (c) only if the
total on line 4, column (b), is more than

$100,000 and you are not using Worksheet
2.
If the amount on line 5, column (b), is
more than $100,000, you will need to make
an allocation in column (c) of the
distribution(s) included in column (b). This is
because the total of your qualified 2018
disaster distributions cannot exceed the
$100,000 limit. If you have distributions from
more than one type of retirement plan, such
as an IRA and a 401(k) plan, you may
allocate the $100,000 limit among the plans
by any reasonable method.
Example 1. You received a distribution
from your Roth IRA in the amount of
$130,000 in 2019. The distribution was made
on June 28, 2019. You had an economic loss
due to the Texas Severe Storms And
Flooding. You had a main home in Texas
during the period listed in Table 1 for this
disaster. This was your only distributions
made in 2018 or 2019. You entered
$130,000 on line 4, columns (a) and (b). You
would then enter $100,000 on line 4, column
(c), since the distribution is in excess of the
$100,000 limit.
Example 2. Assume the same facts as in
Example 1, you also received a distribution
from your 401(k) plan in the amount of
$20,000. This distribution was made on
October 16, 2019. You entered $20,000 on
line 2, columns (a) and (b). You will now
need to make an allocation in column (c)
between the two distributions because the
total on line 5, column (b), is $150,000. You
can choose to make the allocation by any
reasonable method, as long as the total in
column (c) does not exceed $100,000. You
choose to allocate $80,000 to your Roth IRA
distribution on line 4, column (c), and the
entire $20,000 to your 401(k) plan
distribution on line 2, column (c).

Worksheet 2: Use if You Are
Reporting More Than One 2018
Disaster

!

CAUTION

Do not enter any amounts in column
(c) if you are using Worksheet 2,
later.

Column (b). If you suffered economic
losses as the result of more than one
qualified 2018 disaster and your qualified
2018 disaster distributions made in 2018 and
2019 total more than $100,000, you must
use Worksheet 2 to figure the amounts you
are entering in column (b).
In Worksheet 2, column (a), enter the
amounts you already have figured for lines 2
through 5 in Part I of 2019 Form 8915-C. In
Worksheet 2, column (X), start by entering
the amounts you are planning to claim as
qualified 2018 disaster distributions made in
2019. Enter the 2019 distributions for each
qualified 2018 disaster in a separate column.
For simplicity, apply your distributions in
$100,000 amounts as available to each
disaster, beginning with the earliest disaster.
Examples 1 through 4, later, provide
guidance. A blank Worksheet 2 is in
Worksheets at the end of the instructions.
-4-

See Use if Reporting Only One 2018
Disaster, earlier, if you have only one
CAUTION disaster, or your qualified 2018
disaster distributions for 2018 and 2019 total
$100,000 or less. If you have total
distributions of more than $100,000 but no
more than $200,000, use $100,000 for the
earliest disaster and the remaining amount
for your second disaster. See the examples
below if you have two or three disasters. In
each of the examples, we have assumed
Mosley had a main home in the qualified
disaster area during the period listed in
Table 1 for the disaster.

!

Example 1. Mosley suffered economic
losses as a result of these two qualified 2018
disasters in Table 1. Disaster 1: Maryland
Severe Storms And Flooding. Disaster 2:
Maryland Severe Storm And Flooding. In
2019, he received a traditional IRA
distribution. The distribution was made on
April 30 in the amount of $140,000. He
reported no other qualified disaster
distributions for 2018 or 2019. He completes
Mosley's Filled-in Worksheet 2 for
Example 1. One by one, Mosley applies the
distribution up to the $100,000 limit against
each disaster, as possible. He applies
$100,000 of the April 30 distribution to
Disaster 1 and $40,000 of the April 30
distribution to Disaster 2. In column (b), lines
1 through 5, of his 2019 Form 8915-C,
Mosley enters the amounts from lines 1
through 5 of his Filled-in Worksheet 2,
column (b). He leaves column (c) of his 2019
Form 8915-C blank.
Example 2. The facts are the same as in
Example 1, except in 2018, Mosley had a
$20,000 qualified 2018 disaster distribution
from line 4, column (b), of 2018 Form 8915-C
for Disaster 1. He completes the Mosley's
Filled-in Worksheet 2 for Example 2. He
enters $20,000 on line 1 under Disaster 1.
For 2019, one by one, Mosley applies the
distributions up to the $100,000 limit against
each disaster, as possible. He applies
$80,000 of the April 2019, distribution to
Disaster 1. With the $20,000 from 2018, he
has reached his $100,000 limit for that
disaster. He applies $60,000 of the April
2019, distribution to Disaster 2. In column
(b), lines 1 through 5, of his 2019 Form
8915-C, Mosley enters the amounts from
lines 1 through 5 of his Filled-in Worksheet 2,
column (b). He leaves column (c) of his 2019
Form 8915-C blank.
Example 3. Mosley suffered economic
losses as a result of these three qualified
2018 disasters. Disaster 1: Hawaii Severe
Storms, Flooding, Landslides, And
Mudslides. Disaster 2: Kilauea Volcanic
Eruption And Earthquakes. Disaster 3:
Hurricane Lane. In 2019, he received a
traditional IRA distribution of $240,000 and a
Roth IRA distribution of $30,000 for a total of
$270,000 in distributions. These distributions
were made on September 30 and October
16, respectively. He reported no other
qualified disaster distributions for 2018 or
2019. He completes the Mosley's Filled-in
Worksheet 2 for Example 3. One by one,
Mosley applies the distributions up to the

Instructions for Form 8915-C (2019)

$100,000 limit against each disaster, as
possible. He applies $100,000 of the
September 30 distribution to Disaster 1 and
$100,000 of the September 30 distribution to
Disaster 2. Mosley applies the remaining
$40,000 of the September 30 distribution to
the Hurricane Lane disaster. He applies, in
addition, the full $30,000 from the October
distribution to Disaster 3. In column (b), lines
1 through 5, of his 2019 Form 8915-C,
Mosley enters the amounts from lines 1
through 5 of his Filled-in Worksheet 2,
column (b). He leaves column (c) of his 2019
Form 8915-C blank.

Example 4. The facts are the same as in
Example 3, except in 2018, Mosley had a
$20,000 qualified 2018 disaster distribution
from line 4, column (b), of 2018 Form 8915-C
for Disaster 1. He completes the Mosley's
Filled-in Worksheet 2 for Example 4. He
enters $20,000 on line 1 under Disaster 1.
For 2019, one by one, Mosley applies the
distributions up to the $100,000 limit against
each disaster, as possible. He applies
$80,000 of the September 2019 distribution
to Disaster 1. With the $20,000 from 2018,
he has reached his $100,000 limit for that
disaster. He applies $100,000 of the

September 2019 distribution to Disaster 2.
Mosley applies the remaining $60,000 of the
September 2019 distribution to Disaster 3.
He applies, in addition, the full $30,000 from
the October 2019 distribution to Disaster 3.
In column (b), lines 1 through 5, of his 2019
Form 8915-C, Mosley enters the amounts
from lines 1 through 5 of his Filled-in
Worksheet 2, column (b). He leaves column
(c) of his 2019 Form 8915-C blank.

Mosley's Filled-in Worksheets 2: Use if you incurred economic losses from more than one qualified 2018
disaster and your total qualified 2018 disaster distributions made in 2018 and 2019 total more than $100,000.
Mosley’s Filled-in Worksheet 2 for
Example 1

1

(a)

(X)

(b)

Total
available
distributions
in 2019

Qualified 2018 disaster distributions

Qualified 2018 disaster distributions

• If you did not file 2018 Form 8915-C,
enter -0- for each listed Disaster in column
(X).
• If you filed 2018 Form 8915-C and you
only reported one disaster on that form,
enter in column (X) for that disaster the
amount from your 2018 Form 8915-C,
line 4, column (b).
• If for your 2018 Form 8915-C you were
required to use Worksheet 2 in the
instructions, enter in column (X) the
amounts from line 4 of column (X), in your
Worksheet 2 in the 2018 Form 8915-C
instructions.
Note. If the amount on line 1 of this
worksheet is $100,000 or more for a
disaster, you cannot have qualified 2018
disaster distributions in 2019 for that
disaster. Do not complete Worksheet 2 for
that disaster.

2

Distributions from retirement plans (other
than IRAs)

3

Distributions from traditional, SEP, and
SIMPLE IRAs

4

Distributions from Roth IRAs

5

Totals. Add lines 1 through 4.

Instructions for Form 8915-C (2019)

Disaster 1

Disaster 2

Disaster 3

Disaster 4

(Total for all disasters)

-0-

-0-

-0-

-0-

-0-

-0-

-0-

$140,000

$100,000

$40,000

$140,000

-0-

-0-

-0-

-0-

$140,000

$100,000

$40,000

$140,000

-5-

Mosley’s Filled-in Worksheet 2 for Example 2

(a)

(X)

Total
available
distributions
in 2019
1

• If you did not file 2018 Form 8915-C,
enter -0- for each listed Disaster in column (X).
• If you filed 2018 Form 8915-C and you
only reported one disaster on that form, enter
in column (X) for that disaster the amount from
your 2018 Form 8915-C, line 4, column (b).
• If for your 2018 Form 8915-C you were
required to use Worksheet 2 in the
instructions, enter in column (X) the amounts
from line 4 of column (X), in your Worksheet 2
in the 2018 Form 8915-C instructions.
Note. If the amount on line 1 of this worksheet
is $100,000 or more for a disaster, you cannot
have qualified 2018 disaster distributions in
2019 for that disaster. Do not complete
Worksheet 2 for that disaster.

2

Distributions from retirement plans (other than
IRAs)

3

Distributions from traditional, SEP, and
SIMPLE IRAs

4

Distributions from Roth IRAs

5

Totals. Add lines 1 through 4.

Mosley’s Filled-in Worksheet 2 for Example 3

Qualified 2018 disaster distributions
Disaster 1

Disaster 2

Disaster 3

Qualified 2018 disaster distributions
Disaster 4

(Total for all disasters)

$20,000

-0-

$20,000

-0-

-0-

-0-

-0-

$140,000

$80,000

$60,000

$140,000

-0-

-0-

-0-

-0-

$140,000

$100,000

$60,000

$160,000

(a)

(X)

Total
available
distributions
in 2019
1

(b)

• If you did not file 2018 Form 8915-C,
enter -0- for each listed Disaster in column (X).
• If you filed 2018 Form 8915-C and you
only reported one disaster on that form, enter
in column (X) for that disaster the amount from
your 2018 Form 8915-C, line 4, column (b).
• If for your 2018 Form 8915-C you were
required to use Worksheet 2 in the
instructions, enter in column (X) the amounts
from line 4 of column (X), in your Worksheet 2
in the 2018 Form 8915-C instructions.
Note. If the amount on line 1 of this worksheet
is $100,000 or more for a disaster, you cannot
have qualified 2018 disaster distributions in
2019 for that disaster. Do not complete
Worksheet 2 for that disaster.

(b)

Qualified 2018 disaster distributions
Disaster 1

Disaster 2

Disaster 3

Qualified 2018 disaster distributions
Disaster 4

(Total for all disasters)

-0-

-0-

-0-

-0-

-0-

-0-

-0-

-0-

-0-

$240,000

$100,000

$100,000

$40,000

$240,000

2

Distributions from retirement plans (other than
IRAs)

3

Distributions from traditional, SEP, and
SIMPLE IRAs

4

Distributions from Roth IRAs

$30,000

-0-

-0-

$30,000

$30,000

5

Totals. Add lines 1 through 4.

$270,000

$100,000

$100,000

$70,000

$270,000

-6-

Instructions for Form 8915-C (2019)

Mosley’s Filled-in Worksheet 2 for Example 4

(a)

(X)

Total
available
distributions
in 2019

• If you did not file 2018 Form 8915-C,
enter -0- for each listed Disaster in column (X).
• If you filed 2018 Form 8915-C and you
only reported one disaster on that form, enter
in column (X) for that disaster the amount from
your 2018 Form 8915-C, line 4, column (b).
• If for your 2018 Form 8915-C you were
required to use Worksheet 2 in the
instructions, enter in column (X) the amounts
from line 4 of column (X), in your Worksheet 2
in the 2018 Form 8915-C instructions.
Note. If the amount on line 1 of this worksheet
is $100,000 or more for a disaster, you cannot
have qualified 2018 disaster distributions in
2019 for that disaster. Do not complete
Worksheet 2 for that disaster.

1

(b)

Qualified 2018 disaster distributions
Disaster 1

Disaster 2

Disaster 3

Qualified 2018 disaster distributions
Disaster 4

(Total for all disasters)

$20,000

-0-

-0-

$20,000

-0-

-0-

-0-

-0-

-0-

$240,000

$80,000

$100,000

$60,000

$240,000

2

Distributions from retirement plans (other than
IRAs)

3

Distributions from traditional, SEP, and
SIMPLE IRAs

4

Distributions from Roth IRAs

$30,000

-0-

-0-

$30,000

$30,000

5

Totals. Add lines 1 through 4.

$270,000

$100,000

$100,000

$90,000

$290,000

Line 7

See the caution below before you begin
line 7.
Before you begin line 7: If you are
using Worksheet 2, do not complete
CAUTION line 7 until you have completed
Worksheet 2.

!

Instructions for Form 8915-C (2019)

If line 7 includes an amount distributed for
the purchase or construction of a main home
in a qualified 2018 disaster area, but you did
not purchase or construct that home
because of the qualified 2018 disaster,
report this amount on line 2 of Worksheet 3.
See Qualified Distribution for the Purchase or
Construction of a Main Home in Qualified

-7-

2018 Disaster Areas, earlier. Also, see the
instructions for your tax return for reporting
all other distributions included on line 7.

Part II—Qualified 2018
Disaster Distributions
From Retirement Plans
(Other Than IRAs)

Complete Part II if any of the following apply.
• You have an amount entered on 2019
Form 8915-C, line 2, column (b).
• You had an amount on your 2018 Form
8915-C, line 9, and you did not check the
box on that line.
• You made a repayment in 2019 of
qualified 2018 disaster distribution amounts
from line 8 of 2018 Form 8915-C.
Line 9. Enter on line 9 your cost, if any. Your
cost is generally your net investment in the
plan. It does not include pre-tax
contributions. If there is an amount in Form
1099-R, box 2a (taxable amount), the
difference between Form 1099-R, box 1 and
box 2a, is usually your cost. Enter the
difference on line 9.
If there is no amount in Form 1099-R,
box 2a, and the first box in box 2b is
checked, the issuer of Form 1099-R may not
have had all the facts needed to figure the
taxable amount. You may want to get Pub.
575, Pension and Annuity Income, to help
figure your taxable amount.
Also, see Pub. 575 if you use the
Simplified Method Worksheet to figure the
taxable amount of your periodic payments
and you designated some of these payments
as qualified 2018 disaster distributions.
If you have a Form 1099-R with both
qualified 2018 disaster distributions
CAUTION and nonqualified distributions, you
must separately figure the cost attributable to
each distribution.

!

Line 11. If you don’t check the box on
line 11, you must spread the amount on
line 10 over 3 years. If you use this method to
figure the taxable amount of your
distributions, you cannot change it after the
due date (including extensions) for your tax
return. If you checked the box on line 26, you
must check the box on line 11.
If the taxpayer died during 2019 after
receiving a qualified 2018 disaster
distribution, the taxable amount of the
distribution may not be spread over 3 years.
The entire distribution must be reported on
the tax return of the deceased taxpayer.
Line 17. At any time during the 3-year
period that begins the day after the date you
received a qualified 2018 disaster
distribution, you can repay any portion of the
distribution to an eligible retirement plan that
accepts rollover contributions. You cannot,
however, repay more than the amount of the
original distribution. See Repayment of a
Qualified 2018 Disaster Distribution, earlier,
for details.
Enter on line 17 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

elected to repay the distribution over 3 years
and you repaid more than the amount on
line 11, the excess will be carried forward to
your 2020 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 if you elected to repay
the distribution over 3 years. However, you
may have to file an amended return in certain
situations. See Amending Form 8915-C,
earlier.
Example. You received a $90,000
qualified 2018 disaster distribution on
November 7, 2019, from your 401(k) plan.
You had an economic loss due to Hurricane
Florence. On April 2, 2020, you repay
$30,000 to an IRA. You file your return on
April 10, 2020. Since the repayment was
made before you filed your return, and not
later than the due date (including
extensions), you would enter the $30,000
repayment on line 17.

Part III—Qualified 2018
Disaster Distributions
From Traditional, SEP,
SIMPLE, and Roth IRAs

Complete Part III if any of the following apply.
• You have an amount entered on 2019
Form 8915-C, line 3, column (b), or line 4,
column (b).
• You had an amount on your 2018 Form
8915-C, line 17, and you did not check the
box on that line.
• You made a repayment in 2019 of
qualified 2018 disaster distribution amounts
from line 16 of 2018 Form 8915-C.
Before completing this part, complete
2019 Form 8606 if either of the following
applies.
• You received a qualified 2018 disaster
distribution from a traditional, SEP, or
SIMPLE IRA, and you have a basis in the
IRA.
• You received a qualified 2018 disaster
distribution from a Roth IRA.
For more information, see 2019 Form
8606 and its instructions.
Line 26. If you do not check the box on
line 26, you must spread the amount on
line 25 over 3 years. If you use this method to
figure the taxable amount of your
distributions, you cannot change it after the
due date (including extensions) for your tax
return. If you checked the box on line 11, you
must check the box on line 26.
If the taxpayer died during 2019 after
receiving a qualified 2018 disaster
distribution, the taxable amount of the
distribution may not be spread over 3 years.
The entire distribution must be reported on
the tax return of the deceased taxpayer.
Line 32. At any time during the 3-year
period that begins the day after the date you
received a qualified 2018 disaster
distribution, you can repay any portion of the
distribution to an eligible retirement plan that
-8-

accepts rollover contributions. You cannot,
however, repay more than the amount of the
original distribution. See Repayment of a
Qualified 2018 Disaster Distribution, earlier,
for details.
Enter on line 32 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
elected to repay the distribution over 3 years
and you repaid more than the amount on
line 26, the excess will be carried forward to
your 2020 tax return. Repayments made
after the due date of your 2019 return
(including extensions) but before the due
date (including extensions) of your 2020
return generally will be reported on your
2020 tax return if you are spreading the
income over 3 years. However, you may
have to file an amended return in certain
situations. See Amending Form 8915-C,
earlier.
Example. You received a $90,000
qualified 2018 disaster distribution on
October 20, 2019, from your traditional IRA.
You had an economic loss due to Hurricane
Lane. On April 2, 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, and not
later than the due date (including
extensions), you would enter the $30,000
repayment on line 32.

Part IV—Qualified
Distributions for the
Purchase or Construction
of a Main Home in
Qualified 2018 Disaster
Areas

Complete Part IV if, in 2019, you received a
qualified distribution for the purchase or
construction of a main home in a qualified
2018 disaster area that you repaid in whole
or in part no later than June 17, 2020. But
see also Line 1 under Line-by-line
instructions for Worksheet 3, later. Use
Worksheet 3 to determine the amount to
enter on line 35 of Part IV. The instructions
for Worksheet 3 follow.
Only distributions made in 2019 for
Mississippi Severe Storms,
CAUTION Flooding, And Tornado (ending date
December 28, 2018) and Washington
Severe Winter Storms, Straight-line Winds,
Flooding, Landslides, Mudslides, Tornado
(ending date December 24, 2018) can
qualify for Part IV treatment on 2019 Form
8915-C.

!

If you are required to file 2019 Form 8606,
complete that form before you complete this
part.
Note. A distribution made in 2019 for the
purchase or construction of a main home
may be treated as a qualified 2018 disaster
distribution in certain circumstances. See

Instructions for Form 8915-C (2019)

Worksheet 3. Use to determine the amount for line 35 in Part IV of 2019 Form 8915-C.
Note Only distributions made in 2019 for the Mississippi Severe Storms, Flooding, And Tornado and Washington Severe Winter Storms,
Straight-line Winds, Flooding, Landslides, Mudslides, Tornado disasters can qualify for Part IV treatment on 2019 Form 8915-C.
1

Did you receive a qualified distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required to be reported on 2019 Form 8606?
If Yes: Complete lines 2 through 6 of this worksheet, only if you had qualified distributions not required to be reported on 2019 Form 8606.
If No: Go to line 2.

2

Enter the total amount of qualified distributions you received in for the purchase or construction of a main home. Don’t include any
amounts reported on 2019 Form 8606. Also, don’t include any distributions you reported on 2019 Form 8915-D, line 6 or line 15, or on
2019 Form 8915-C, line 8 or 24, if any . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

3

Enter the applicable cost of distributions, if any

.......................................................

$

4

Subtract line 3 from line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

5

Enter the total amount of any repayments you made. See instructions for allowable repayments. Don’t include any repayments treated
as rollovers on Form 8606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

6

Taxable amount. Subtract line 5 from line 4. Enter the result here and on 2019 Form 8915-C, line 35.

$

• If the distribution is from an IRA, include this amount in the total on 2019 Form 1040 or 1040-SR, line 4b; or 2019 Form 1040-NR, line 16b.
• If the distribution is from a retirement plan (other than an IRA), include this amount in the total on 2019 Form 1040 or 1040-SR, line 4d; or 2019 Form
1040-NR, line 17b.
Note. You may be subject to an additional tax on the amount on line 6 of this worksheet. See instructions.

Repayment of a Qualified Distribution for the
Purchase or Construction of a Main Home,
earlier.
Line-by-line instructions for Worksheet
3. The instructions for the lines of
Worksheet 3 are below.
Line 1. If you said “Yes,” but are not
required to complete lines 2 through 5 of
Worksheet 3, you still must file 2019 Form
8915-C to show that you received a qualified
distribution in 2019.
Line 2. Enter on line 2 your qualified
distributions (see Qualified Distribution for
the Purchase or Construction of a Main
Home in Qualified 2018 Disaster Areas,
earlier).
Don’t include any distributions you
designated as qualified 2018 disaster
distributions reported on line 8 or line 24.
Also, don’t include any amounts reported on
2019 Form 8606.
Line 3. Enter on line 3 your cost, if any.
Your cost is generally your net investment in
the plan. It does not include pre-tax
contributions. If there is an amount in Form
1099-R, box 2a (taxable amount), the
difference between Form 1099-R, box 1 and
box 2a, is usually your cost. See Pub. 575 for
more information about figuring your cost in
the plan.
In many cases, a hardship distribution
from a 401(k) plan or a tax-sheltered annuity
contract will not have any cost.
If you received a first-time homebuyer
distribution from an IRA, don’t enter any
amount on line 3. Any cost or basis in an IRA
is figured on 2019 Form 8606 if you made
nondeductible contributions.
If you have a Form 1099-R with both
qualified distributions and
CAUTION nonqualified distributions, you must
separately figure the cost attributable to each
distribution.

!

Instructions for Form 8915-C (2019)

Line 5. At any time before June 18,
2020, you can repay any portion of a
qualified distribution to an eligible retirement
plan that accepts rollovers (see Repayment
of a Qualified Distribution for the Purchase or
Construction of a Main Home, earlier). You
can’t, however, repay more than the amount
of the original distribution.
Enter on line 5 the amount of any
repayments you make no later than June 17,
2020. Don’t include any repayments treated
as rollovers on 2019 Form 8606 nor any
repayments of nontaxable amounts.
Line 6. Most distributions from qualified
retirement plans (including IRAs) made to
you before you reach age 591/2 are subject to
an additional tax on early distributions and
are reported on Form 5329. Qualified
distributions for the purchase or construction
of a main home in a qualified 2018 disaster
area that were not repaid to an eligible
retirement plan before June 18, 2020, may
be subject to this additional tax unless you
qualify for an exception. See the Instructions
for Form 5329 for information on exceptions
to this tax. If you have not repaid the
distribution before June 18, 2020, you may
be able to designate the qualified distribution
as a qualified 2018 disaster distribution. See
Repayment of a Qualified Distribution for the
Purchase or Construction of a Main Home,
earlier.

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 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

-9-

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 information, or you provide
incomplete or false information, you may be
subject to penalties. You are not required to
provide the information requested on a form
that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB
control number. Books or records relating to
a form or its instructions must be retained as
long as their contents may become material
in the administration of any Internal Revenue
law. Generally, tax returns and return
information are confidential, as required by
section 6103. However, we may give this
information to the Department of Justice for
civil and criminal litigation, and to cities,
states, the District of Columbia, and U.S.
commonwealths and possessions to carry
out their tax laws. We may also disclose this
information to other countries under a tax
treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to
federal law enforcement and intelligence
agencies to combat terrorism.
The average time and expenses required
to complete and file this form will vary
depending on individual circumstances. For
the estimated averages, see the instructions
for your income tax return.
If you have suggestions for making this
form simpler, we would be happy to hear
from you. See the instructions for your
income tax return.

Worksheets

A blank Worksheet 2 follows. A blank
Worksheet 3 is earlier. Worksheet 1 is
reserved.

Worksheet 1: Reserved.

Worksheet 2: Use if you incurred economic losses from more than one qualified 2018 disaster and your total
qualified 2018 disaster distributions made in 2018 and 2019 total more than $100,000.
Worksheet 2 for Form 8915-C

(a)
Total
available
distributions
in 2019

1

(X)

(b)

Qualified 2018 disaster distributions
Disaster 1

Disaster 2

Disaster 3

Qualified 2018 disaster distributions

Disaster 4

(Total for all disasters)

• If you did not file 2018 Form 8915-C,
enter -0- for each listed Disaster in
column (X).
• If you filed 2018 Form 8915-C and
you only reported one disaster on that
form, enter in column (X) for that
disaster the amount from your 2018
Form 8915-C, line 4, column (b).
• If for your 2018 Form 8915-C you
were required to use Worksheet 2 in the
instructions, enter in column (X) the
amounts from line 4 of column (X), in
your Worksheet 2 in the 2018 Form
8915-C instructions.
Note. If the amount on line 1 of this
worksheet is $100,000 or more for a
disaster, you cannot have qualified
2018 disaster distributions in 2019 for
that disaster. Do not complete
Worksheet 2 for that disaster.

2

Distributions from retirement plans
(other than IRAs)

3

Distributions from traditional, SEP, and
SIMPLE IRAs

4

Distributions from Roth IRAs

5

Totals. Add lines 1 through 4.

-10-

Instructions for Form 8915-C (2019)

Table 1. Qualified 2018 Disaster Areas for Form 8915-C
Disaster Area

Qualified 2018 Disaster

Date of Declaration

Disaster Period aka Incident Period

Alabama

Severe Storms And Tornadoes (DR-4362)

April 26, 2018

March 19, 2018 - March 20, 2018

Alabama

Hurricane Michael (DR-4406)

November 05, 2018

October 10, 2018 - October 13, 2018

Alaska

Flooding (DR-4391)

September 05, 2018

May 11, 2018 - May 13, 2018

Alaska

Earthquake (DR-4413)

January 31, 2019

November 30, 2018

American Samoa

Tropical Storm Gita (DR-4357)

March 02, 2018

February 07, 2018 - February 12, 2018

California

Wildfires And High Winds (DR-4382)

August 04, 2018

July 23, 2018 - September 19, 2018

California

Wildfires (DR-4407)

November 12, 2018

November 08, 2018 - November 25, 2018

Confederated Tribes of the Colville
Reservation

Flooding (DR-4384)

August 17, 2018

May 05, 2018 - May 28, 2018

Connecticut

Severe Storms, Tornadoes, And Straight-line Winds (DR-4385)

August 20, 2018

May 15, 2018

Connecticut

Severe Storms And Flooding (DR-4410)

December 05, 2018

September 25, 2018 - September 26, 2018

Florida

Hurricane Michael (DR-4399)

October 11, 2018

October 07, 2018 - October 19, 2018

Georgia

Hurricane Michael (DR-4400)

October 14, 2018

October 09, 2018 - October 23, 2018

Guam

Typhoon Mangkhut (DR-4398)

October 01, 2018

September 10, 2018 - September 11, 2018

Havasupai Tribe

Severe Storms, Flooding, And Landslides (DR-4389)

August 31, 2018

July 11, 2018 - July 12, 2018

Hawaii

Severe Storms, Flooding, Landslides, And Mudslides (DR-4365)

May 08, 2018

April 13, 2018 - April 16, 2018

Hawaii

Kilauea Volcanic Eruption And Earthquakes (DR-4366)

May 11, 2018

May 03, 2018 - August 17, 2018

Hawaii

Hurricane Lane (DR-4395)

September 27, 2018

August 22, 2018 - August 29, 2018

Indiana

Severe Storms And Flooding (DR-4363)

May 04, 2018

February 14, 2018 - March 04, 2018

Iowa

Severe Storms, Tornadoes, Straight-line Winds, And Flooding (DR-4386)

August 20, 2018

June 06, 2018 - July 02, 2018

Iowa

Severe Storm And Tornadoes (DR-4392)

September 12, 2018

July 19, 2018

Kansas

Severe Storms, Straight-line Winds, And Flooding (DR-4403)

October 19, 2018

September 01, 2018 - September 08, 2018

Kansas

Severe Storms, Straight-line Winds, And Flooding (DR-4417)

February 25, 2019

October 04, 2018 - October 15, 2018

Kentucky

Severe Storms, Flooding, Landslides, And Mudslides (DR-4358)

April 12, 2018

February 09, 2018 - February 14, 2018

Kentucky

Severe Storms, Tornadoes, Flooding, Landslides, And Mudslides (DR-4361)

April 26, 2018

February 21, 2018 - March 21, 2018

Maine

Severe Storm And Flooding (DR-4367)

May 30, 2018

March 02, 2018 - March 08, 2018

Maryland

Severe Storms And Flooding (DR-4374)

June 25, 2018

May 15, 2018 - May 19, 2018

Maryland

Severe Storm And Flooding (DR-4376)

July 02, 2018

May 27, 2018 - May 28, 2018

Massachusetts

Severe Winter Storm And Flooding (DR-4372)

June 25, 2018

March 02, 2018 - March 03, 2018

Massachusetts

Severe Winter Storm And Snowstorm (DR-4379)

July 19, 2018

March 13, 2018 - March 14, 2018

Michigan

Severe Storms, Flooding, Landslides, And Mudslides (DR-4381)

August 02, 2018

June 16, 2018 - June 18, 2018

Minnesota

Severe Storms, Tornadoes, Straight-line Winds, And Flooding (DR-4390)

September 05, 2018

June 15, 2018 - July 12, 2018

Minnesota

Severe Storms And Flooding (DR-4414)

February 01, 2019

October 09, 2018 - October 11, 2018

Mississippi

Severe Storms, Flooding, And Tornado (DR-4415)

February 14, 2019

December 27, 2018 - December 28, 2018

Montana

Flooding (DR-4388)

August 30, 2018

April 12, 2018 - May 06, 2018

Montana

Flooding (DR-4405)

October 31, 2018

May 01, 2018 - June 10, 2018

Nebraska

Severe Winter Storm and Straight-line Winds (DR-4375)

June 29, 2018

April 13, 2018 - April 18, 2018

Nebraska

Severe Storms, Tornadoes, Straight-line Winds, And Flooding (DR-4387)

August 27, 2018

June 17, 2018 - July 01, 2018

New Hampshire

Severe Winter Storm And Snowstorm (DR-4371)

June 08, 2018

March 13, 2018 - March 14, 2018

New Hampshire

Severe Storm And Flooding (DR-4370)

June 08, 2018

March 02, 2018 - March 08, 2018

New Jersey

Severe Winter Storm And Snowstorm (DR-4368)

June 08, 2018

March 06, 2018 - March 07, 2018

New York

Severe Storms And Flooding (DR-4397)

October 01, 2018

August 13, 2018 - August 15, 2018

North Carolina

Tornado And Severe Storms (DR-4364)

May 08, 2018

April 15, 2018

North Carolina

Hurricane Florence (DR-4393)

September 14, 2018

September 07, 2018 - September 29, 2018

North Carolina

Tropical Storm Michael (DR-4412)

January 31, 2019

October 10, 2018 - October 12, 2018

Northern Mariana Islands

Typhoon Mangkhut (DR-4396)

September 29, 2018

September 10, 2018 - September 11, 2018

Northern Mariana Islands

Super Typhoon Yutu (DR-4404)

October 26, 2018

October 24, 2018 - October 26, 2018

Ohio

Severe Storms, Landslides, And Mudslides (DR-4360)

April 17, 2018

February 14, 2018 - February 25, 2018

Oklahoma

Wildfires (DR-4373)

June 25, 2018

April 11, 2018 - April 20, 2018

Pennsylvania

Severe Storms And Flooding (DR-4408)

November 27, 2018

August 10, 2018 - August 15, 2018

South Carolina

Hurricane Florence (DR-4394)

September 16, 2018

September 08, 2018 - October 08, 2018

Texas

Severe Storms And Flooding (DR-4377)

July 06, 2018

June 19, 2018 - July 13, 2018

Texas

Severe Storms And Flooding (DR-4416)

February 25, 2019

September 10, 2018 -November 02, 2018

Tohono O’odham Nation

Severe Storms And Flooding (DR-4409)

November 30, 2018

October 01, 2018 - October 03, 2018

Vermont

Severe Storm And Flooding (DR-4380)

July 30, 2018

May 04, 2018 - May 05, 2018

Virginia

Hurricane Florence (DR-4401)

October 15, 2018

September 08, 2018 - September 21, 2018

Virginia

Tropical Storm Michael (DR-4411)

December 18, 2018

October 09, 2018 - October 16, 2018

Washington

Severe Winter Storms, Straight-line Winds, Flooding, Landslides, Mudslides, Tornado (DR-4418)

March 04, 2019

December 10, 2018 -December 24, 2018

West Virginia

Severe Storms, Flooding, Landslides, And Mudslides (DR-4359)

April 17, 2018

February 14, 2018 - February 20, 2018

West Virginia

Severe Storms, Flooding, Landslides, And Mudslides (DR-4378)

July 12, 2018

May 28, 2018 - June 03, 2018

Wisconsin

Severe Storms, Straight-line Winds, And Flooding (DR-4383)

August 10, 2018

June 15, 2018 - June 19, 2018

Wisconsin

Severe Storms, Tornadoes, Straight-line Winds, Flooding, And Landslides (DR-4402)

October 18, 2018

August 17, 2018 - September 14, 2018

Instructions for Form 8915-C (2019)

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