This version of the form is not currently in use and is provided for reference only.
Download this version of IRS Form 5498-SA for the current year.
IRS Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information is a form filed with the Internal Revenue Service (IRS) by a trustee or custodian of a Health Savings Account (HSA), Medicare Advantage MSA (MA MSA), or Archer Medical Savings Account (Archer MSA). Trustees or custodians are required to file a separate form for each type of plan and for each person for whom they maintained one of these savings accounts.
Download a fillable IRS Form 5498-SA through the link below or through the IRS official website. This form was last revised in 2019.
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