IRS Form 1099‑SA – Fillable HSA Distribution Tax Form

The IRS Form 1099‑SA reports distributions from a Health Savings Account (HSA), Archer MSA, or Medicare Advantage MSA. Financial institutions issue this form to you and the IRS whenever you receive a distribution. Accurate reporting is essential to avoid penalties and to correctly calculate any taxable amount on your tax return.

What Is Form 1099‑SA?

Form 1099‑SA is a one‑page informational return that shows the total amount distributed from your HSA during the calendar year, the type of distribution (e.g., normal, excess, or rollover), and any federal income tax withheld. You use the information on this form when completing Form 8889 (Health Savings Accounts) on your individual tax return.

How to Fill Out the HSA Distribution Form Online

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load directly in your browser, letting you complete every field instantly.

Common Mistakes to Avoid

• Entering the wrong distribution code – double‑check the box that matches the reason for the distribution.
• Omitting the amount of federal tax withheld – even a $0 entry must be entered.
• Failing to sign the form if you are printing it for paper filing.
• Using the wrong tax year version – make sure you are on the 2023 (or current year) PDF.

Where to Submit Your Completed Form

Form 1099‑SA is sent to the IRS by the payer (your bank or HSA custodian). You, the recipient, keep a copy for your records and use the figures when preparing your personal tax return. If you file electronically, the data from the fillable PDF can be imported directly into most tax‑software programs.

Need a printable copy? After you finish filling the form in Formize, click **Download PDF** and print it for your records.