Internal Revenue Service United States Department of the Treasury
Level Basic Advanced Military International

Health Savings Accounts (HSA)


Intake/Interview Process

Use Form 13614-C, Intake/Interview & Quality Review Sheet, to determine if the taxpayer had HSA contributions or distributions. Use the intake and interview sheet as a starting point for a comprehensive interaction with the taxpayer in combination with all the source documents provided by the taxpayer to prepare an accurate return.

Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information, is used to report HSA contributions. Form 1099-SA, Distributions from an HSA, Archer MSA, or Medicare Advantage MSA, is used to report HSA distributions. These information documents are issued by the HSA trustee to taxpayers who have HSA contributions or distributions, for use in tax return preparation.

Form 13614C, Intake and interview sheet showing Taxpayer HSA information.