Form 5498-QA
2019
Cat. No. 67556T
ABLE Account
Contribution
Information
Copy A
For
Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-2262
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2019 General
Instructions for
Certain Information
Returns.
2A2A
VOID CORRECTED
ISSUER'S name, street address, city or town, state or province, country, and
ZIP or foreign postal code
ISSUER’S TIN BENEFICIARY'S TIN
BENEFICIARY'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 ABLE contributions
$
2 ABLE to ABLE Rollovers
$
3 Cumulative contributions
$
4 Fair market value
$
5 Check if account opened
in 2019
6 Basis of eligibility
7 Code
Form 5498-QA
www.irs.gov/Form5498QA
Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page
Form 5498-QA
2019
ABLE Account
Contribution
Information
Copy B
For Beneficiary
Department of the Treasury - Internal Revenue Service
This information
is being furnished
to the IRS.
OMB No. 1545-2262
CORRECTED
ISSUER'S name, street address, city or town, state or province, country, and
ZIP or foreign postal code
ISSUER’S TIN BENEFICIARY'S TIN
BENEFICIARY'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 ABLE contributions
$
2 ABLE to ABLE Rollovers
$
3 Cumulative contributions
$
4 Fair market value
$
5 If checked, account was
opened in 2019
6 Basis of eligibility
7 Code
Form 5498-QA
(keep for your records)
www.irs.gov/Form5498QA
Instructions for Beneficiary
The information on Form 5498-QA is furnished to you by the issuer of your
Achieving a Better Life Experience (ABLE) savings account. Form 5498-QA
reports contributions, rollovers, and program-to-program transfers to this
ABLE account for 2019. For more information, see Pub. 907.
Beneficiary's taxpayer identification number (TIN). For your
protection, this form may show only the last four digits of your TIN
(social security number (SSN), individual taxpayer identification
number (ITIN), or adoption taxpayer identification number (ATIN)).
However, the issuer has reported your complete TIN to the IRS.
Account number. May show an account or other unique number the
issuer assigned to distinguish your account.
Box 1. Shows the amount of contributions made to this ABLE account
in 2019. Include all cash contributions and Qualified Tuition Plan (QTP)
to ABLE account rollovers, and QTP to ABLE program-to-program
transfers. Do not deduct these amounts on your income tax return.
If the total contributions (including any contributions from a section
529 program/QTP), but not including contributions of the designated
beneficiary's compensation income made under section 529A(b)(2)(B)
(ii) made to your ABLE account for 2019 exceeded $15,000, or if the
contributions of an employed designated beneficiary's compensation
income exceeded, the applicable amount under section 529A(b)(2)(B)
(ii), the excess contributions, plus the earnings on them, must be
returned by the date your tax return is due (including extensions), or
you may owe a penalty. Check with your ABLE program to verify that
excess contributions and earnings are returned timely. You must keep
track of your ABLE account basis (contributions and distributions).
Box 2. Shows the amount of any rollover or program-to-program transfer
made to this ABLE account from another ABLE account in 2019.
Generally, any amount rolled over from one ABLE account to another
ABLE account for the benefit of the named beneficiary or of an eligible
individual who is a member of the beneficiary's family who is described in
section 152(d)(2)(B) is not taxable.
Box 3. May show the cumulative amount contributed since the
establishment of the ABLE account (or of an ABLE account of the
same designated beneficiary that was rolled over, or directly
transferred (in a program-to-program transfer), to the current ABLE
account).
Box 4. Shows the FMV of the ABLE account as of the end of the year.
Box 5. The ABLE account was opened in 2019 if the box is checked.
Box 6. These codes show the basis for your ABLE account eligibility.
Aeligibility established under 529A(e)(1)(A), SSDI, Title II SSA.
Beligibility established under 529A(e)(1)(A), SSI, Title XVI SSA.
Celigibility established by disability certification under section
529A(e)(1)(B).
Box 7. These codes show the type of disability for which you are
receiving ABLE account qualifying benefits. 1developmental
disorders (including autism); 2intellectual disability; 3psychiatric
disorders; 4nervous disorders (including blindness and deafness);
5congenital anomalies (including Down syndrome); 6respiratory
disorders; 7other.
Future developments. For the latest information about developments
related to Form 5498-QA and its instructions, such as legislation
enacted after they were published, go to www.irs.gov/Form5498QA.
Form 5498-QA
2019
ABLE Account
Contribution
Information
Copy C
For Issuer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2262
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2019 General
Instructions for
Certain
Information
Returns.
VOID CORRECTED
ISSUER'S name, street address, city or town, state or province, country, and
ZIP or foreign postal code
ISSUER’S TIN BENEFICIARY'S TIN
BENEFICIARY'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 ABLE contributions
$
2 ABLE to ABLE Rollovers
$
3 Cumulative contributions
$
4 Fair market value
$
5 Check if account opened
in 2019
6 Basis of eligibility
7 Code
Form 5498-QA
www.irs.gov/Form5498QA
Instructions for Issuer
To complete Form 5498-QA, use:
• The 2019 General Instructions for Certain Information
Returns, and
• The 2019 Instructions for Form 5498-QA.
To get or to order these instructions, go to
www.irs.gov/Form5498QA.
Due dates. Furnish Copy B of this form to the
beneficiary (participant) by March 16, 2020.
File Copy A of this form with the IRS by June 1, 2020.
Need help? If you have questions about reporting on
Form 5498-QA, call the information reporting customer
service site toll free at 1-866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome