FORM 5498-SA File Schema

Sample File = Schema\2019\TEXT\T5498SA.txt


String fields are displayed within quotations

CRLF=Carriage Return Line Feed (Hex 0D0A)

 

"Name line 1"

"Name line 2"

"Street address line 1"

"Street address line 2"

"City"

"State"

"Zip code"

"USPS Delivery Point"

"Foreign address indicator" ¹

"Foreign city, province, postal code, etc."

"TIN Type"

"Taxpayer ID"

"Name control"

"Account number"

Box 1 - Employee or self-employed person's Archer MSA contributions

Box 2 - Total contributions made in 2019

Box 3 - Total HSA or Archer MSA contributions made in 2020 for 2019

Box 4 - Rollover contributions

Box 5 - FMV of HSA, Archer MSA, or MA MSA

"Health Savings Account (HSA) indicator" ¹

"Archer MSA indicator" ¹

"Medicare Advantage (MA) MSA indicator" ¹

"Do not print indicator" ¹

"E-Mail address"

"Client ID"

CRLF

 

¹ "X" if applicable, otherwise, enter a null string ""