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employees for each coverage period

under this part, to the extent that

be retained as long as their contents

during the calendar year.

payment of the tax would be excessive

may become material in the

relative to the failure involved. This only

administration of any Internal Revenue

“Comparable contributions” are

applies to failures due to reasonable

law. Generally, tax returns and return

contributions which are the same

cause and not to willful neglect.

information are confidential, as required

amount or which are the same

by section 6103.

percentage of the annual deductible

Controlled group. For purposes of this

limit under the high deductible health

part, all persons treated as a single

The time needed to complete and file

plan covering the employees.

employer under section 414(b), (c), (m),

this form will vary depending on

or (o) will be treated as one employer.

individual circumstances. The estimated

“Comparable participating

average time is:

employees” are employees who are

Part V. Tax Due

eligible individuals covered under any

Recordkeeping

12 hr., 40 min.

. . .

high deductible health plan of the

Make your check or money

employer, and who have the same

Learning about

order payable to “United States

category of coverage.

the law or the

Treasury” for the full amount

form

4 hr., 0 min.

due. Attach the payment to your return.

. . . . . . . . . . .

To determine whether contributions

Write your name, identifying number,

are comparable, see Regulations

Preparing and

plan number, and “Form 8928,

sections 54.4980G-1 through

sending the form

Part(s)____” on your payment.

54.4980G-7.

to the IRS

6 hr., 47 min.

. . . . . . .

Line 35. Enter the aggregate amount

File at the address shown under Where

contributed to employees' Archer MSAs

To File, earlier.

for tax years ending with or within the

Comments and suggestions. We

calendar year.

Privacy Act and Paperwork Reduc-

welcome your comments about this

tion Act Notice. We ask for the

publication and your suggestions for

Waiver of excise tax. The Secretary

information on this form to carry out the

future editions. You can send us

may waive part or all of the excise tax

Internal Revenue laws of the United

comments from

under this part, to the extent that

States. Taxpayers subject to the

formspubs. Click on "More Information"

payment of the tax would be excessive

provisions of sections 4980B, 4980D,

and then on "Give us feedback." Or you

relative to the failure involved. This only

4980E, and 4980G are required to

can write to:

applies to failures due to reasonable

provide the information requested on

cause and not to willful neglect.

Internal Revenue Service

this form. Section 6109 requires you to

Controlled group. For purposes of this

Tax Forms and Publications

provide your identifying number. If you

part, all persons treated as a single

1111 Constitution Ave. NW

fail to provide this information in a timely

employer under section 414(b), (c), (m),

IR-6526

manner, you may be liable for penalties.

or (o) will be treated as one employer.

Washington, DC 20224

Routine uses of this information include

giving it to the Department of Justice for

Part IV. Tax on Failure To

civil and criminal litigation, to other

We respond to many letters by

Make Comparable HSA

federal agencies as authorized by law,

telephone. Therefore, it would be helpful

and to cities, states, the District of

if you would include your daytime phone

Contributions Under

Columbia, and U.S. commonwealths

number, including the area code, in your

Section 4980G

and possessions for use in

correspondence. Although we cannot

administering their tax laws. We may

An employer is liable for tax under

respond individually to each comment

also disclose this information to other

section 4980G if he fails to make

received, we do appreciate your

countries under a tax treaty, to federal

comparable contributions to the HSAs

feedback and will consider your

and state agencies to enforce federal

of all comparable participating

comments as we revise our tax

nontax criminal laws, or to federal law

employees for each coverage period

products.

enforcement and intelligence agencies

during the calendar year.

Ordering forms and publications.

to combat terrorism.

Line 37. Enter the aggregate amount

Visit

formspubs

You are not required to provide the

contributed to employees' HSAs for tax

download forms and publications.

information requested on a form that is

years ending with or within the calendar

Otherwise, you can go to

subject to the Paperwork Reduction Act

year.

orderforms

to order forms.

unless the form displays a valid OMB

Waiver of excise tax. The Secretary

control number. Books or records

may waive part or all of the excise tax

relating to a form or its instructions must

-5-

Instructions For Form 8928 - Return Of Certain Excise Taxes Under Chapter 43 Of The Internal Revenue Code - 2016 Page 5

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