Tax Form 5498-SA Information Entry Form
Enter details required for Tax Form 5498-SA preparation. Please provide accurate information for each field.
Filer Name
*
First Name
Last Name
Recipient Name
*
First Name
Last Name
Recipient Email Address
*
example@example.com
Account Type
*
HSA (Health Savings Account)
Archer MSA (Medical Savings Account)
MA MSA (Medicare Advantage MSA)
Tax Year
*
Please Select
2026
2025
2024
Type of Contribution
*
Regular
Rollover
Transfer
Total Contributions (USD)
*
Rollover or Transfer Amount (USD)
Fair Market Value as of December 31 (USD)
*
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Information
Should be Empty: