HB
HSA custodian
HSA Bank
Self-calc requiredLast verified 2026-05-04
Form name
Health Savings Account Excess Contribution Removal Form (PDF)
Auto-calculates NIA?
No — bring hand-calculated figure
Official page
NIA calculation note
HSA Bank's official excess-removal form (PDF) requires the holder to fill in 'Earnings on excess: $___.' Form text instructs use of the §1.408-11 calculation method.
Known quirks
- 1Form contains a dedicated 'Earnings on excess: $___' field that the holder must fill in. Form text directs use of '§1.408-11' calculation method (the IRA NIA reg, transposed onto the HSA form).
- 2Form offers an alternate option to 'Apply my excess contribution as my current year's contribution' — flagged on the form itself as potentially triggering 6% excise tax.
- 3Default refund method is by check unless an external bank account is linked to the HSA.
- 4HSA NIA is taxable in the year RECEIVED (per §223(f)(3)) — different from IRA NIA, which is taxable in the contribution year. Plan accordingly.
- 5Form does not provide Form 8889 guidance; refer to IRS Pub 969 for tax-related questions.
Submission method
Online upload via account.hsabank.com Secure Document Upload, email to [email protected], or mail to 909 N 8th Street, Suite 200, Sheboygan, WI 53081-4056.
Process at HSA Bank
- Confirm the contribution is in fact excess (limit lookup, MAGI check).
- Compute NIA — required; custodian will not calculate.
- Submit the Health Savings Account Excess Contribution Removal Form.
- Allow processing time per the custodian's stated SLA (typically 3–10 business days).
- Receive Form 1099-R (IRA) or 1099-SA (HSA) the following January with the applicable distribution code (8 / P for IRA current vs prior-year correction).
- Report the earnings (NIA) as taxable income — in the year of distribution per IRC §223(f)(3).
Logo & branding note
HSA Bank's wordmark and logo are not displayed on this page. The initials mark above is a neutral placeholder; using the custodian's actual mark requires permission.
Also relevant
- All custodian guides — index of every custodian we've verified.
- Run the NIA calculator — produce the earnings figure to bring to HSA Bank's form.
- Removal decision tree — confirm the corrective path before initiating.
- When to file — Apr 15 / Oct 15 windows that gate timely removal vs. the §4973 6% excise.
- What counts as excess — including the HSA monthly-eligibility nuance and IRC §223(f)(3) tax-year treatment.
Informational, not tax advice. Consult a CPA or Enrolled Agent before acting on a corrective distribution.