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Statements to Recipients

Box 5.

If you are required to file Form 5498-QA, with the IRS, you

Check the box if the ABLE account was opened in 2015.

also must furnish a statement to the designated

Box 6. Basis of Eligibility

beneficiary by March 15, 2016. Furnish a copy of Form

5498-QA or an acceptable substitute statement to each

You must enter one code letter in box 6.

recipient. See part M in the 2015 General Instructions for

Certain Information Returns.

CAUTION

DRAFT AS OF

Truncating recipient’s identification number on pay-

Report the basis of the designated beneficiary's eligibility

ee statements. Pursuant to Treasury Regulations

using the codes below.

section 301.6109-4, all filers of this form may truncate a

Code A—eligibility established under IRC 529A(e)(1)

recipient’s identification number (social security number

(A), SSDI. Title II SSA.

(SSN), individual taxpayer identification number (ITIN),

Code B—eligibility established under IRC 529A(e)(1)

adoption taxpayer identification number (ATIN), or

(A), SSI, Title XVI SSA.

July 2, 2015

employer identification number (EIN)) on payee

Code C—Designated beneficiary is the subject of a

statements. Truncation is not allowed on any documents

disability certification filed with the IRS for 2015.

the filer files with the IRS. A payer's identification number

may not be truncated on any form. See part J in the 2015

Box 7.

General Instructions for Certain Information Returns.

The following information will only be used for

Account Number

aggregate reporting purposes as required by law.

The IRS encourages you to designate an account number

CAUTION

Report only one primary code number for the type of

for all Forms 5498-QA that you file. See part L in the 2015

disability for which the designated beneficiary is receiving

General Instructions for Certain Information Returns.

ABLE qualifying benefits. If more than one code applies,

Box 1. ABLE Contributions

select the most significant code.

Code 1—Developmental Disorders: Autistic Spectrum

Enter the total amount of contributions made to the ABLE

Disorder, Asperger’s Disorder, Developmental Delays and

account in 2015, net of any excess contributions returned

Learning Disabilities

to the contributor. If no contributions were made in 2015,

Code 2—Intellectual Disability: May be reported as

enter zero in this box.

mild, moderate, or severe intellectual disability

Box 2. Rollover Contributions

Code 3—Psychiatric Disorders: Schizophrenia; Major

depressive disorder; Post-traumatic stress disorder

Enter any rollover contributions to the ABLE account in

(PTSD); Anorexia nervosa; Attention deficit/hyperactivity

2015. A rollover contribution is a contribution to an ABLE

disorder (AD/HD); Bipolar disorder

account of a designated beneficiary (or of an eligible

Code 4—Nervous Disorders: Blindness, Deafness,

individual who is a member of the family of the designated

Cerebral Palsy, Muscular Dystrophy, Spina Bifida

beneficiary) of all or a portion of an amount withdrawn

Juvenile-onset Huntington's disease; Multiple sclerosis;

from the designated beneficiary’s ABLE account, provided

Severe sensorineural hearing loss; Congenital cataracts

the contribution is made within 60 days of the date of the

withdrawal and, in the case of a rollover to the designated

Code 5—Congenital Anomalies: Chromosomal

beneficiary’s ABLE account, no rollover has been made to

abnormalities, including Down Syndrome, Osteogenesis

an ABLE account of the designated beneficiary within the

imperfecta; Xeroderma pigmentosum; Spinal muscular

prior 12 months.

atrophy; Fragile X syndrome; Edwards syndrome

Code 6—Respiratory Disorders: Cystic Fibrosis

Box 3. Cumulative Contributions

Code 7—Other: Includes Tetralogy of Fallot;

Enter the cumulative contributions for the ABLE account.

Hypoplastic left heart syndrome; End-stage liver disease;

Juvenile-onset rheumatoid arthritis; Sickle cell disease;

Box 4. Fair Market Value

Hemophilia; and any other disability not listed under

Enter the FMV of the account as of December 31, 2015.

Codes 1-6

-3-

Instructions for Forms 1099-QA and 5498-QA (2015)

Instructions For Forms 1099-Qa And 5498-Qa Draft - Department Of The Treasury - 2015 Page 4

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