Form 5498-ESA Form 5498-ESA Coverdell ESA Contribution Information

7272

VOID

CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$
TRUSTEE’S/ISSUER’S TIN

2022

Coverdell ESA
Contribution
Information

Form 5498-ESA

Copy A

BENEFICIARY’S TIN

For
Internal Revenue
Service Center

BENEFICIARY’S name

File with Form 1096.
Street address (including apt. no.)

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2022 General
Instructions for
Certain Information
Returns.

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

Cat. No. 34011J

www.irs.gov/Form5498ESA

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

CORRECTED
TRUSTEE’S or ISSUER’S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$
TRUSTEE’S/ISSUER’S TIN

2022

Coverdell ESA
Contribution
Information

Form 5498-ESA

Copy B

BENEFICIARY’S TIN

For Beneficiary

BENEFICIARY’S name

This information
is being furnished
to the IRS.

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

(keep for your records)

www.irs.gov/Form5498ESA

Department of the Treasury - Internal Revenue Service

Instructions for Beneficiary
The information on Form 5498-ESA is furnished to you by
the trustee or issuer of your Coverdell education savings
account (ESA) by May 1, 2023. Form 5498-ESA reports
contributions and rollover contributions made for you for
2022. For more information about Coverdell ESAs, see
Pub. 970.
Beneficiary’s taxpayer identification number (TIN). For
your protection, this form may show only the last four digits
of your TIN (social security number (SSN), individual
taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification
number (EIN)). However, the issuer has reported your
complete TIN to the IRS.
Account number. May show an account or other unique
number the trustee/issuer assigned to distinguish your
account.
Box 1. Shows Coverdell ESA contributions made in 2022
and through April 18, 2023, for 2022 on your behalf. Do not
deduct these amounts on your income tax return.

If the total contributions made to all your Coverdell ESAs
for 2022 exceeded $2,000, you must withdraw the excess,
plus earnings, by May 31, 2023, or you may owe a penalty.
You must keep track of your Coverdell ESA basis
(contributions and distributions).
Box 2. Shows any rollover (including a direct rollover and
contribution of a military death gratuity) you made in 2022.
Generally, any amount rolled over from one Coverdell ESA
to another Coverdell ESA for the benefit of the named
beneficiary or a member of the beneficiary’s family who is
under age 30 (except for a beneficiary with special needs)
is not taxable.
Future developments. For the latest information about
developments related to Form 5498-ESA and its
instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form5498ESA.
Free File Program. Go to www.irs.gov/FreeFile to see if
you qualify for no-cost online federal tax preparation,
e-filing, and direct deposit or payment options.

VOID

CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$
TRUSTEE’S/ISSUER’S TIN

Form 5498-ESA

Copy C

BENEFICIARY’S TIN

For Trustee

BENEFICIARY’S name

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2022 General
Instructions for
Certain
Information
Returns.

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

2022

Coverdell ESA
Contribution
Information

www.irs.gov/Form5498ESA

Department of the Treasury - Internal Revenue Service

Instructions for Trustee or Issuer
To complete Form 5498-ESA, use:
• The 2022 General Instructions for Certain Information
Returns, and
• The 2022 Instructions for Form 5498-ESA.
To get or to order these instructions, go to
www.irs.gov/EmployerForms.
Filing and furnishing. For filing and furnishing
instructions, including due dates, and requesting filing
or furnishing extensions, see the current General
Instructions for Certain Information Returns.

Need help? If you have questions about reporting on
Form 5498-ESA, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).