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Instructions for Form 8915-F

Department of the Treasury
Internal Revenue Service

(January 2022)

Qualified Disaster Retirement Plan Distributions and Repayments
Contents

Page

These instructions discuss 2021
disasters and also the 2020
CAUTION Washington (4593-DR-WA)
disaster. If legislation for those disasters
is not approved before these
instructions go to print, those
discussions will be removed from the
body of these instructions.

How Do I Distinguish My Form
8915-F and Its Disasters From
Other Forms 8915-F?

DRAFT AS OF
December 2, 2021

General Instructions . . . . . . . . .
Future Developments . . . . .
Helpful Hints . . . . . . . . . .
Purpose of Form . . . . . . .
Purpose of These
Instructions . . . . . . . . .
How Do I Distinguish My
Form 8915-F and Its
Disasters From Other
Forms 8915-F? . . . . . . .
When Should I Not Use a
Form 8915-F? . . . . . . .
Who Must File . . . . . . . . .
When and Where To File . .
What Is a Qualified Disaster
Distribution? . . . . . . . . .
Qualified Disaster
Distribution . . . . . . . . .
Qualified Distribution for the
Purchase or Construction
of a Main Home in
Qualified Disaster Areas
Amending Form 8915-F
(2020 Disasters) and
Form 8915-F (2021
Disasters) . . . . . . . . . .
Specific Instructions . . . . . . . . .
Required General
Information . . . . . . . . .
Part I—Total Distributions
From All Retirement
Plans (Including IRAs) . .
Part II—Qualified Disaster
Distributions From
Retirement Plans (Other
Than IRAs) . . . . . . . . .
Part III—Qualified Disaster
Distributions From
Traditional, SEP,
SIMPLE, and Roth IRAs .
Part IV—Qualified
Distributions for the
Purchase or Construction
of a Main Home in
Qualified Disaster Areas .
Worksheets . . . . . . . . . . .
Appendix A, Which Lines
Should I Use? . . . . . . . .
Appendix B, Qualified
Disaster Areas by Year . .

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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-F and its
instructions, such as legislation enacted after
they were published, go to IRS.gov/
Form8915F.

Nov 30, 2021

!

Helpful Hints

Form 8915-F can be e-filed. The Form
8915-F can be completed electronically and
e-filed with your tax return.

Form 8915-F is a forever form. Form
8915-F is a redesigned Form 8915.
Beginning in 2021, additional alphabetical
Forms 8915 (that is, Form 8915-G, Form
8915-H, etc.) will not be issued. The same
Form 8915-F will be used for distributions for
2020 and later disasters and for each year of
reporting of income and repayments of those
distributions. The boxes you check in items
A and B will help us determine the exact year
of the form you are filing, and the year of the
qualified disasters, qualified disaster
distributions, and qualified distributions you
are reporting. Earlier Forms 8915 had a
different alphabetical Form 8915 for each
year of disasters and a different form for
each year the alphabetical form existed. See
How Do I Distinguish My Form 8915-F and
Its Disasters From Other Forms 8915-F and
When Should I Not Use a Form 8915-F,
later.

Purpose of Form

Use Form 8915-F to report:
• Qualified 2021 and later disaster
distributions, if any;
• Qualified 2020 disaster distributions made
in 2021 or 2022, as applicable
(coronavirus-related distributions can't be
made after December 30, 2020);
• Repayments of qualified 2020 and later
disaster distributions;
• Income in 2021 and later years from
qualified 2020 and later disaster
distributions; and
• Qualified distributions received in 2021
and later years.

Purpose of These Instructions

These instructions provide detailed
information for use with your 2021 Forms
8915-F. For your convenience, Appendix A,
Which Lines Should I Use, later, provides, as
well, the lines you should complete on your
Form 8915-F for all tax years applicable to
2020 and 2021 disasters.

Cat. No. 37509G

Name of form. These instructions will refer
to the different Forms 8915-F by their names.
The name is based on the boxes you check
in items A and B at the top of page 1 of your
Form 8915-F.

Form 8915-F (2020 disasters). Check
the 2020 box in item B of your Form 8915-F if
you were adversely affected by a qualified
2020 disaster listed in Table for Qualified
2020 Disaster Areas in Appendix B,
Qualified Disaster Areas by Year at the end
of these instructions, and:
• A qualified disaster distribution described
in Qualified 2020 disaster distribution
requirements, later, was made to you;
• You are repaying, or have income from, a
coronavirus-related distribution or other
qualified 2020 disaster distribution reported
on Part I of 2020 Form 8915-E; or
• You received a qualified distribution
described in Qualified 2020 disaster areas
under Qualified Distribution for the Purchase
or Construction of a Main Home in Qualified
Disaster Areas, later.
Your form will be called Form 8915-F (2020
disasters).
The year of the form will be the year you
checked in item A at the top of page 1 of your
Form 8915-F. If you checked the 2021 box in
item A, your form will be called 2021 Form
8915-F (2020 disasters).
Form 8915-F (2021 disasters). Check
the 2021 box in item B of your Form 8915-F if
you were adversely affected by a qualified
2021 disaster listed in Table for Qualified
2021 Disaster Areas in Appendix B at the
end of these instructions, and a distribution
described in Qualified 2021 disaster
distribution requirements, later, was made to
you, or you received a distribution described
in Qualified 2021 disaster areas under
Qualified Distribution for the Purchase or
Construction of a Main Home, later. Your
form will be called Form 8915-F (2021
disasters).
The year of the form will be the year you
checked in item A at the top of page 1 of your
Form 8915-F. If you checked the 2021 box in
item A, your form will be called 2021 Form
8915-F (2021 disasters).
Names of disasters and distributions.
Except when referring to them generally,
these instructions will refer to the different
qualified disasters and qualified disaster
distributions by their specific name using the
year you checked in item B at the top of
page 1 of your Form 8915-F. For example, if
you checked the "2020" box in item B, you

should read the discussions of qualified 2020
disasters and of distributions for those
disasters.

When Should I Not Use a Form
8915-F?
Reporting coronavirus-related and other
distributions for qualified 2020 disasters
made or received in 2020. This form
replaces Form 8915-E for tax years
beginning after 2020. Do not use a Form
8915-F to report qualified 2020 disaster
distributions made in 2020 or qualified
distributions received in 2020 for 2020
disasters.

When and Where To File

Qualified Disaster Distribution
Requirements

File your Form 8915-F with your Form 1040,
1040-SR, or 1040-NR for the year checked
in item A at the top of page 1 of your Form
8915-F.

A coronavirus-related distribution
can't be made after 2020. Also, a
CAUTION distribution is not a qualified 2020
disaster distribution or a qualified 2021
disaster distribution if it is listed in
Distributions that are not qualified disaster
distributions, later. See Limit, later, for the
dollar limit on qualified disaster distributions.

!

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-F, see
Amending Form 8915-F, later.

DRAFT AS OF
December 2, 2021

You will still use 2020 Form 8915-E
to report coronavirus-related and
CAUTION other qualified disaster distributions
made in 2020 and to report qualified
distributions received in 2020 for qualified
2020 disasters.

!

Qualified 2019 and earlier disasters. Do
not use Form 8915-F to do the following.
• Repay qualified 2017 disaster
distributions. Use Form 8915-B for those
repayments.
• Repay qualified 2018 disaster
distributions. Use Form 8915-C for those
repayments.
• Repay, and report income from, qualified
2019 disaster distributions. Use Form
8915-D for those repayments and income.

Which Lines Should I
Complete?
If you e-file your return, the software

TIP you use may determine which lines
you need.

At any rate, you might not need to enter
amounts on each line of your Form 8915-F.
The tables in Form 8915-F (2020 Disasters):
Lines To Use and Form 8915-F (2021
Disasters): Lines To Use, later, provide the
lines you need to complete on the form you
will be using. The lines you use will depend
on:
• Whether qualified disaster distributions
were made to you,
• Whether you have received qualified
distributions,
• Whether you are recognizing income from
distributions, and
• Whether you are repaying distributions.

Who Must File

File Form 8915-F for the year you checked in
item A at the top of page 1 of the form if any
of the following apply to you for that year for
the disasters you checked in item B.
• A qualified disaster distribution was made
to you from an eligible retirement plan.
• You received a qualified distribution.
• A qualified disaster distribution was made
to you in a prior year that you are including in
income in equal amounts over 3 years and
the 3-year period has not yet lapsed.
• You made a repayment of a qualified
disaster distribution.

What Is a Qualified
Disaster Distribution?

For 2021, qualified disaster distributions are:
• The qualified 2019 disaster distributions
for the Puerto Rico Earthquakes on 2021
Form 8915-D,
• The qualified 2020 disaster distributions
for qualified 2020 disasters reported on 2021
Form 8915-F (2020 disasters), and
• The qualified 2021 disaster distributions
for qualified 2021 disasters reported on 2021
Form 8915-F (2021 disasters).

!

Coronavirus-related distributions
can't be made in 2021.

CAUTION

Qualified Disaster
Distribution
How Is a Qualified Disaster
Distribution Taxed?

Generally, a qualified 2020 disaster
distribution or qualified 2021 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.
On your 2021 Form 8915-F (2020
disasters), lines 11 and 22, you must either
spread all the income for all your qualified
2020 disaster distributions made for 2021 or
include all the income from those
distributions in 2021. Similarly, on your 2021
Form 8915-F (2021 disasters), lines 11 and
22, you must either spread all the income for
all your qualified 2021 disaster distributions
made in for 2021 or include all the income
from those distributions in 2021.
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 2020 disaster distributions
and qualified 2021 disaster distributions
aren't subject to the additional 10% tax on
early distributions.
If a taxpayer who spread the income
from a qualified 2020 disaster
CAUTION distribution or qualified 2021 disaster
distribution over 3 years dies before the last
tax year of that 3-year period, 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.

!

-2-

Qualified 2020 disaster distribution requirements. Qualified 2020 disaster
distributions made in 2021 are reported on
2021 Form 8915-F (2020 disasters) and
must meet the following criteria. You must
meet these requirements separately for each
of your disasters that you are reporting on
2021 Form 8915-F (2020 disasters).
1. The distribution was made no later
than June 24, 2021, unless it was a
distribution for the Washington
(4593-DR-WA) disaster. For the Washington
(4593-DR-WA) disaster, the distribution can
be made at any time in 2021.
2. Your main home was located in a
qualified 2020 disaster area listed in Table
for Qualified 2020 Disaster Areas in
Appendix B at any time during the disaster
period shown for that area in that table. See
Main home, later. The qualified 2020
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 2020 disaster distribution,
regardless of whether the distribution was
made on account of a qualified 2020
disaster. Qualified 2020 disaster distributions
are permitted without regard to your need or
the actual amount of your economic loss.
See Eligible retirement plan, later, for the list
of plans from which qualified 2020 disaster
distributions can be made.
A reduction or offset of your account
balance in an eligible retirement plan (other
than an IRA) in order to repay a loan can also
be designated as a qualified 2020 disaster
distribution. See Distribution of plan loan
offsets, later.
Qualified 2021 disaster distribution requirements. Qualified 2021 disaster
distributions made in 2021 are reported on
2021 Form 8915-F (2021 disasters) and
must meet the following criteria. You must
meet these requirements separately for each
of your disasters that you are reporting on
2021 Form 8915-F (2021 disasters).

Instructions for Form 8915-F (Rev. 1-2022)

1. The distribution was made in 2021 no
earlier than the beginning date of your
disaster.
2. Your main home was located in a
qualified 2021 disaster area listed in Table
for Qualified 2021 Disaster Areas in
Appendix B at any time during the disaster
period shown for that area in that table. See
Main home, later. The qualified 2021
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.

Limit. For each qualified 2020 disaster and
for each qualified 2021 disaster, the total of
your qualified 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 on line 5, column (a), of your Form
8915-F exceeds your total available qualified
disaster distribution amount from line 1e of
your Form 8915-F, you may allocate the
amount among the plans by any reasonable
method when determining the amounts on
lines 2, 3, and 4 of column (b).

Your repayment can't be made any earlier
than the day after the date you received the
qualified 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.

DRAFT AS OF
December 2, 2021

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 2021 disaster distribution
made for 2021, regardless of whether the
distribution was made on account of a
qualified 2021 disaster. Qualified 2021
disaster distributions are permitted without
regard to your need or the actual amount of
your economic loss. See Eligible retirement
plan, later, for the list of plans from which
qualified 2021 disaster distributions can be
made.
A reduction or offset of your account
balance in an eligible retirement plan (other
than an IRA) in order to repay a loan can also
be designated as a qualified 2021 disaster
distribution. See Distribution of plan loan
offsets, later.
Distributions that are not qualified disaster distributions. The following
distributions are not qualified disaster
distributions.
• Corrective distributions of elective
deferrals and employee contributions that
are returned to the employee (together with
the income allocable thereto) in order to
comply with the section 415 limitations.
• Excess elective deferrals under section
402(g), excess contributions under section
401(k), and excess aggregate contributions
under section 401(m).
• Loans that are treated as deemed
distributions pursuant to section 72(p).
• Dividends paid on applicable employer
securities under section 404(k).
• The cost of current life insurance
protection.
• Prohibited allocations that are treated as
deemed distributions pursuant to section
409(p).
• Distributions that are permissible
withdrawals from an eligible automatic
contribution arrangement within the meaning
of section 414(w).
• Distributions of premiums for accident or
health insurance under Treasury Regulations
section 1.402(a)-1(e)(1)(i).

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 box 1 of Form 1099-R.
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 2020 disaster distributions and
qualified 2021 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, the amount on line 7 of your Form
8915-F may be subject to the additional tax.
See the Instructions for Form 5329 on how to
figure the additional tax on your distributions.
Note. If you choose to treat a distribution as
a qualified 2020 disaster distribution or a
qualified 2021 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
Disaster Distribution

If you choose, you can generally repay any
portion of a qualified disaster distribution that
is eligible for tax-free rollover treatment to an
eligible retirement plan. Also, you can repay
a qualified disaster distribution made on
account of hardship from a retirement plan.
However, see Exceptions, later, for qualified
disaster distributions you can’t repay.

Instructions for Form 8915-F (Rev. 1-2022)

-3-

Include on 2021 Form 8915-F (2020
disasters) and 2021 Form 8915-F (2021
disasters), as applicable, any repayments
you made before filing your 2021 return. Any
repayments you made will reduce the
amount of qualified disaster distributions
reported on your return for 2021. Do not
include on your 2021 Form 8915-F (2020
disasters) or 2021 Form 8915-F (2021
disasters) any repayments you made later
than the due date (including extensions) for
filing your 2021 return. If you made a
repayment in 2022 after you filed your 2021
return, the repayment will reduce the amount
of your:
• Qualified 2020 disaster distributions made
for 2021 and included in income on your
2021 return if you have spread the income
over 3 years, unless you filed 2020 Form
8915-E and are eligible to amend your 2020
return; and
• Qualified 2021 disaster distributions made
for 2021 and included in income on your
2021 return if you have spread the income
over 3 years.
See Amending Form 8915-F, later.
Also, if you have spread the income over
3 years, any excess repayments you made
for 2021 will be carried:
• Forward to your 2022 Form 8915-F (2020
disasters) if you reported the excess on your
2021 Form 8915-F (2020 disasters);
• Forward to your 2022 Form 8915-F (2021
disasters) if you reported the excess on your
2021 Form 8915-F (2021 disasters); or
• Back to your 2020 Form 8915-E if you
reported the excess on 2021 Form 8915-F
(2020 disasters), you filed 2020 Form
8915-E, and are eligible to amend your 2020
return.
Example 1. On your 2020 Form 8915-E,
you reported a coronavirus-related
distribution of $9,000 made to you from your
traditional IRA on April 14, 2020. You spread
the income over 3 years ($3,000 in each of
2020, 2021, and 2022). You made no
repayments of the distribution in 2020. In
2021, you made a repayment of $4,500. You
will report $3,000 of the repayment on your
2021 Form 8915-F (2020 disasters). The
excess repayment of $1,500 can be carried
forward to 2022 and reported on your 2022
Form 8915-F (2020 disasters) or carried
back to 2020 and reported on your 2020
Form 8915-E.
Example 2. You suffered economic
losses in 2020 in Hawaii as the result of
DR-4549-HI. You received a qualified 2020
disaster distribution in the amount of $75,000

on April 30, 2021, and $15,000 on May 30,
2021. You wish to treat a contribution of
$90,000 you made on May 19, 2021, as a
repayment of both distributions. Only
$75,000 can be reported as a qualified 2020
disaster distribution repayment. Repayments
can only be made after the date on which the
distribution was received.
Exceptions. You cannot repay the
following types of distributions.
1. Qualified 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.

If the distribution was received in

TIP 2020 or 2019, see 2020 qualified

distributions or 2019 qualified
distributions, respectively, under Amending
Form 8915-F (2020 Disasters), later.
Qualified 2021 disaster areas. To be a
qualified distribution on 2021 Form 8915-F
(2021 disasters) for the purchase or
construction of a main home in a qualified
2021 disaster area, the distribution must
meet all of the following requirements.
1. The disaster was a qualified 2021
disaster. See Table for Qualified 2021
Disaster Areas at the end of these
instructions; it lists the qualified 2021
disasters.
2. 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.
3. The distribution was received no
earlier than 180 days before the first day of
the qualified 2021 disaster and no later than
30 days after the last day of the qualified
2021 disaster. Table for Qualified 2021
Disaster Areas at the end of these
instructions lists the qualified 2021 disasters’
beginning and ending dates.
4. The distribution was to be used to
purchase or construct a main home in the
qualified 2021 disaster area and the main
home was not purchased or constructed
because of the disaster. See Main home,
earlier. The disaster area is the state,
territory, or tribal government in which the
disaster occurs.

disaster (XXXXXXXXXX, in the case of the
Washington (4593-DR-WA) disaster), may
be taxable in the year of the distribution and
may be subject to the additional 10% tax (or
the additional 25% tax for certain SIMPLE
IRAs) on early distributions. See the
Instructions for Form 5329 to figure any tax.
You may be able to designate a qualified
distribution for a 2020 disaster as a qualified
2020 disaster distribution if all of the
following apply.
1. The distribution was made in 2021.
2. The distribution (or any portion
thereof) is not repaid before June 26, 2021,
in the case of the Alaska (4585-DR-AK)
disaster (XXXXXXXXXX, in the case of the
Washington (4593-DR-WA) disaster).
3. The distribution can otherwise be
treated as a qualified 2020 disaster
distribution. See Qualified 2020 disaster
distribution requirements, earlier.

DRAFT AS OF
December 2, 2021

Qualified Distribution for
the Purchase or
Construction of a Main
Home in Qualified Disaster
Areas
Qualified Distribution
Requirements
Qualified 2020 disaster areas. To be a
qualified distribution on 2021 Form 8915-F
(2020 disasters) for the purchase or
construction of a main home in a qualified
2020 disaster area, the distribution must
meet all of the following requirements.
1. The disaster was the Washington
Severe Winter Storm, Straight-line Winds,
Flooding, Landslides, and Mudslides
(4593-DR-WA) or the Alaska Severe Storm,
Flooding, Landslides, and Mudslides
(4585-DR-AK). Leave 2021 Form 8915-F
(2020 disasters), Part IV, blank if your only
qualified 2020 disaster was the coronavirus
or any other 2020 disaster.
2. 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.
3. The distribution was received no later
than 30 days after the last day of the
4593-DR-WA or 4585-DR-AK disaster, as
applicable. Table for Qualified 2020 Disaster
Areas in Appendix B at the end of these
instructions lists the ending dates for the
4593-DR-WA and 4585-DR-AK disasters.
4. The distribution was to be used to
purchase or construct a main home in the
qualified 2020 disaster area and the main
home was not purchased or constructed
because of the disaster. See Main home,
earlier. The disaster area is the state,
territory, or tribal government in which the
disaster occurs.

If the distribution was received in

TIP 2020, see 2020 qualified

distributions under Amending Form
8915-F (2021 disasters), later.

Repayment of a Qualified
Distribution for the Purchase or
Construction of a Main Home
Qualified 2020 disaster areas. If you
received a qualified distribution, in 2021, to
purchase or construct a main home in a
qualified 2020 disaster area, you can choose
to repay that distribution to an eligible
retirement plan no later than June 25, 2021,
in the case of the Alaska (4585-DR-AK)
disaster (XXXXXXXXXX, in the case of the
Washington (4593-DR-WA) disaster). For
this purpose, an eligible retirement plan is
any plan, annuity, or IRA to which a rollover
can be made. Amounts that are repaid no
later than June 25, 2021, in the case of the
Alaska (4585-DR-AK) disaster
(XXXXXXXXXX, in the case of the
Washington (4593-DR-WA) disaster), 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 26, 2021, in
the case of the Alaska (4585-DR-AK)
-4-

If the distribution was received in

TIP 2019 or 2020 for any qualified 2020

disaster, see 2019 qualified
distributions or 2020 qualified distributions
under Amending Form 8915-F (2020
disasters), later.

Qualified 2021 disaster areas. If you
received a qualified distribution, in 2021, to
purchase or construct a main home, in 2021,
you can choose to repay that distribution to
an eligible retirement plan on or after the first
day of the disaster and no later than
XXXXXXXXXX. For this purpose, an eligible
retirement plan is any plan, annuity, or IRA to
which a rollover can be made.
Amounts that are repaid no later than
XXXXXXXXX, 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 XXXXXXXXX, may
be taxable in the year of the distribution,
which may be 2021 (or even 2020; see 2020
qualified distributions under Amending Form
8915-F (2021 disasters), later) and may be
subject to the additional 10% tax (or the
additional 25% tax for certain SIMPLE IRAs)
on early distributions. See the Instructions for
Form 5329 to figure any tax.
You may be able to designate a qualified
distribution as a qualified 2021 disaster
distribution if all of the following apply.
1. The distribution was made in 2021 on
or after the first day of the disaster.
2. The distribution (or any portion
thereof) is not repaid before XXXXXXXXXX.
3. The distribution can otherwise be
treated as a qualified 2021 disaster
distribution. See Qualified 2021 disaster
distribution requirements, earlier.

Instructions for Form 8915-F (Rev. 1-2022)

If the distribution was received in

TIP 2020, see 2020 qualified

distributions under Amending Form
8915-F (2021 disasters), later.

Amending Form 8915-F
(2020 Disasters) and Form
8915-F (2021 Disasters)

Example 2. You received a qualified
2020 disaster distribution in the amount of
$90,000 in 2021. You elected to have the full
income from the distribution recognized in
2021. On November 19, 2022, you make a
repayment of $45,000. The entire $45,000 is
carried back to 2021.
Example 3. You received a qualified
2020 disaster distribution in the amount of
$90,000 in 2021. You choose to spread the
$90,000 over 3 years ($30,000 in income for
2021, 2022, and 2023). On November 19,
2022, you make a repayment of $45,000. For
2022, none of the qualified 2020 disaster
distribution is included in income. The
excess repayment of $15,000 ($45,000 −
$30,000) can be carried back to 2021. Also,
instead of carrying the excess repayment
back to 2021, you can choose to carry it
forward to 2023.

[mm/dd/2021] to an eligible retirement plan
in repayment of a qualified distribution made
[mm/dd/2019] under the Taxpayer Certainty
and Disaster Tax Relief Act of 2020, sec.
302(b). The disaster was the [name of the
qualified 2020 disaster from Table for
Qualified 2020 Disaster Areas] disaster." If
the distribution was from a retirement plan
other than an IRA, in Part III of your amended
return, enter: "The amount I reported on
[2019 Form 1040 or 1040-SR, line 4d, or
2019 Form 1040-NR, line 17b, as applicable]
is being reduced by a contribution made
[mm/dd/2021] to an eligible retirement plan
in repayment of a qualified distribution made
[mm/dd/2019] under the Taxpayer Certainty
and Disaster Tax Relief Act of 2020, sec.
302(b). The disaster was the [name of the
qualified 2020 disaster from Table for
Qualified 2020 Disaster Areas] disaster."
Use the full name of the disaster. Include the
state, territory, or tribal government and the
FEMA DR number from Table for Qualified
2020 Disaster Areas at the end of these
instructions.

DRAFT AS OF
December 2, 2021

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 for a credit or refund 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.

Amending Form 8915-F (2020
Disasters)

Qualified 2020 disaster distributions. If,
after filing your 2021 return, you make a
repayment of a qualified 2020 disaster
distribution, the repayment may reduce the
amount of your qualified 2020 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 of a qualified
2020 disaster distribution by the due date of
your 2021 return (including extensions),
include the repayment on a Form 1040-X
amending your 2021 Form 8915-F (2020
disasters).
If you make the repayment after the due
date of your 2021 return (including
extensions) but before the due date of your
2022 return (including extensions) and you
have spread the income over 3 years,
include the repayment on your 2022 Form
8915-F (2020 disasters). However, you may
file a Form 1040-X amending your 2021
Form 8915-F (2020 disasters) if either of the
following applies.
• You elected on 2020 Form 8915-E, lines 9
and 17, or 2021 Form 8915-F (2020
disasters), lines 11 and 22, as applicable, to
include all of your qualified 2020 disaster
distributions in income in 2020 or 2021, as
applicable (instead of over 3 years).
• You have spread the income over 3 years,
the amount of the repayment exceeds the
amount of your qualified 2020 disaster
distributions that are included in income on
your 2022 Form 8915-F (2020 disasters),
and you choose to carry the excess back to
2021. See the examples below.
Example 1. You received a
coronavirus-related distribution in the
amount of $9,000 in 2020. You choose to
spread the $9,000 over 3 years ($3,000 in
income for 2020, 2021, and 2022). On
November 19, 2022, you make a repayment
of $4,500. For 2022, none of the qualified
2020 disaster distribution is included in
income. The excess repayment of $1,500
($4,500 − $3,000) can be carried back to
2021. Also, instead of carrying the excess
repayment back to 2021, you can choose to
carry it back to 2020.

2020 qualified distributions. If the
coronavirus is your only qualified 2020
disaster, this discussion does not apply to
you.
You may reduce the amount of a qualified
distribution reported on 2020 Form 8915-E
by the amount of a repayment made in 2021
before June 26 (XXXXXXXXXX, in the case
of a qualified distribution for the Washington
(4593-DR-WA) disaster). (See Part
IV—Qualified Distributions for the Purchase
or Construction of a Main Home in Qualified
2020 Disaster Areas in the 2020 Instructions
for Form 8915-E for details on qualified
distributions received in 2020.) If you have
already filed your 2020 return on which you
reported the distribution, you should file an
amended 2020 return or an amended 2020
Form 8915-E to report the repayment
following the usual rules. See Part IV in the
Specific Instructions in the 2020 Instructions
for Form 8915-E.

2019 qualified distributions. If the
coronavirus is your only qualified 2020
disaster, this discussion does not apply to
you.
You may reduce the amount of a qualified
distribution for a qualified 2020 disaster
included in income in 2019 by the amount of
a repayment made in 2021 before June 26.
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 25, 2021, you may
have a qualified distribution received in 2019
for which you are making repayments in
2021. If you have already filed your 2019
return on which you reported the distribution,
you should file an amended 2019 return to
report the repayment. On your amended
return (Form 1040-X), you will write in "2019"
for the calendar year at the top of page 1 if
you are a calendar year filer 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, enter: "The amount I reported on
[2019 Form 1040 or 1040-SR, line 4b, or
2019 Form 1040-NR, line 16b, as applicable]
is being reduced by a contribution made

Instructions for Form 8915-F (Rev. 1-2022)

-5-

Example. You received a distribution
from a traditional IRA on December 12,
2019, to construct a home in the Mississippi
Severe Storms, Tornadoes, Straight-line
Winds, and Flooding (DR-4478-MS) disaster
area which you did not construct because of
that disaster. The disaster began January
10, 2020, and the distribution now qualifies
as a qualified distribution. On June 14, 2021,
you made a contribution that qualifies as a
repayment of the distribution. You have
already filed your 2019 return, a Form 1040.
You will need to file a Form 1040-X for 2019
to claim the repayment. On your Form
1040-X, you write in "2019" for the calendar
year at the top of page 1 because you are a
calendar year filer and, in parentheses in
column B of line 1, you enter the amount of
the repayment. In Part III of your amended
return, enter: "The amount I reported on
2019 Form 1040, line 4b, is being reduced
by a contribution made 06/14/2021 to an
eligible retirement plan in repayment of a
qualified distribution made 12/12/2019 under
the Taxpayer Certainty and Disaster Tax
Relief Act of 2020, sec. 302(b). The disaster
was the Mississippi Severe Storms,
Tornadoes, Straight-line Winds, and
Flooding (DR-4478-MS) disaster."
Form 1040-NR. If you are amending a
Form 1040-NR, only complete the address
block and Part III of your Form 1040-X. Make
your adjustments on a corrected Form
1040-NR on which you have written
"Amended" at the top of page 1.

Amending Form 8915-F (2021
Disasters)
Qualified 2021 disaster distributions. If,
after filing your 2021 return, you make a
repayment of a qualified 2021 disaster
distribution, the repayment may reduce the
amount of your qualified 2021 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 of a qualified
2021 disaster distribution by the due date of
your 2021 return (including extensions),
include the repayment on your amended
2021 Form 8915-F (2021 disasters).
If you make the repayment after the due
date of your 2021 return (including
extensions) but before the due date of your
2022 return (including extensions) and you
have spread the income over 3 years,
include the repayment on your 2022 Form
8915-F (2021 disasters). However, you may
file an amended 2021 Form 8915-F (2021
disasters) if either of the following applies.
• You elected on 2021 Form 8915-F (2021
disasters), lines 11 and 22, as applicable, to
include all of your qualified 2021 disaster
distributions in income in 2021 (instead of
over 3 years).
• You have spread the income over 3 years,
the amount of the repayment exceeds the
amount of your qualified 2021 disaster
distributions that are included in income on
your 2022 Form 8915-F (2021 disasters),
and you choose to carry the excess back to
2021. See the example below.

[mm/dd/2021] to an eligible retirement plan
in repayment of a qualified distribution made
[mm/dd/2020] under the XXXXXXXXXX,
sec. XXXX. The disaster was the [name of
the qualified 2021 disaster from Table for
Qualified 2021 Disaster Areas] disaster." If
the distribution was from a retirement plan
other than an IRA, in Part III of your amended
return, enter: "The amount I reported on
[2020 Form 1040, 1040-SR, or 1040-NR,
line 5b, as applicable] is being reduced by a
contribution made [mm/dd/2021] to an
eligible retirement plan in repayment of a
qualified distribution made [mm/dd/2020]
under the XXXXXXXXXX, sec. XXXX. The
disaster was the [name of the qualified 2021
disaster from Table for Qualified 2021
Disaster Areas] disaster." Use the full name
of the disaster. Include the state, territory, or
tribal government and the FEMA DR number
from Table for Qualified 2021 Disaster Areas
at the end of these instructions.

and SSN of the spouse whose information is
being reported on that Form 8915-F.

Required General
Information
Item A. Check the box that describes the
tax year of the return to which you will be
attaching your Form 8915-F.

DRAFT AS OF
December 2, 2021

Example 1. You received a qualified
2021 disaster distribution in the amount of
$90,000 in 2021. You elected to have the full
income from the distribution recognized in
2021. On November 19, 2022, you make a
repayment of $45,000. The entire $45,000 is
carried back to 2021.
Example 2. You received a qualified
2021 disaster distribution in the amount of
$90,000 in 2021. You choose to spread the
$90,000 over 3 years ($30,000 in income for
2021, 2022, and 2023). On November 18,
2022, you make a repayment of $45,000. For
2022, none of the qualified 2021 disaster
distribution is included in income. The
excess repayment of $15,000 ($45,000 −
$30,000) can be carried back to 2021. Also,
instead of carrying the excess repayment
back to 2021, you can choose to carry it
forward to 2023.
2020 qualified distributions. You may
reduce the amount of a qualified distribution
for a qualified 2021 disaster included in
income in 2020 by the amount of a
repayment made in 2022 before
XXXXXXXXXX. 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
XXXXXXXXXX, you may have a qualified
distribution received in 2020 for which you
are making repayments in 2021. If you have
already filed your 2020 return on which you
reported the distribution, you should file an
amended 2020 return to report the
repayment. On your amended return (Form
1040-X), you will write in "2020" for the
calendar year at the top of page 1 if you are a
calendar year filer 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, enter:
"The amount I reported on [2020 Form 1040,
1040-SR, or 1040-NR, line 4b, as applicable]
is being reduced by a contribution made

Example. You received a distribution
from a traditional IRA on December 11,
2020, to construct a home in the Mississippi
Severe Winter Storms (DR-4598-MS)
disaster area which you did not construct
because of that disaster. The disaster began
February 11, 2021, and the distribution now
qualifies as a qualified distribution. On June
14, 2022, you made a contribution that
qualifies as a repayment of the distribution.
You have already filed your 2021 return, a
Form 1040. You will need to file a Form
1040-X for 2020 to claim the repayment. On
your Form 1040-X, you write in "2020" for the
calendar year at the top of page 1 because
you are a calendar year filer and, in
parentheses in column B of line 1, you enter
the amount of the repayment. In Part III of
your amended return, enter: "The amount I
reported on 2020 Form 1040, line 4b, is
being reduced by a contribution made
06/14/2022 to an eligible retirement plan in
repayment of a qualified distribution made
12/11/2020 under the XXXXXXXXXX, sec.
XXXX. The disaster was the Mississippi
Severe Winter Storms (DR-4598-MS)
disaster."

Form 1040-NR. If you are amending a
Form 1040-NR, only complete the portions of
the Form 1040-X listed in Resident and
nonresident aliens in the Instructions for
Form 1040-X. Make your adjustments on a
corrected Form 1040-NR on which you have
written "Amended" at the top of page 1.

Specific Instructions
Married filers. If both you and your spouse
are required to file Form 8915-F, file a
separate Form 8915-F for each of you. If you
and your spouse are both filing Forms
8915-F, the $100,000 limits on qualified
disaster distributions and the elections on
lines 11 and 22 to include all qualified
disaster distributions in income (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
-6-

Item B. Check the box that describes the
calendar year in which the disaster(s) for
which you are reporting distributions on your
Form 8915-F began.
Item C. Enter the FEMA DR number from
Table for Qualified 2020 Disaster Areas or
Table for Qualified 2021 Disaster Areas, as
applicable. For example, for the 2020
Louisiana Hurricane Delta, you would enter
DR-4559-LA.

!

Do not enter the coronavirus in item
C.

CAUTION

Item D. Check the box if the coronavirus is a
disaster you are reporting on your Form
8915-F.

Part I—Total Distributions
From All Retirement Plans
(Including IRAs)

You can only report qualified disaster
distributions for disasters listed in item C.
Coronavirus-related distributions can’t be
made in 2021.

Lines 1a through 1d. You may not need to
complete lines 1a through 1d. See below.
When to leave lines 1a through 1d
blank. Leave lines 1a through 1d blank on
your:
• 2021 Form 8915-F (2020 disasters) if
either you didn’t file 2020 Form 8915-E or the
only disaster you reported on 2020 Form
8915-E was the coronavirus, and
• 2021 Form 8915-F (2021 disasters).
When and how to complete lines 1a
through 1d. Complete lines 1a through 1d,
as follows, if you are filing 2021 Form 8915-F
(2020 disasters) and you filed 2020 Form
8915-E for disasters other than the
coronavirus.
• Line 1a. Count the disasters reported on
your 2020 Form 8915-E that you are now
reporting in item C. Enter, on line 1a, the
product of that number and $100,000.
• Line 1b. Enter, on line 1b, the amount on
2020 Form 8915-E, line 5, column (c), if you
completed that line (otherwise from the
amount on 2020 Form 8915-E, line 5, column
(b)) that reflects the distributions for the
disasters you reported on 2020 Form 8915-E
that you are now reporting in item C of your
2021 Form 8915-F. If you used Worksheet 2
in your 2020 Instructions for Form 8915-E,
the amount for line 1b is figured by adding
together the amounts in column (X), line 4, of
that worksheet for the disasters you reported
on 2020 Form 8915-E that you are now
reporting in item C of your 2021 Form
8915-F.

Instructions for Form 8915-F (Rev. 1-2022)

• Line 1d. Count the disasters reported in
item C of your 2021 Form 8915-F (2020
disasters) that were not reported on your
2020 Form 8915-E. Enter, on line 1d, the
product of that number and $100,000.
Line 1e. Complete line 1e as follows.
• If you have been instructed above to leave
lines 1a through 1d blank, enter on line 1e
the product of $100,000 times the number of
disasters you reported in item C of your 2021
Form 8915-F (2020 disasters) or 2021 Form
8915-F (2021 disasters), as applicable.
• Otherwise, enter the sum of lines 1c and
1d on line 1e.

8915-F (2020 disasters), and 2021 Form
8915-F (2021 disasters)? If so, complete
your forms in this order.
• First, complete 2021 Form 8915-D, if
applicable.
• Your available distributions for your 2021
Form 8915-F (2020 disasters) are the
distributions left after completing Part I of
2021 Form 8915-D, if applicable.
• Next, complete 2021 Form 8915-F (2021
disasters).
• Your available distributions for your 2021
Form 8915-F (2021 disasters) are the
distributions left after completing Part I of
2021 Form 8915-F (2020 disasters).

Worksheet 1A for Example 1A. Because the
$40,000 is being used on 2021 Form 8915-F
(2020 disasters), it should not be counted on
line 7 of his 2021 Form 8915-D in
determining the taxable amount of his
distributions on that form.
Example 1B. Roger suffered economic
losses as a result of the Mississippi
Hurricane Zeta (DR-4576-MS) disaster in
2020 and the Mississippi Severe Winter
Storms (DR-4598-MS) disaster in 2021. His
main home was in Mississippi during the
disaster period for each disaster. These
events were qualified 2020 and 2021
disasters, respectively. In 2021, he received
a traditional IRA distribution of $140,000.
The distribution was made on May 26. He
received no other distributions in 2020 or
2021. He is completing 2021 Form 8915-F
(2020 disasters) and 2021 Form 8915-F
(2021 disasters). He must complete his 2021
Form 8915-F (2020 disasters) first. He
reports $100,000 from the distribution as a
qualified 2020 disaster distribution on 2021
Form 8915-F (2020 disasters). He reports
the remaining $40,000 from the distribution
as qualified 2021 disaster distributions in the
2021 Form 8915-F (2021 disasters) portion
of his Filled-in Worksheet 1B for
Example 1B. On lines 2 through 4 of column
(a) in Part I of his 2021 Form 8915-F (2021
disasters), Roger enters the amounts shown
in column (a), lines 2 through 4, of 2021
Form 8915-F (2021 disasters) on his Filled-in
Worksheet 1B for Example 1B. Because the
$40,000 is being used on 2021 Form 8915-F
(2021 disasters), it should not be counted on
line 7 of his 2021 Form 8915-F (2020
disasters) in determining the taxable amount
of his distributions on that form.

DRAFT AS OF
December 2, 2021

Lines 2 through 4 in 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 box 1 of Form 1099-R.
Enter the amounts from box 1 of all your
Forms 1099-R on the lines 2 through 4 in
column (a), as applicable. But see Are You
Claiming Qualified Disaster Distributions on
Two or More 2021 Forms 8915 next for the
limitations if you are completing two or more
of the following: 2021 Form 8915-D, 2021
Form 8915-F (2020 disasters), and 2021
Form 8915-F (2021 disasters).

Are You Claiming Qualified
Disaster Distributions on Two
or More 2021 Forms 8915?
This section does not apply to you:

TIP

• If you are filing 2021 Form 8915-F (2020
disasters) and you are not completing Part I
of 2021 Form 8915-D, or
• If you are filing 2021 Form 8915-F (2021
disasters) and you are not completing Part I
of either 2021 Form 8915-D or 2021 Form
8915-F (2020 disasters).
Have you completed Part I of two of the
following: 2021 Form 8915-D, 2021 Form

See the Filled-in Worksheet 1A and 1B
examples below for guidance. Blank
Worksheets 1A and IB are at the end of the
instructions under Worksheets.

Example 1A. Arnell suffered economic
losses as a result of the Puerto Rico
Earthquakes (DR-4473-PR) disaster in 2019
and the Puerto Rico Hurricane Isaias
(DR-4560-PR) disaster in 2020. His main
home was in Puerto Rico during the disaster
period for each disaster. These events were
qualified 2019 and 2020 disasters,
respectively. In 2021, he received a
traditional IRA distribution of $140,000. The
distribution was made on May 26. He
received no other distributions in 2019, 2020,
or 2021. He is completing 2021 Form
8915-D, and 2021 Form 8915-F (2020
disasters). He must complete his Form
8915-D first. He reports $100,000 from the
distribution as a qualified 2019 disaster
distribution on Form 8915-D. He reports the
remaining $40,000 from the distribution as
qualified 2020 disaster distributions in the
2021 Form 8915-F (2020 disasters) portion
of his Filled-in Worksheet 1A for
Example 1A. On lines 2 through 4 of column
(a) in Part I of his 2021 Form 8915-F (2020
disasters), Arnell enters the amounts shown
in column (a), lines 2 through 4, of 2021
Form 8915-F (2020 disasters) on his Filled-in

Instructions for Form 8915-F (Rev. 1-2022)

-7-

The numbers on the left border of

TIP the Filled-in Worksheets are line

numbers that correspond to the lines
on the indicated forms.

Filled-in Worksheet 1A. Use if you complete Part I of 2021 Form 8915-D and of either 2021 Form 8915-F (2020 disasters) or 2021
Form 8915-F (2021 disasters). Example 1A for Arnell column (a).
Form 8915-D
2
3
4

column (a)

column (b)

column (c)

Total distributions in 2021

Qualified disaster distributions

Allocation of column (b)

-0-

-0-

-0-

Distributions from retirement plans (other than
IRAs) made in 2021

DRAFT AS OF
December 2, 2021
Distributions from traditional, SEP, and SIMPLE
IRAs made in 2021

$140,000

$100,000

-0-

-0-

-0-

-0-

Distributions from Roth IRAs made in 2021

column (a)

Form 8915-F (2020 disasters) or Form 8915-F (2021
disasters)

2
3
4

Available distributions for this year

Enter, in column (a), distributions from retirement plans
(other than IRAs) made this year.

-0-

Enter, in column (a), distributions from traditional, SEP, and
SIMPLE IRAs made this year.

$40,000

Enter, in column (a), distributions from Roth IRAs made this
year.

-0-

Filled-in Worksheet 1B. Use if you complete Part I of both 2021 Form 8915-F (2020 disasters) and 2021 Form 8915-F (2021 disasters). Example 1B for Roger column (a).
Form 8915-F (2020 disasters)
2

Enter, in column (a), distributions from retirement plans (other
than IRAs) made this year.

3

Enter, in column (a), distributions from traditional, SEP, and
SIMPLE IRAs made this year.

4

Enter, in column (a), distributions from Roth IRAs made this year.

column (a)

column (b)

Available distributions for this year

Qualified disaster distributions for the
disasters in item C

-0-

-0-

$140,000

$100,000

-0-

-0-

column (a)

Form 8915-F (2021 disasters)

Available distributions for this year

2

Enter, in column (a), distributions from retirement plans
(other than IRAs) made this year.

3

Enter, in column (a), distributions from traditional, SEP, and
SIMPLE IRAs made this year.

$40,000

4

Enter, in column (a), distributions from Roth IRAs made this
year.

-0-

Line 7
If you are completing Part I of both

TIP 2021 Form 8915-F (2020 disasters)

and 2021 Form 8915-F (2021
disasters), reduce the amount on line 7 of
your 2021 8915-F (2020 disasters) by the
available distributions used on your 2021
Form 8915-F (2021 disasters). See the
examples under Are You Claiming Qualified
Disaster Distributions on Two or More 2021
Forms 8915, earlier.
The amount on line 7 should generally be
apportioned into IRA and pension & annuity
amounts, as applicable, and reported on
your tax return as taxable distributions in
accordance with Form 5329 and the
instructions for that return. See the

-0-

instructions for your tax return for reporting
the distributions included on line 7. See also
the Instructions for Form 5329.
Example. You reported a total of
$120,000 in distributions in 2021 on line 5,
column (a). The entire $120,000 in
distributions were IRA distributions other
than Roth distributions. You reported
$100,000 of those distributions on line 3. On
line 7, you reported $120,000 minus
$100,000 (that is, $20,000). These
distributions are IRA distributions. You will
refer to your tax return, Form 5329, and their
instructions for directions on how to treat
these IRA distributions.

-8-

If line 7 includes an amount

TIP distributed for the purchase or

construction of a main home in a
qualified disaster area, see 2021 Form
8915-F (2020 disasters) or 2021 Form
8915-F (2021 disasters) below, as
applicable.
2021 Form 8915-F (2020 disasters).
Reduce line 7 of your 2021 Form 8915-F
(2020 disasters) by any amount distributed
for the purchase or construction of a main
home in the Washington (4593-DR-WA)
disaster area that you did not purchase or
construct because of that disaster. Include
this amount on line 28 of your 2021 Form
8915-F (2020 disasters). See Qualified
Distribution for the Purchase or Construction

Instructions for Form 8915-F (Rev. 1-2022)

of a Main Home in Qualified Disaster Areas,
earlier. Also, see Form 5329 and the
instructions for your tax return for reporting
all other distributions included on line 7.

Line 12. Use Worksheet 2 to figure the
amount to enter on line 12 of your Form
8915-F.

2021 Form 8915-F (2021 disasters).
Reduce line 7 of your 2021 Form 8915-F
(2021 disasters) by any amount distributed
for the purchase or construction of a main
home in a qualified 2021 disaster area that
you did not purchase or construct because of
the qualified 2021 disaster. Include this
amount on line 28 of your 2021 Form 8915-F
(2021 disasters). See Qualified 2021
disaster areas, earlier. Also, see Form 5329
and the instructions for your tax return for
reporting all other distributions included on
line 7.

Worksheet 2. Total Income From Other-Than-IRA Distributions Made in Prior
Years

Worksheet 3. Total Repayment of Other-Than-IRA Distributions
1. If you are completing 2021 Form
8915-F (2020 disasters), enter
the amount, if any, from your
2020 Form 8915-E, line 10.
If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- . . . . . . . . . . . . .

DRAFT AS OF
December 2, 2021
1. If you are completing 2021 Form
8915-F (2020 disasters), enter
here and on line 12 of your 2021
Form 8915-F (2020 disasters)
the amount, if any, from your
2020 Form 8915-E, line 9. If you
checked the box on that line,
enter -0- here and on line 12 of
your 2021 Form 8915-F (2020
disasters).
If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- here and on line 12 of
your 2021 Form 8915-F (2021
disasters) . . . . . . . . . . . .

Part II—Qualified Disaster
Distributions From
Retirement Plans (Other
Than IRAs)
See the tables under Appendix A, later, for
the lines in Part II you should complete, if
any.

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 box 2a
of Form 1099-R, the difference between
box 1 and box 2a of Form 1099-R is usually
your cost. Enter the difference on line 9.
If there is no amount in box 2a of Form
1099-R 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 disaster distributions on the
Form 8915-F you are completing.
If you have a Form 1099-R with both
qualified disaster distributions and
CAUTION 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. By checking the box,
you elect to include the entire amount in
income in the year of distribution. You cannot
make or change this election after the due
date (including extensions) for your tax
return. If you checked the box on line 22, you
must check the box on line 11.
If the taxpayer died after receiving a
qualified disaster distribution, the taxable
amount of the distribution may not be spread
beyond the year in which they died. The
remainder of the distribution must be
reported on the tax return of the deceased
taxpayer.

If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- . . . . . . . . . . . . .

3. Subtract line 2 from
line 1 . . . . . . . . . . . . . . . .

1.

Line 14. Enter on line 14 of your 2021 Form
8915-F (2020 disasters) or 2021 Form
8915-F (2021 disasters), your total
repayments—the sum of your excess
repayments carried to 2021 and your
repayments made for 2021. See Worksheet
3 below. A repayment is made in 2021 if it is
made before you filed your 2021 return, and
not later than the due date (including
extensions).
At any time during the 3-year period that
begins the day after the date you received a
qualified 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
Disaster Distribution, earlier, for details.
Worksheet 3. Use Worksheet 3 to figure
the total repayment to enter on line 14 of
your Form 8915-F.

!

CAUTION

Don’t use Worksheet 3 to report
repayments of qualified 2017, 2018,
or 2019 disaster distributions.
Complete a separate Worksheet 3

TIP for your Form 8915-F (2020

disasters) and for your Form 8915-F
(2021 disasters) if filing both forms. You can't
use the same repayments as repayments on
both Form 8915-F (2020 disasters) and Form
8915-F (2021 disasters).

Instructions for Form 8915-F (Rev. 1-2022)

1.

2. If you are completing 2021 Form
8915-F (2020 disasters), enter
the amount, if any, from your
2020 Form 8915-E, line 9.

2.
3.

4. If you are completing 2021 Form
8915-F (2020 disasters), enter
the total amount of any
repayments you made, with
respect to that form, before filing
your 2021 tax return.
If you are completing 2021
Form 8915-F (2021 disasters),
enter the total amount of any
repayments you made, with
respect to that form, before
filing your 2021 tax
return . . . . . . . . . . . . . . .

4.

5. Enter the total of lines 3 and 4
here and on line 14 of your 2021
Form 8915-F (2020 disasters) or
your 2021 Form 8915-F (2021
disasters), as
applicable . . . . . . . . . . . . . 5.

Worksheet 3, line 4: Don't include
these amounts. On line 4 of Worksheet 3,
don't include any repayments made later
than the due date (including extensions) for
your 2021 return or any repayments of
nontaxable amounts.
Repayments reported on later returns.
If you elected to spread the income over 3
years and you repaid more than the amount
on line 13 of your 2021 Form 8915-F (2020
disasters) or your 2021 Form 8915-F (2021
disasters), the excess will be carried forward
to your 2022 tax return. Repayments made
after the due date of your 2021 return
(including extensions) but before the due
date of your 2022 return (including
extensions) will generally be reported on
your 2022 tax return if you elected to spread
the income over 3 years. However, you may
have to file an amended return in certain
situations. See Amending Form 8915-F
(2020 Disasters) and Form 8915-F (2021
Disasters), earlier.

Part III—Qualified Disaster
Distributions From
Traditional, SEP, SIMPLE,
and Roth IRAs
See the tables under Appendix A, later, for
the lines in Part III you should complete, if
any.

-9-

Line 22. If you don’t check the box on
line 22, you must spread the amount on
line 26 over 3 years. By checking the box,
you elect to include the entire amount in
income in the year of distribution. You cannot
make or change this election 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 22.
If the taxpayer died after receiving a
qualified disaster distribution, the taxable
amount of the distribution may not be spread
beyond the year in which they died. The
remainder of the distribution must be
reported on the tax return of the deceased
taxpayer.

both Form 8915-F (2020 disasters) and Form
8915-F (2021 disasters).
Worksheet 5. Total Repayment of IRA
Distributions
1. If you are completing 2021 Form
8915-F (2020 disasters), enter
the amount, if any, from your
2020 Form 8915-E, line 18.

Part IV—Qualified
Distributions for the
Purchase or Construction
of a Main Home in
Qualified Disaster Areas
2021 Form 8915-F (2020 disasters).
On 2021 Form 8915-F (2020 disasters),
qualified distributions can only be reported
for the Washington (4593-DR-WA) disaster
and the Alaska (4585-DR-AK) disaster.
Complete Part IV of 2021 Form 8915-F
(2020 disasters) if, in 2021, you received a
qualified distribution for the purchase or
construction of a main home in the Alaska
(4585-DR-AK) disaster (XXXXXXXXXX for
the Washington (4593-DR-WA) disaster).
See Qualified 2020 disaster areas under
Repayment of a Qualified Distribution for the
Purchase or Construction of a Main Home,
earlier. You must complete the required lines
of Part IV if you received a qualified
distribution for a qualified 2020 disaster in
2021 even if you made no repayments in
2021. Any portion of the qualified distribution
not repaid before June 26, 2021, for the
Alaska (4585-DR-AK) disaster
(XXXXXXXXXX for the Washington
(4593-DR-WA) disaster) will not be allowed
the special tax benefits available to qualified
distributions.
For qualified distributions received in
2019 for a qualified 2020 disaster, see 2019
qualified distributions under Amending Form
8915-F (2020 Disasters), earlier.
If you are required to file 2021 Form 8606,
complete that form before you complete Part
IV.

DRAFT AS OF
December 2, 2021

Line 23. Use Worksheet 4 to figure the
amount to enter on line 23 of your Form
8915-F.

Worksheet 4. Total Income From IRA
Distributions Made in Prior Years
1. If you are completing 2021 Form
8915-F (2020 disasters), enter
here and on line 23 of your 2021
Form 8915-F (2020 disasters)
the amount, if any, from your
2020 Form 8915-E, line 17. If
you checked the box on that line,
enter -0- here and on line 23 of
your 2021 Form 8915-F (2020
disasters).
If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- here and on line 23 of
your 2021 Form 8915-F (2021
disasters) . . . . . . . . . . . .

1.

Worksheet 5. Use Worksheet 5 to figure
the total repayment to enter on line 25 of
your Form 8915-F.

CAUTION

Don’t use Worksheet 5 to report
repayments of qualified 2017, 2018,
or 2019 disaster distributions.

1.

2. If you are completing 2021 Form
8915-F (2020 disasters), enter
the amount, if any, from your
2020 Form 8915-E, line 17.
If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- . . . . . . . . . . . . .

3. Subtract line 2 from
line 1 . . . . . . . . . . . . . . . .

2.
3.

4. If you are completing 2021 Form
8915-F (2020 disasters), enter
the total amount of any
repayments you made, with
respect to that form, before filing
your 2021 tax return.
If you are completing 2021
Form 8915-F (2021 disasters),
enter the total amount of any
repayments you made, with
respect to that form, before
filing your 2021 tax
return . . . . . . . . . . . . . . .

Line 25. Enter on line 23 of your 2021 Form
8915-F (2020 disasters) or 2021 Form
8915-F (2021 disasters), your total
repayments—the sum of your excess
repayments carried to 2021 and your
repayments made for 2021. See Worksheet
5 below. A repayment is made in 2021 if it is
made before you filed your 2021 return, and
not later than the due date (including
extensions).
At any time during the 3-year period that
begins the day after the date you received a
qualified 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
Disaster Distribution, earlier, for details.

!

If you are completing 2021
Form 8915-F (2021 disasters),
enter -0- . . . . . . . . . . . . .

4.

5. Enter the total of lines 3 and 4
here and on line 25 of your 2021
Form 8915-F (2020 disasters) or
your 2021 Form 8915-F (2021
disasters), as
applicable . . . . . . . . . . . . . 5.

Note. A distribution for the purchase or
construction of a main home may be treated
as a qualified 2020 disaster distribution in
certain circumstances. See Qualified 2020
disaster areas under Repayment of a
Qualified Distribution for the Purchase or
Construction of a Main Home, earlier.

Worksheet 5, line 4: Don't include
these amounts. On line 4 of Worksheet 5,
don't include any repayments made later
than the due date (including extensions) for
your 2021 return or any repayments of
nontaxable amounts.
Repayments reported on later returns.
If you elected to spread the income over 3
years and you repaid more than the amount
on line 24 of your 2021 Form 8915-F (2020
disasters) or your 2021 Form 8915-F (2021
disasters), the excess will be carried forward
to your 2022 tax return. Repayments made
after the due date of your 2021 return
(including extensions) but before the due
date (including extensions) of your 2022
return will generally be reported on your
2022 tax return if you elected to spread the
income over 3 years. However, you may
have to file an amended return in certain
situations. See Amending Form 8915-F
(2020 Disasters) and Form 8915-F (2021
Disasters), earlier.

Complete a separate Worksheet 5

TIP for your Form 8915-F (2020

disasters) and for your Form 8915-F
(2021 disasters) if filing both forms. You can't
use the same repayments as repayments on
-10-

2021 Form 8915-F (2021 disasters).
Complete Part IV of 2021 Form 8915-F
(2021 disasters) if, in 2021, you received a
qualified distribution for the purchase or
construction of a main home in a qualified
2021 disaster area. See Qualified 2021
disaster areas under Repayment of a
Qualified Distribution for the Purchase or
Construction of a Main Home, earlier. You
must complete Part IV if you received a
qualified distribution for a qualified 2021
disaster in 2021 even if you made no
repayments in 2021. Any portion of the
qualified distribution not repaid before
XXXXXXXXXX will not be allowed the
special tax benefits available to qualified
distributions.
For qualified distributions received in
2020 for a qualified 2021 disaster, see
Qualified 2021 disaster distributions under
Amending Form 8915-F (2021 Disasters),
earlier.

Instructions for Form 8915-F (Rev. 1-2022)

If you are required to file 2021 Form 8606,
complete that form before you complete Part
IV.
Note. A distribution for the purchase or
construction of a main home made no earlier
than the first day of the qualified 2021
disaster and no later than XXXXXXXXXX,
may be treated as a qualified 2021 disaster
distribution in certain circumstances. See
Qualified 2021 disaster areas under
Repayment of a Qualified Distribution for the
Purchase or Construction of a Main Home,
earlier.

Line 31. You can repay any portion of a
qualified distribution to an eligible retirement
plan that accepts rollovers but the
repayments must be made within the time
frame specified in 2021 Form 8915-F (2020
disasters) or 2021 Form 8915-F (2021
disasters), as applicable, above in this part
(also, 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 31 the amount of any
repayments you make within the time frame
specified. Don't include any repayments
treated as rollovers on 2021 Form 8606 or
any repayments of nontaxable amounts.

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.

DRAFT AS OF
December 2, 2021

Line 27. If you check the “Yes” box, but are
not required to complete lines 28 through 32,
you must still file the required Form 8915-F
to show that you received a qualified
distribution.
Line 28. Enter on line 28 your qualified
distributions (see Qualified 2020 disaster
areas or Qualified 2021 disaster areas, as
applicable, under Qualified Distribution for
the Purchase or Construction of a Main
Home in Qualified Disaster Areas, earlier).
Don't include any distributions you
designated as qualified 2020 disaster
distributions or qualified 2021 disaster
distributions, as applicable, reported on
line 8 or line 20 of your Form 8915-F. Also,
don't include any amounts reported on 2021
Form 8606.

Line 29. Enter on line 29 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 box 2a
of Form 1099-R, the difference between
box 1 and box 2a of Form 1099-R 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 29. Any cost or basis in an
IRA is figured on 2021 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.

!

Line 32. Most distributions from qualified
retirement plans (including IRAs) made to
you before you reach age 59 1/2 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 2020 or 2021
disaster area that were not repaid to an
eligible retirement plan within the time frame
specified in 2021 Form 8915-F (2020
disasters) or 2021 Form 8915-F (2021
disasters), as applicable, above in this part,
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 the specified end
date, you may be able to designate the
qualified distribution as a qualified disaster
distribution. See Qualified 2020 disaster
areas or Qualified 2021 disaster areas, as
applicable, under 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
contributions or received certain distributions

Instructions for Form 8915-F (Rev. 1-2022)

-11-

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

Blank Worksheets 1A and 1B follow. The
numbers on the left border of Worksheets 1A
and 1B are line numbers that correspond to
the lines on the indicated forms.

Worksheet 1A. Use if you complete Part I of 2021 Form 8915-D and either of 2021 Form 8915-F (2020 disasters) or 2021 Form
8915-F (2021 disasters).
Form 8915-D
2

Distributions from retirement plans (other than IRAs)
made in 2021

3

Distributions from traditional, SEP, and SIMPLE
IRAs made in 2021

4

column (a)

column (b)

column (c)

Total distributions in 2021

Qualified disaster distributions

Allocation of column (b)

DRAFT AS OF
December 2, 2021
Distributions from Roth IRAs made in 2021

column (a)

Form 8915-F (2020 disasters) or Form 8915-F (2021
disasters)

2
3
4

Available distributions for this year

Enter, in column (a), distributions from retirement plans (other
than IRAs) made this year.
Enter, in column (a), distributions from traditional, SEP, and
SIMPLE IRAs made this year.

Enter, in column (a), distributions from Roth IRAs made this year.

Worksheet 1B. Use if you complete Part I of two of 2021 Form 8915-F (2020 disasters) and 2021 Form 8915-F (2021 disasters).
Form 8915-F (2020 disasters)
2

Enter, in column (a), distributions from retirement plans (other than
IRAs) made this year.

3

Enter, in column (a), distributions from traditional, SEP, and SIMPLE
IRAs made this year.

4

Enter, in column (a), distributions from Roth IRAs made this year.

column (a)

column (b)

Available distributions for this year

Qualified disaster distributions for the disasters
in item C

column (a)

Form 8915-F (2021 disasters)
2

Enter, in column (a), distributions from retirement plans (other than
IRAs) made this year.

3

Enter, in column (a), distributions from traditional, SEP, and SIMPLE
IRAs made this year.

4

Enter, in column (a), distributions from Roth IRAs made this year.

Available distributions for this year

-12-

Instructions for Form 8915-F (Rev. 1-2022)

Appendix A
Which Lines Should I Use?
Form 8915-F (2020 Disasters):
Lines To Use

See Qualified 2020 disaster

TIP distribution requirements, earlier,

under Qualified Disaster Distribution
Requirements and also Qualified
Distributions, earlier, for the cutoff dates for

making these distributions and for other
criteria for these distributions.

Look for the year of the form you are filing.

2021 Form 8915-F (2020 Disasters)

DRAFT AS OF
December 2, 2021

IF . . .

AND . . .

THEN . . .

Complete Parts I, II, and III, as applicable. If you received qualified distributions for
the Washington (4593-DR-WA) disaster or for the Alaska (4585-DR-AK) disaster in
2021, complete Part IV.

Qualified 2020 disaster distributions were made to
you in 2021

—

If you must complete Part III, complete 2021 Form 8606 if either of the following
applies.

• You received a qualified 2020 disaster distribution in 2021 from a traditional,
SEP, or SIMPLE IRA, and you have a basis in the IRA.
• You received a qualified 2020 disaster distribution from a Roth IRA.

For more information, see 2021 Form 8606 and its instructions.

You did NOT check the box
on line 9 or 17 on the 2020
Form 8915-E

You claimed coronavirus-related or other qualified
2020 disaster distributions on a 2020 Form 8915-E
(2020 disasters), but qualified 2020 disaster
distributions were NOT made to you in 2021

You checked the box on
line 9 or 17 on the 2020
Form 8915-E

Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2021
Form 8915-F (2020 disasters). If you received qualified distributions for the
Washington (4593-DR-WA) disaster or for the Alaska (4585-DR-AK) disaster in
2021, complete Part IV.

If you are repaying those distributions, complete lines 14 and 25, as applicable, of
your 2021 Form 8915-F (2020 disasters). If you received qualified distributions for
the Washington (4593-DR-WA) disaster or for the Alaska (4585-DR-AK) disaster in
2021, complete Part IV.
If you aren’t repaying those distributions, but you received qualified distributions for
the Washington (DR-4593-WA) disaster or for the Alaska (DR-4585-AK) disaster in
2021, complete Part IV.
If you aren’t repaying those distributions and you did NOT receive any
qualified distributions, STOP. You can’t use 2021 Form 8915-F (2020
disasters).

Qualified 2020 disaster distributions were not
made to you in 2021 AND you did not file a 2020
Form 8915-E

You received qualified
distributions for the
Washington (4593-DR-WA)
disaster or for the Alaska
(4585-DR-AK) disaster in
2021
You did NOT receive
qualified distributions in
2021 for 4593-DR-WA or
4585-DR-AK

Instructions for Form 8915-F (Rev. 1-2022)

Complete Part IV.

STOP. You can’t use 2021 Form 8915-F.

-13-

2022 Form 8915-F (2020 Disasters)
IF . . .

AND . . .

THEN . . .
Complete Parts I, II, and III, as applicable.
If you must complete Part III, complete 2021 Form 8606 if either of the following
applies.

Qualified 2020 disaster distributions for the
Washington (4593-DR-WA) disaster were made to
you in 2022

—

• You received a qualified 2020 disaster distribution in 2021 from a traditional,
SEP, or SIMPLE IRA, and you have a basis in the IRA.

DRAFT AS OF
December 2, 2021
• You received a qualified 2020 disaster distribution from a Roth IRA.

For more information, see 2021 Form 8606 and its instructions.

You claimed qualified 2020 disaster distributions
on a 2021 Form 8915-F (2020 disasters) AND you
claimed coronavirus-related distributions or other
qualified 2020 disaster distributions on a 2020
Form 8915-E

You claimed qualified 2020 disaster distributions
on a 2021 Form 8915-F (2020 disasters) but you
did not claim coronavirus-related distributions or
other qualified 2020 disaster distributions on a
2020 Form 8915-E

You claimed coronavirus-related distributions or
other qualified 2020 disaster distributions on a
2020 Form 8915-E but not on a 2021 Form 8915-F
(2020 disasters)

You didn’t check the box on Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022
line 11 or 22 on the 2021
Form 8915-F (2020 disasters).
Form 8915-F (2020
disasters) AND/OR on
line 9 or 17 on the 2020
Form 8915-E

You checked the box on
If you are repaying those distributions, complete lines 14 and 25, as applicable, of your
line 11 or 22 on the 2021
2022 Form 8915-F.
Form 8915-F (2020
If you aren’t repaying those distributions, you can’t use 2022 Form 8915-F (2020
disasters) AND on line 9 or disasters).
17 on the 2020 Form
8915-E

Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022
You didn’t check the box on
Form 8915-F (2020 disasters).
line 11 or 22 on the 2021
Form 8915-F (2020
disasters)
You didn’t checked the box
on line 9 or 17 on the 2020
Form 8915-E
You checked the box on
line 9 or 17 on the 2020
Form 8915-E

You did NOT claim qualified 2020 disaster
distributions on a 2021 Form 8915-F (2020
disasters) AND you did not claim
coronavirus-related distributions or other qualified
2020 disaster distributions on a 2020 Form 8915-E

Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022
Form 8915-F (2020 disasters).
If you are repaying those distributions, complete lines 14 and 25, as applicable, of your
2023 Form 8915-F (2021 disasters).
If you aren’t repaying those distributions, STOP. You can’t use 2023 Form
8915-F.
STOP. You can’t use 2023 Form 8915-F (2020 disasters).

—

2023 Form 8915-F (2020 Disasters)
IF . . .

You claimed qualified 2020 disaster distributions on a 2021 Form
8915-F (2020 disasters)

AND . . .

THEN . . .

You did not check the box on line 11
or 22 on that form

Complete lines 12 through 15 and lines 23 through 26, as
applicable, of your 2023 Form 8915-F (2020 disasters).

You checked the box on line 11 or
22 on that form

You claimed coronavirus-related distributions or other qualified 2020
disaster distributions on a 2020 Form 8915-E and you did NOT claim
qualified 2020 disaster distributions on a 2021 Form 8915-F (2020
disasters)

—

You did NOT claim qualified 2020 disaster distributions on a 2021
Form 8915-F (2020 disasters) AND you did not claim
coronavirus-related distributions or other qualified 2020 disaster
distributions on a 2020 Form 8915-E

—

-14-

If you are repaying qualified 2020 disaster distributions
made in 2020 or in 2021, complete lines 14 and 25, as
applicable, of your 2023 Form 8915-F (2020 disasters). .
If you aren’t repaying qualified 2020 disaster distributions
made in 2020 or in 2021, you can’t use 2023 Form
8915-F (2020 disasters).
If you are repaying coronavirus-related distributions or
other qualified 2020 disaster distributions, complete lines
14 and 25, as applicable, of your 2023 Form 8915-F (2020
disasters).
If you aren’t repaying coronavirus-related
distributions or other qualified 2020 disaster
distributions, STOP. You can’t use 2023 Form 8915-F
(2020 disasters).
STOP. You can’t use 2023 Form 8915-F (2020
disasters).

Instructions for Form 8915-F (Rev. 1-2022)

2024 Form 8915-F (2020 Disasters)
IF . . .

You claimed qualified 2020 disaster distributions on 2022 Form
8915-F (2020 disasters) for the Washington (4593-DR–WA) disaster

AND . . .

THEN . . .

You did not check the box on line 11
or 22 on that form

Complete lines 12 through 15 and lines 23 through 26, as
applicable, of your 2024 Form 8915-F (2020 disasters).

You checked the box on line 11 or
22 on that form

If you are repaying qualified 2020 disaster distributions
made in 2021 or, for the Washington (4593-DR-WA)
disaster, made in 2022, complete lines 14 and 25, as
applicable, of your 2024 Form 8915-F (2020 disasters).

DRAFT AS OF
December 2, 2021

You claimed coronavirus-related distributions or other qualified 2020
disaster distributions on a 2020 Form 8915-E and you did NOT claim
qualified 2020 disaster distributions on a 2021 Form 8915-F (2020
disasters)

—

You did NOT claim qualified 2020 disaster distributions on a 2021
Form 8915-F (2020 disasters) AND you did not claim
coronavirus-related distributions or other qualified 2020 disaster
distributions on a 2020 Form 8915-E

—

If you aren’t repaying qualified 2020 disaster distributions
made in 2021 or in 2022, you can’t use 2024 Form
8915-F (2020 disasters).

If you are repaying coronavirus-related distributions or
other qualified 2020 disaster distributions, complete lines
14 and 25, as applicable, of your 2024 Form 8915-F (2020
disasters).
If you aren’t repaying coronavirus-related
distributions or other qualified 2020 disaster
distributions, STOP. You can’t use 2024 Form 8915-F
(2020 disasters).

STOP. You can’t use 2024 Form 8915-F (2020
disasters).

2025 Form 8915-F (2020 Disasters)
IF . . .

THEN . . .

You are repaying in 2024 qualified 2020 disaster distributions for the Washington
(4593-DR-WA) disaster made to you in 2022

You must complete lines 14 and 25, as applicable, of your 2025 Form 8915-F (2020
disasters).

You are NOT repaying in 2024 qualified 2020 disaster distributions for the
Washington (4593-DR-WA) disaster made to you in 2022

STOP. You can’t use 2025 Form 8915-F (2020 disasters).

*Note: Coronavirus-related distributions can NOT be repaid after 2023.

Instructions for Form 8915-F (Rev. 1-2022)

-15-

Form 8915-F (2021 Disasters):
Lines To Use

Look for the year of the form you are filing.

See Qualified 2021 disaster

TIP distribution requirements, earlier,

under Qualified Disaster Distribution
Requirements and also Qualified

Distributions, earlier, for the cutoff dates for
making these distributions and for other
criteria for these distributions.

2021 Form 8915-F (2021 Disasters)
IF . . .

AND . . .

THEN . . .
Complete Parts I, II, and III of 2021 Form 8915-F (2021
disasters), as applicable. If you received qualified
distributions in 2021 for 2021 disasters, complete Part IV.

DRAFT AS OF
December 2, 2021

Qualified 2021 disaster distributions were made to you in 2021

—

If you received qualified distributions for 2021 disasters in
2021, complete Part IV.

Qualified 2021 disaster distributions were not made to you in 2021

—

If you did NOT receive qualified distributions in
2021 for 2021 disasters, STOP. You can’t use 2021
Form 8915-F (2021 disasters).

2022 Form 8915-F (2021 Disasters)
IF . . .

AND . . .

THEN . . .

Qualified 2021 disaster distributions were made to you in 2022

—

Complete Parts I, II, and III of 2022 Form 8915-F (2021
disasters), as applicable. Also, if you received qualified
distributions in 2022 for 2021 disasters, complete Part IV.

You didn’t check the box on line 11 or Complete lines 12 through 15 and lines 23 through 26, as
22 on the 2021 Form 8915-F (2021
applicable, of your 2021 Form 8915-F (2021 disasters).
disasters)
Also, if you received qualified distributions in 2022 for
2021 disasters, complete Part IV.
You filed a 2021 Form 8915-F (2021 disasters), but qualified 2021
disaster distributions were NOT made to you in 2022

You checked the box on line 11 or
22 on the 2021 Form 8915-F (2021
disasters)

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2021 Form 8915-F (2021
disasters). Also, if you received qualified distributions in
2022 for 2021 disasters, complete Part IV.
If you aren’t repaying those distributions but you received
qualified distributions in 2022, complete Part IV.
If you aren’t repaying those distributions and you
did not receive qualified distributions in 2022, STOP.
You can’t use 2021 Form 8915-F (2021 disasters).

Qualified 2021 disaster distributions were not made to you in 2022
AND you did not file a 2021 Form 8915-F (2021 disasters)

-16-

—

If you received qualified distributions for 2021 disasters in
2021, complete Part IV.

—

If you did NOT receive qualified distributions in 2021
for 2021 disasters, STOP. You can’t use 2021 Form
8915-F (2021 disasters).

Instructions for Form 8915-F (Rev. 1-2022)

2023 Form 8915-F (2021 Disasters)
IF . . .

You claimed qualified 2021 disaster distributions on a 2021 Form
8915-F (2021 disasters) AND you filed a 2022 Form 8915-F (2021
disasters)

AND . . .

THEN . . .

You didn’t check the box on line 11 or Complete lines 12 through 15 and lines 23 through 26, as
22 on the 2021 Form 8915-F (2021
applicable, of your 2023 Form 8915-F (2021 disasters).
disasters) AND/OR on the 2022 Form
8915-F (2021 disasters)
You checked the box on line 11 or
22 on the 2021 Form 8915-F (2021
disasters) AND on the 2022 Form
8915-F (2021 disasters)

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2023 Form 8915-F (2021
disasters).

DRAFT AS OF
December 2, 2021

You claimed qualified 2021 disaster distributions on a 2022 Form
8915-F (2021 disasters) but did not file a 2021 Form 8915-F (2021
disasters)

You filed a 2021 Form 8915-F (2021 disasters) but did not claim
qualified 2021 disaster distributions on a 2022 Form 8915-F (2021
disasters)

If you aren’t repaying those distributions, STOP. You
can’t use 2023 Form 8915-F (2021 disasters).

You didn’t check the box on line 11 or Complete lines 12 through 15 and lines 23 through 26, as
22 on the 2022 Form 8915-F (2021
applicable, of your 2023 Form 8915-F (2021 disasters).
disasters), as applicable
You checked the box on line 11 or
22 on the 2022 Form 8915-F (2021
disasters), as applicable

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2023 Form 8915-F (2021
disasters).

If you aren’t repaying those distributions, STOP. You
can’t use 2023 Form 8915-F (2021 disasters).

You didn’t check the box on line 11 or Complete lines 12 through 15 and lines 23 through 26, as
22 on the 2021 Form 8915-F (2021
applicable, of your 2023 Form 8915-F (2021 disasters).
disasters)
You checked the box on line 11 or
22 on the 2021 Form 8915-F (2021
disasters)

You did NOT claim qualified 2021 disaster distributions on a 2022
Form 8915-F (2021 disasters) OR file a 2021 Form 8915-F (2021
disasters)

—

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2023 Form 8915-F (2021
disasters).
If you aren’t repaying those distributions, STOP. You
can’t use 2023 Form 8915-F (2021 disasters).
STOP. You can’t use 2023 Form 8915-F (2021
disasters).

2024 Form 8915-F (2021 Disasters)
IF . . .
You claimed qualified 2021 disaster distributions on a 2022 Form
8915-F (2021 disasters). You may or may not have claimed
coronavirus-related or other qualified 2021 disaster distributions on a
2021 Form 8915-F (2021 disasters)

AND . . .

THEN . . .

You did not check the box on line 11
or 22 on that form

Complete lines 12 through 15 and lines 23 through 26, as
applicable, of your 2024 Form 8915-F (2021 disasters).

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2024 Form 8915-F (2021
You checked the box on line 11 or 22
disasters).
on that form
If you aren’t repaying those distributions, STOP.
You can’t use 2024 Form 8915-F (2021 disasters).

You filed a 2021 Form 8915-F (2021 disasters) and you did NOT
claim qualified 2021 disaster distributions on a 2022 Form 8915-F
(2021 disasters)

You did NOT claim qualified 2021 disaster distributions on a 2021
Form 8915-F (2021 disasters) or on a 2022 Form 8915-F (2021
disasters)

—

If you are repaying those distributions, complete lines 14
and 25, as applicable, of your 2024 Form 8915-F (2021
disasters).

—

STOP. You can’t use 2024 Form 8915-F (2021
disasters).

If you aren’t repaying those distributions, STOP.
You can’t use 2024 Form 8915-F (2021 disasters).

2025 Form 8915-F (2021 Disasters)
IF . . .

THEN . . .

You are repaying in 2025 qualified 2021 disaster distributions made to you in 2022

You must complete lines 14 and 25, as applicable, of your 2025 Form 8915-F (2021
disasters).

You are NOT repaying in 2025 qualified 2021 disaster distributions made to you in
2022

STOP. You can’t use 2025 Form 8915-F (2021 disasters).

Instructions for Form 8915-F (Rev. 1-2022)

-17-

Appendix B
Qualified Disaster Areas
by Year
Table for Qualified 2020 Disaster Areas. Use for Form 8915-F (2020 disasters).
Disaster Area

Qualified 2020 Disaster (includes the FEMA DR
number (that is, FEMA’s major disaster
declaration number))

Date of Declaration

Disaster Period aka Incident Period

Qualified Individuals
(see Qualified
individuals, earlier)

Virus SARS-CoV-2 or coronavirus disease 2019
(referred to collectively in these instructions as
coronavirus)

Not relevant

Not relevant

Alabama

Severe Storms and Flooding (DR-4546-AL)

May 21, 2020

February 5, 2020 - March 6, 2020

Alabama

Severe Thunderstorms (DR-4555-AL)

July 10, 2020

April 12, 2020 - April 13, 2020

Alabama

Severe Storms, Straight-line Winds, and Tornadoes
(DR-4554-AL)

July 10, 2020

April 19, 2020

Alabama

Hurricane Sally (DR-4563-AL)

September 20, 2020

September 14, 2020 - September 16, 2020

Alabama

Hurricane Zeta (DR-4573-AL)

December 10, 2020

October 28, 2020 - October 29, 2020

Alaska

Severe Storm, Flooding, Landslides, and Mudslides
(4585-DR-AK)

March 3, 2021

November 30, 2020 - December 2, 2020

Arkansas

Severe Storms, Tornadoes, and Straight-line Winds
(DR-4544-AR)

May 8, 2020

March 28, 2020

Arkansas

Severe Storms and Straight-line Winds (DR-4556-AR)

July 10, 2020

April 12, 2020

California

Wildfires (DR-4558-CA)

August 22, 2020

August 14, 2020 - September 26, 2020

California

Wildfires (DR-4569-CA)

October 16, 2020

September 4, 2020 - November 17, 2020

Colorado

Wildfires (4581-DR-CO)

January 15, 2021

September 6, 2020 - November 5, 2020

Connecticut

Tropical Storm Isaias (4580-DR-CT)

January 12, 2021

August 4, 2020

Delaware

Tropical Storm Isaias (DR-4566-DE)

October 2, 2020

August 4, 2020 - August 7, 2020

Florida

Hurricane Sally (DR-4564-FL)

September 23, 2020

September 14, 2020 - September 28, 2020

Georgia

Tropical Storm Zeta (4579-DR-GA)

January 12, 2021

October 28, 2020 - November 1, 2020

Hawaii

Severe Storms and Flooding (DR-4549-HI)

July 9, 2020

March 27, 2020 - March 28, 2020

Iowa

Severe Storms (DR-4557-IA)

August 17, 2020

August 10, 2020

Kentucky

Severe Storms, Flooding, Landslides, and Mudslides
(DR-4540-KY)

April 24, 2020

February 3, 2020 - February 29, 2020

Louisiana

Hurricane Laura (DR-4559-LA)

August 28, 2020

August 22, 2020 - August 27, 2020

Louisiana

Hurricane Delta (DR-4570-LA)

October 16, 2020

October 6, 2020 - October 10, 2020

Louisiana

Hurricane Zeta (4577-DR-LA)

January 12, 2021

October 26, 2020 - October 29, 2020

Maryland

Tropical Storm Isaias (4583-DR-MD)

February 4, 2021

August 3, 2020 - August 4, 2020

Michigan

Severe Storms and Flooding (DR-4547-MI)

July 9, 2020

May 16, 2020 - May 22, 2020

Mississippi

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4478-MS)

March 12, 2020

January 10, 2020 - January 11, 2020

Mississippi

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4536-MS)

April 16, 2020

April 12, 2020

Mississippi

Severe Storms, Flooding, and Mudslides
(DR-4538-MS)

April 23, 2020

February 10, 2020 - February 18, 2020

Mississippi

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4551-MS)

July 9, 2020

April 22, 2020 - April 23, 2020

Mississippi

Hurricane Zeta (4576-DR-MS)

December 31, 2020

October 28, 2020 - October 29, 2020

Missouri

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4552-MO)

July 9, 2020

May 3, 2020 - May 4, 2020

New Jersey

Tropical Storm Isaias (DR-4574-NJ)

December 11, 2020

August 4, 2020

DRAFT AS OF
December 2, 2021

-18-

Instructions for Form 8915-F (Rev. 1-2022)

Table for Qualified 2020 Disaster Areas. Use for Form 8915-F (2020 disasters). continued
Disaster Area

Qualified 2020 Disaster (includes the FEMA DR
number (that is, FEMA’s major disaster
declaration number))

Date of Declaration

Disaster Period aka Incident Period

New York

Tropical Storm Isaias (DR-4567-NY)

October 2, 2020

August 4, 2020

North Carolina

Severe Storms, Tornadoes, and Flooding
(DR-4543-NC)

May 8, 2020

February 6, 2020 - February 19, 2020

North Carolina

Hurricane Isaias (DR-4568-NC)

October 14, 2020

July 31, 2020 - August 4, 2020

North Dakota

Flooding (DR-4553-ND)

July 9, 2020

April 1, 2020 - April 25, 2020

North Dakota

Severe Storms and Flooding (DR-4565-ND)

October 2, 2020

June 29, 2020 - July 1, 2020

Oklahoma

Severe Winter Storm (4575-DR-OK)

December 21, 2020

October 26, 2020 - October 29, 2020

Oregon

Severe Storms, Flooding, Landslides, and Mudslides
(DR-4519-OR)

April 3, 2020

February 5, 2020 - February 9, 2020

Oregon

Wildfires and Straight-line Winds (DR-4562-OR)

September 15, 2020

September 7, 2020 - November 3, 2020

Puerto Rico

Hurricane Isaias (DR-4560-PR)

September 9, 2020

July 29, 2020 - July 31, 2020

Puerto Rico

Severe Storm and Flooding (DR-4571-PR)

November 5, 2020

September 13, 2020

Sac & Fox Tribe of The
Mississippi of Iowa

Derecho Midwest (DR-4561-IA)

September 10, 2020

August 10, 2020

South Carolina

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4479-SC)

March 17, 2020

February 6, 2020 - February 13, 2020

South Carolina

Severe Storms, Tornadoes, and Straight-line Winds
(DR-4542-SC)

May 1, 2020

April 12, 2020 - April 13, 2020

Tennessee

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4476-TN)

March 5, 2020

March 3, 2020

Tennessee

Severe Storms, Tornadoes, Straight-line Winds, and
Flooding (DR-4541-TN)

April 24, 2020

April 12, 2020 - April 13, 2020

Tennessee

Severe Storms, Straight-line Winds, and Flooding
(DR-4550-TN)

July 9, 2020

May 3, 2020 - May 4, 2020

Texas

Hurricane Laura (DR-4572-TX)

December 9, 2020

August 23, 2020 - August 27, 2020

Utah

Earthquake and Aftershocks (DR-4548-UT)

July 9, 2020

March 18, 2020 - April 17, 2020

Utah

Severe Storm (4578-DR-UT)

January 12, 2021

September 7, 2020 - September 8, 2020

Washington

Severe Storms, Flooding, Landslides, and Mudslides
(DR-4539-WA)

April 23, 2020

January 20, 2020 - February 10, 2020

Washington

Wildfires and Straight-line Winds (4584-DR-WA)

February 4, 2021

September 1, 2020 to September 19, 2020

Washington

Severe Winter Storm, Straight-line Winds, Flooding,
Landslides, and Mudslides (4593-DR-WA)

April 8, 2021

December 29, 2020 - January 16, 2021

Wisconsin

Severe Winter Storm and Flooding (DR-4477-WI)

March 11, 2020

January 10, 2020 - January 12, 2020

DRAFT AS OF
December 2, 2021

Instructions for Form 8915-F (Rev. 1-2022)

-19-

Table for Qualified 2021 Disaster Areas. Use for Form 8915-F (2021 disasters).
Disaster Area

Qualified 2020 Disaster (includes the FEMA DR
number (that is, FEMA’s major disaster
declaration number))

Date of Declaration

Disaster Period aka Incident Period

Alabama

Severe Storms, Straight-line Winds, and Tornadoes
(4596-DR-AL)

April 26, 2021

March 25, 2021- March 26, 2021

Arizona

Severe Storm and Flooding (4620-DR-AZ)

September 13, 2021

July 22, 2021 - July 24, 2021

California

Wildfires (4610-DR-CA)

August 24, 2021

August 26, 2021 - September 3, 2021

California

Caldor Fire (4619-DR-CA)

September 12, 2021

August 14, 2021, continuing

Connecticut

Remnants of Hurricane Ida (DR-4629-CT)

October 30, 2021

September 1, 2021 - September 2, 2021

Delaware

Remnants of Hurricane Ida (DR-4627-DE)

October 24, 2021

September 1, 2021 - September 7, 2021

Georgia

Servere Storms and Tornadoes (4600-DR-GA)

May 5, 2021

March 25, 2021- March 26, 2021

Hawaii

Severe Storms, Flooding, and Landslides
(4604-DR-HI)

May 13, 2021

March 8, 2021 - March 18, 2021

Idaho

Straight-line Winds (4589-DR-ID)

March 4, 2021

January 13, 2021

Kentucky

Severe Winter Storms, Landslides, and Mudslides
(DR-4592-KY)

March 31, 2021

February 8, 2021 - February 19, 2021

Kentucky

Severe Storms, Flooding, Landslides, and Mudslides
(4595-DR-KY)

April 23, 2021

February 27, 2021 - March 14, 2021

Louisiana

Severe Winter Storms (4590-DR-LA)

March 9, 2021

February 11, 2021 - February 19, 2021

Louisiana

Severe Storms, Tornadoes, and Flooding
(4606-DR-LA)

June 2, 2021

May 17, 2021 - May 21, 2021

Louisiana

Hurricane Ida (4611-DR-LA)

August 29, 2021

August 26, 2021 - September 3, 2021

Michigan

Severe Storms, Flooding, and Tornadoes
(DR-4607-MI)

July 15, 2021

June 25, 2021 - June 26, 2021

Mississippi

Severe Winter Storms (4598-DR-MS)

May 4, 2021

February 11, 2021 - February 19, 2021

Mississippi

Hurricane Ida (DR-4626-MS)

October 22, 2021

August 28, 2021 - September 1, 2021

Missouri

Severe Storms, Straight-line Winds, Tornadoes, and
Flooding (4612-DR-MO)

September 1, 2021

June 24, 2021 - July 1, 2021

Montana

Straight-line Winds (4608-DR-MT)

August 13, 2021

June 10, 2021

Montana

Richard Spring Fire (DR-4623-MT)

September 30, 2021

August 8, 2021 - August 20, 2021

Nebraska

Severe Storms and Straight-line Winds (4616-DR-NE)

September 6, 2021

July 9, 2021 - July 10, 2021

New Hampshire

Severe Storm and Flooding (DR-4622-NH)

September 30, 2021

July 17, 2021 - July 19, 2021

New Hampshire

Severe Storm and Flooding (DR-4624-NH)

October 4, 2021

July 29, 2021 - July 30, 2021

New Jersey

Severe Winter Storm and Snowstorm (4597-DR-NJ)

April 28, 2021

January 31, 2021 - February 2, 2021

New Jersey

Remnants of Tropical Hurricane Ida (4614-DR-NJ)

September 5, 2021

September 1, 2021 - September 3, 2021

New York

Remnants of Tropical Hurricane Ida (4615-DR-NY)

September 5, 2021

September 1, 2021 - September 3, 2021

New York

Remnants of Tropical Storm Fred (DR-4625-NY)

October 8, 2021

August 18, 2021 - August 19, 2021

North Carolina

Tropical Storm Eta (4588-DR-NC)

March 3, 2021

November 12, 2020 - November 15, 2020

North Carolina

Remnants of Tropical Storm Fred (4617-DR-NC)

September 8, 2021

August 16, 2021 - August 18, 2021

North Dakota

Severe Storm, Straight-line Winds, and Flooding
(4613-DR-ND)

September 1, 2021

June 7, 2021 - June 11, 2021

Oklahoma

Severe Winter Storms (4587-DR-OK)

February 24, 2021

February 8, 2021 - February 20, 2021

Oregon

Winter Storm 02-13-2021 (4599-DR-OR)

May 4, 2021

February 11, 2021 - February 15, 2021

Pennsylvania

Remnants of Hurricane Ida (4618-DR-PA)

September 10, 2021

August 31, 2021 - September 5, 2021

Tennessee

Severe Winter Storms (4594-DR-TN)

April 21, 2021

February 11, 2021 - February 19, 2021

Tennessee

Severe Storms, Tornadoes, and Flooding
(4601-DR-TN)

May 8, 2021

March 25, 2021 - April 3, 2021

Tennessee

Severe Storm and Flooding (4609-DR-TN)

August 23, 2021

August 21, 2021

Texas

Severe Winter Storms (4586-DR-TX)

February 19, 2021

February 11, 2021 - February 21, 2021

Vermont

Severe Storm and Flooding (DR-4621-VT)

September 29, 2021

July 29, 2021 - July 30, 2021

Virginia

Severe Winter Storms (4602-DR-VA)

May 10, 2021

February 11, 2021 - February 13, 2021

Virginia

Flooding, Landslides, and Mudslides (DR-4628-VA)

October 26, 2021

August 30, 2021 - August 31, 2021

West Virginia

Severe Winter Storms (4603-DR-WV)

May 13, 2021

February 10, 2021 - February 16, 2021

West Virginia

Servere Storms and Flooding (4605-DR-WV)

May 20, 2021

February 27, 2021 - March 4, 2021

DRAFT AS OF
December 2, 2021

-20-

Instructions for Form 8915-F (Rev. 1-2022)