Information Collection

HSA, Archer MSA, or Medicare Advantage MSA Information

IC 18582 under ICR 202501-1545-001 · OMB 1545-1518.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information	Form
Form 5498-SA HSA, ARCHER MSA OR MEDICARE ADVANTAGE MSA INFORMATION HSA, Archer MSA, or Medicare Advantage MSA Information	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
5498-SA HSA, ARCHER MSA OR MEDICARE ADVANTAGE MSA INFORMATION 2025 Form 5498-SA.pdf	Form
5498-SA HSA, ARCHER MSA OR MEDICARE ADVANTAGE MSA INFORMATION 2025 Form 5498-SA.pdf	Form

IC Title:

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5498-SA	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS 22.061âInformation Return Master File (IRMF); Treasury/IRS 24.030-Customer Account

FR Citation: 80 FR 54064

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: 99 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38,473,400	38,464,233	9,167
Annual IC Time Burden (Hours)	6,412,233	6,410,674	1,559
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.

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