Sample Excel Import File: 5498-SA 2023.xlsx |
|
| Field Name | Size | Type | Description | Notes |
|---|---|---|---|---|
| See Form Filer Common Fields | Filer fields common to all form types. | |||
| See Recipient Common Fields | Recipient fields common to all form types. | |||
Box 1 Amount | 12 | Amount | Box 1: Employee or self-employed person's Archer MSA contributions... | |
Box 2 Amount | 12 | Amount | Box 2: Total contributions made in 2020 | |
Box 3 Amount | 12 | Amount | Box 3: Total HSA or MSA contributions made in 2021 for 2020 | |
| Box 4 Amount | 12 | Amount | Box 4: Rollover contributions | |
| Box 5 Amount | 12 | Amount | Box 5: Fair market value of HSA, Archer MSA, or MA MSA | |
| Box 6 Checkbox 1 | 1 | Checkbox | Box 6: HSA | X / Y / T / 1 = Checked |
| Box 6 Checkbox 2 | 1 | Checkbox | Box 6: Archer MSA | X / Y / T / 1 = Checked |
| Box 6 Checkbox 3 | 1 | Checkbox | Box 6: MA MSA | X / Y / T / 1 = Checked |
| See Form Common Fields | Form fields common to all form types. | |||
