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The trustee of your HSA, Archer MSA, or MA MSA may provide other information about your account on this form. Note: Dont attach Form 5498-SA to your income tax return. Instead, keep it for your records.
Form G-1145 09/26/14 Y. Page 1 of 1. Use this form to request an electronic notification (e-Notification) when U.S. Citizenship and Immigration Services accepts your immigration application. This service is available for applications filed at a USCIS Lockbox facility.
Complete / Review information, sign, and date. Fax signed forms to Molina Pharmacy Prior Authorization Department at 1-888-487-9251. Please contact Molina Pharmacy Prior Authorization Department at 1-855-322-4080 with questions regarding the prior authorization process.
Form 942 is a tax form used by employers who hire household employees, such as nannies, housekeepers, or caregivers. Its used to report and pay federal income tax, Social Security, and Medicare taxes for household employees. It is used to report any withheld income tax on wages paid to household employees.
Schedule B (Form 8995-A) must be completed each year to show your trade or business aggregation(s) and must include any aggregation of an RPE in which you hold a direct or indirect interest.
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The information on Form 5498 is submitted to the IRS by the trustee or issuer of your individual retirement arrangement (IRA) to report contributions, including any catch-up contributions, rollovers, repayments, required minimum distributions (RMDs), and the fair market value (FMV) of the account.
Form 4598 (Rev. 8-2004) Subject. Form W-2, 1098, or 1099 Not Received, Incorrect or Lost.
IRA contributions will be reported on Form 5498: IRA contribution information is reported for each person for whom any IRA was maintained, including SEP or SIMPLE IRAs. An IRA includes all investments under one IRA plan. The institution maintaining the IRA files this form.

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