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Form 8853

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General Instructions 20 - IRS tax forms

www.irs.gov

The beneficiary completes Form 8853 as follows. • Enter “Death of Archer MSA account holder” across the top of Form 8853. • Enter the name(s) shown on the beneficiary's tax return and the beneficiary's SSN in the spaces provided at the top of the form and skip Part I. …

  Form, Instructions, 8538, Form 8853, Irs tax forms

HSA, Archer MSA, or Medicare Advantage MSA Information 2

www.irs.gov

See Form 8853 and its instructions or Form 8889 and its instructions. Any employer contributions made to an Archer MSA are shown on your Form W-2 in box 12 (code R); employer contributions made to an HSA are shown in box 12 (code W). For more information, see Pub. 969. Participant’s taxpayer identification number (TIN). For your protection, this

  Form, Information, Medicare, Advantage, Archer, 8538, Form 8853, Archer msa, Or medicare advantage msa information

2018 Form 8889 - IRS tax forms

www.irs.gov

Name(s) shown on Form 1040 or Form 1040NR Social security number of HSA beneficiary. If both spouses have HSAs, see instructions . . Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required. Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing ...

  Form, 8538, Form 8853, Irs tax forms

Electronic Funds Transfer (EFT) & Electronic Remittance ...

www.triwest.com

Download the EFT Authorization Form found on TriWest Payer Space on Availity.com. Print and complete the EFT registration package and mail it to: PGBA, LLC, PO Box 108853, Florence, SC 29502-8853 or fax it to: 803-419-3233.

  Form, 8538

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