Form 8928- Return of Certain Excise Taxes Under Chapter 43 & TD 9457-Employer Comparable Contributions to HSAs and Requirement for filing excise taxes under sections 4980B, 4980D, 4980E and 4980G.

OMB 1545-2146

Form 8928 is used by employers, group health plans, HMOs, and third party administrators to report and pay excise taxes due for failures under sections 4980B, 4980D, 4980E, and 4980G. The information results from the requirement from TD 9457 to file a return for the payment of the excise taxes under section 4980B, 4980D, 4980E, and 4980G of the code.

The latest form for Form 8928- Return of Certain Excise Taxes Under Chapter 43 & TD 9457-Employer Comparable Contributions to HSAs and Requirement for filing excise taxes under sections 4980B, 4980D, 4980E and 4980G. expires 2022-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 8928 Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code Form
REG-120476-07.pdf Supplementary Document
TD 9457.docx Supplementary Document
20201-12_SS_1545-2146sc.docx Supporting Statement A
Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code Form

All Historical Document Collections

202201-1545-020 Approved without change	Extension without change of a currently approved collection	2022-02-28
201806-1545-022 Approved without change	Extension without change of a currently approved collection	2018-10-30
201507-1545-006 Approved without change	Revision of a currently approved collection	2015-08-31
201203-1545-007 Approved without change	Extension without change of a currently approved collection	2012-05-31
200912-1545-019 Approved without change	Revision of a currently approved collection	2009-12-23
200903-1545-021 Preapproved	New collection (Request for a new OMB Control Number)	2009-03-31