OMB control number
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
OMB 1545-1517 · TREAS/IRS.
OMB 1545-1517
Form 1099-SA is used to report distributions made from a health savings account (HSA), Archer medical savings account (Archer MSA), or Medicare Advantage MSA (MA MSA). The distribution may have been paid directly to a medical service provider or to the account holder. A separate return must be filed for each plan type.
The latest form for Distributions From an HSA, Archer MSA, or Medicare Advantage MSA expires 2028-05-31 and can be found here.
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