Information Collection

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

IC 18577 under ICR 202409-1545-014 · OMB 1545-1517.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1099-SA Form 1099-SA - Distributions From an HSA, Archer MSA, or Medicare Advantage MSA	Form
i1099-sa_and_5498-sa--2025-00-00_draft.pdf	Instruction
i1099-sa_and_5498-sa--2025-00-00_draft.pdf	Instruction
i1099-general--2025-00-00.pdf	Instruction
i1099-general--2025-00-00.pdf	Instruction
1099-SA Distributions From an HSA, Archer MSA or Medical Advanta f1099-sa--2024-11-00.pdf	Form
1099-SA Distributions From an HSA, Archer MSA or Medical Advanta f1099-sa--2024-11-00.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1099-SA	Distributions From an HSA, Archer MSA or Medical Advantage MSA	f1099-sa--2024-11-00.pdf	Yes	Yes	Fillable Fileable
Instruction			i1099-sa_and_5498-sa--2025-00-00_draft.pdf	Yes	No	Printable Only
Instruction			i1099-general--2025-00-00.pdf	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: Treasury/IRS 22.061âInformation Return Master File (IRMF); Treasury/IRS 24.030-Customer Account Data Engine Master File; and IRS 34.037âIRS Audit Trail and Security Records System

FR Citation: 83 FR 42980

Number of Respondents: 10,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,392,600	20,366,761	25,839
Annual IC Time Burden (Hours)	3,738,643	3,735,025	3,618
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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