HSA Forms
Health Savings Account Forms
HSA deadline for 2020 contributions has been extended to May 17, 2021.
| Title | Type | Size |
| Employer Group Set Up | 59 KB | |
| HSA Contribution Instruction form | 42 KB | |
| HSA Designation or Change of Beneficiary Request form | 40 KB | |
| HSA Distribution Form | 50 KB | |
| Request for Transfer to HSA | 40 KB | |
| HSA Rollover Review | 35 KB | |
| Secondary Signer Form | 366 KB | |
| IRSQualified | 1505 KB | |
| RolloverReview | 35 KB | |
| RequestTransfer | 40 KB | |
| Investments | 132 KB | |
| ContributionInstructions | 46 KB |
By accessing the noted link, you will be leaving Inland Bank's website and entering a website hosted by another party. Inland Bank does not operate this alternate site, nor is Inland Bank responsible for the content of the site you are about to enter.
We encourage you to read and evaluate the privacy and security policies of the site you are entering, as they may differ from those practiced by Inland Bank.