Hsa bank account form 2025

See details

4 out of 5

52 votes

The document is a Health Savings Account (HSA) Bank Account Closing Form, which allows accountholders to withdraw all funds and close their HSA with Health Savings Administrators and HSA Bank. It provides instructions for completing and submitting the form, details on the account closing fee, and reasons for account closure. Additionally, it includes sections for accountholder information, signature, and bank authorization.

Here's how it works

01. Edit your hsaforms hsabank com online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send hsa bank account closing via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out HSA Bank Account Closing Form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the HSA Bank Account Closing Form in the editor.
Begin by filling out the ACCOUNTHOLDER INFORMATION section. Enter your first name, middle initial, last name, street address, city, state, ZIP code, and Social Security Number. Ensure all details are accurate for a smooth processing.
Next, indicate your ACCOUNT NUMBER. This is crucial for identifying your specific account that you wish to close.
In the CLOSING REASON section, select one or more reasons for closing your account. Options include account fees, interest rates, or transferring to another financial institution. If 'Other', please specify.
Finally, sign and date the form in the SIGNATURE section. This certifies that you are authorized to receive payments from the HSA and that all information provided is true.

Start using our platform today to easily complete your HSA Bank Account Closing Form online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you create an HSA account on your own?

Your employer may offer a High Deductible Health Plan (HDHP), or you may purchase an HDHP on your own. Once you are enrolled in an HDHP, check to see if an HSA was automatically opened for you by your insurer. If not, you can open one with a bank or another financial institution that offers HSAs.

Do I need to file a HSA form?

Distributions from a health savings account (HSA), Archer medical savings account (MSA), or Medicare Advantage (MA) MSA are reported to you on Form 1099-SA. File Form 8853 or Form 8889 with your Form 1040 or 1040-SR to report a distribution from these accounts even if the distribution isnt taxable.

How to set up an HSA bank account?

You must report contributions from your HSA on IRS Form 8889. Get 5498-SA information in the If I dont have a 5498-SA, how can I get my contributions by tax year? question. Find a sample 5498-SA form from the IRS. The HSA Bank 5498-SA form may look slightly different, but it will contain the same information.

How much does it cost to set up an HSA account?

Fidelity is the best choice if youre shopping on your own for a health savings account (HSA) because it has no fees or minimum balance requirements, offers a vast array of investment choices, and has a stellar interest rate on deposits.

Do I get a 1099 for my HSA?

Go to .irs.gov/Form8889 for instructions and the latest information. Name(s) shown on Form 1040, 1040-SR, or 1040-NR Social security number of HSA beneficiary. If both spouses have HSAs, see instructions.

Try more PDF tools