Request for Transfer to a 2026

1. Click ‘Get Form’ to open the Request for Transfer to a Health Savings Account in the editor.
2. Begin by filling out the HSA Owner Information section. Enter your name, address, Social Security number, date of birth, daytime phone number, and email (optional).
3. Select the type of transfer you wish to initiate: either from HSA to HSA or from an Archer Medical Savings Account (MSA) to an HSA.
4. In the Transferor Custodian/Trustee Request section, provide details about your current custodian/trustee including their name, address, phone number, and account number.
5. Specify your transfer instructions. Choose whether you want to transfer your entire balance or a portion of it. If applicable, indicate the payment schedule and investments.
6. Complete the Delivery Instructions by providing the transferee HSA account number and specifying how checks should be made payable.
7. Finally, sign and date the form in the designated areas to certify that all information is accurate.

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