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Health Saving Account Forms
For your convenience, HSA Manager forms are available below. To access
the documents, simply click on the links to the right.
If you need additional assistance, please contact our Health Savings
Account Client Service Team at 800.783.4022.
Need to establish an Account?
| HSA Manager Kit |
HSA Kit |
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| Pershing HSA Manager Kit |
PER Kit |
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Need to update an already established Account?
| Add additional authorized signer for
debit card |
HSA-012 |
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| Address Change |
HSA-013 |
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| Contributions by ACH |
HSA-017 |
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| Give Third Party Authorization to your
Account |
HSA-008 |
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| Update Beneficiary designation |
HSA-016 |
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| Funding Form |
HSA-018 |
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Need to make a Distribution or submit
a Transfer to your HSA Account?
| HSA Distribution Form |
HSA-014 |
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| Transfer from another HSAs, MSAs, or IRA |
HSA-007 |
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| Transfer from FSAs or HRAs |
HSA-019 |
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Statements and Agreements
| HSA Manager Fee Schedule |
HSA-CLT-009 |
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| Partial List of IRA Expenses |
List |
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| 2009 Instructions for IRS Form 8889 |
Dir 8889 |
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| 2009 IRS Form 8889 |
IRS 8889 |
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