Form 8915-F (1-2022)
Page 3
Part II
Qualified Disaster Distributions From Retirement Plans (Other Than IRAs) for the Coronavirus and
Disaster(s) Listed in Item C
8 Did you enter an amount on line 2, column (b)?
No. Skip lines 8 through 11, and go to line 12. Yes. 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. This is the taxable amount of your other-than-IRA retirement plan qualified
disaster distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11
The entire taxable amount on line 10 will be spread over 3 years unless you elect to have it taxed in this year.
If you elect NOT to spread the taxable amount over 3 years, check this box
▶
and enter the
amount from line 10 (see instructions). Otherwise, enter the amount from line 10 divided by 3.0. You
must check the box on this line if you check the box on line 22 . . . . . . . . . . . . . .
11
12 Enter the amount, if any, from Worksheet 2 in the instructions. This is your income for prior years from
other-than-IRA retirement plan qualified disaster distributions . . . . . . . . . . . . . . . 12
13 Add lines 11 and 12. This is your total income this year from other-than-IRA retirement plan qualified
disaster distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Total repayment. Enter the amount, if any, from Worksheet 3. This is your total repayment for this year of
other-than-IRA retirement plan qualified disaster distributions . . . . . . . . . . . . . . . 14
15 Amount subject to tax this year. Subtract line 14 from line 13. If zero or less, enter -0-. Include this
amount in the total on line 5b of this year’s Form 1040, 1040-SR, or 1040-NR. See instructions . . . . 15
Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.
Part III
Qualified Disaster Distributions From Traditional, SEP, SIMPLE, and Roth IRAs for the Coronavirus and
Disaster(s) Listed in Item C
16 Did you enter an amount on line 3, column (b), or line 4, column (b)?
Yes. Go to line 17. No. Skip lines 17 through 22, and go to line 23.
17 Did you receive a qualified disaster distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required
to be reported on this year’s Form 8606?
Yes. Go to line 18. No. Skip lines 18 and 19, and go to line 20.
18
Enter the amount, if any, from this year’s Form 8606, line 15b. But if you are entering amounts here and on
other Forms 8915-F for this year, only enter on line 18 the amount on Form 8606, line 15b, attributable to
Form 8915-F distributions for this form. See the instructions for Form 8606, line 15b . . . . . . .
18
19
Enter the amount, if any, from this year’s Form 8606, line 25b. But if you are entering amounts here and on
other Forms 8915-F for this year, only enter on line 19 the amount on Form 8606, line 25b, attributable to
Form 8915-F distributions for this form. See the instructions for Form 8606, line 25b . . . . . . .
19
20 Enter the amount from line 3, column (b), if any. Don’t include on line 20 any amounts reported on Form
8606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21
Add lines 18, 19, and 20. This is the taxable amount of your IRA qualified disaster distributions
. . . . . 21
22
The entire taxable amount on line 21 will be spread over 3 years unless you elect to have it taxed in this year.
If you elect NOT to spread the taxable amount over 3 years, check this box
▶
and enter the
amount from line
21 (see instructions). Otherwise, enter the amount from line 21 divided by 3.0. You
must check the box on this line if you check the box on line 11 . . . . . . . . . . . . . .
22
23 Enter the amount, if any, from Worksheet 4 in the instructions. This is your income for prior years from IRA
qualified disaster distributions . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Add lines 22 and 23. This is your total income this year from IRA qualified disaster distributions . . . . 24
25 Total repayment. Enter the amount, if any, from Worksheet 5. This is your total repayment for
this year of
IRA qualified disaster distributions . . . . . . . . . . . . . . . . . . . . . . . 25
26 Amount subject to tax. Subtract line 25 from line 24. If zero or less, enter -0-. Include this amount in the
total on line 4b of this year’s Form 1040, 1040-SR, or 1040-NR. See instructions . . . . . . . . .
26
Form 8915-F (1-2022)