Form
8915B
Department of the Treasury
Internal Revenue Service
Qualified 2017 Disaster Retirement
Plan Distributions and Repayments
▶
Go to www.irs.gov/Form8915B for instructions and the latest information.
▶
Attach to 2018 Form 1040 or 2018 Form 1040NR.
OMB No. 1545-0074
2018
Attachment
Sequence No.
915
Name. If married, file a separate form for each spouse required to file 2018 Form 8915B. See instructions. Your social security number
Fill in Your Address Only
if You Are Filing This
Form by Itself and Not
With Your Tax Return
▲
Home address (number and street, or P.O. box if mail is not delivered to your home) Apt. no.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete the
spaces below (see instructions).
If this is an amended
return, check here
▶
Foreign country name Foreign province/state/county Foreign postal code
Part I
Total Distributions From All Retirement Plans (Including IRAs)
Before you begin:
• Complete this part only if you have qualified 2017 disaster distributions in 2018 and the total of your qualified 2017 disaster distributions in 2017, if any, for the type of
qualified 2017 disaster distribution(s) (hurricanes or wildfires) made in 2018 was less than $100,000. See instructions.
• If you have both qualified hurricane distributions and qualified wildfire distributions in 2018, see Worksheet 2 in the instructions to figure the amounts for column (b).
Complete line 1 first. Then complete lines 2 through 5 of one column
before going to the next column.
(a)
Total distributions
in 2018
(b)
Qualified 2017 disaster
distributions
(see instructions)
(c)
Allocation of
column (b)
(see instructions)
1
Enter in columns (b) and (c) the amount described below for your situation
.
• If you did not file 2017 Form 8915B, enter -0-.
• If you filed 2017 Form 8915B, you only had one type (hurricane or wildfire) of qualified
2017 disaster distribution in both 2017 and 2018, and the type of distribution you
reported on 2017 Form 8915B is different from the type you are reporting on 2018
Form 8915B, enter -0-.
• If you filed 2017 Form 8915B, you only had one type (hurricane or wildfire) of qualified
2017 disaster distribution in both 2017 and 2018, and the type of distribution you
reported on 2017 Form 8915B is the same as the type you are reporting on 2018 Form
8915B, enter the amount from your 2017 Form 8915B, line 4, column (b).
• If for your 2017 Form 8915B you were required to use Worksheet 2 in the instructions,
but on your 2018 Form 8915B you only have qualified hurricane distributions or
qualified wildfire distributions (but not both), enter the amount (hurricane or wildfire)
from line 4 of column (X) in your Worksheet 2 in the 2017 Form 8915B instructions for
the type of qualified 2017 disaster distributions made in 2018.
• If your situation is not described above, see Worksheet 2 in the instructions.
If the amount you are entering in column (b) is $100,000 or more, do not complete
this part; you have no qualified 2017 disaster distributions in 2018 . . .
2
Distributions from retirement plans (other than IRAs) made in 2018
.
3
Distributions from traditional, SEP, and SIMPLE IRAs made in 2018
.
4 Distributions from Roth IRAs made in 2018 . . . . . . .
5 Totals. Add lines 1 through 4 in columns (a) and (b). If line 5, column
(b), is more than $100,000 and you did not use Worksheet 2, you
must complete column (c) and enter $100,000 on line 5, column (c)
6 Subtract line 1 in column (c) from $100,000 . . . . . . .
7
If you completed column (c), enter the excess of the amount on line 5, column (a), over the amount on line 6, column (c). Otherwise,
enter the excess of the amount on line 5, column (a), over the sum of the amounts on lines 2 through 4 in column (b). Report these
distributions under the normal rules in accordance with the instructions for your tax return . . . . . . . . . . .
7
Part II
Qualified 2017 Disaster Distributions From Retirement Plans (Other Than IRAs)
8
Did you enter an amount on line 2, column (b)?
No. Skip lines 8 through 11, and go to line 12.
Yes. If you completed line 2, column (c), enter that amount. Otherwise, enter the amount
from line 2, column (b) . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Enter the applicable cost of distributions, if any. See instructions . . . . . . . . . . . . . . 9
10 Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 If you elect NOT to spread the taxable amount over 3 years, check this box ▶
and enter the amount from line 10 (see instructions). You must check this box if you check the box on line 26.
Otherwise, divide line 10 by 3.0 . . . . . . . . . . . . . . . . . . . . . . . .
11
12 Enter the amount, if any, from your 2017 Form 8915B, line 9. If you checked the box on that line, enter -0- . 12
13 Add lines 11 and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Enter the amount, if any, from your 2017 Form 8915B, line 10 . . . . . . 14
15 Enter the amount, if any, from your 2017 Form 8915B, line 9 . . . . . . 15
16 Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 16
17
Enter the total amount of any repayments you made before filing your 2018 tax return. But do not include repayments made later than
the due date (including extensions) for that return. If you repaid amounts that previously were reported as qualified 2016 disaster
distributions in 2016 or 2017 Form 8915A, Part II, file 2018 Form 8915A to claim a repayment of those amounts. See instructions . .
17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
19 Amount subject to tax in 2018. Subtract line 18 from line 13. If zero or less, enter -0-. Include this amount in
the total on 2018 Form 1040, line 4b; or 2018 Form 1040NR, line 17b . . . . . . . . . . . . 19
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 71180D
Form 8915B (2018)
