Form 1099-Qa - Distributions From Able Accounts - 2017 Page 3
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5Instructions for Recipient
expenses, or rolled over to another ABLE account within 60 days, are not
included in income. Report taxable amounts as “Other income” on Form 1040.
Recipient's taxpayer identification number. For your protection, this form may
Also see Form 5329 and its separate instructions.
show only the last four digits of your SSN, ITIN, or ATIN. However, the payer
Box 3. Shows your basis in the gross distribution reported in box 1.
has reported your complete identification number to the IRS.
Box 4. This box is checked if a program-to-program transfer was made from
Account number. May show an account or other unique number the payer has
this ABLE account to another ABLE account.
assigned to distinguish your account.
Box 5. This box is checked if the ABLE account was terminated in 2017.
Box 1. Shows the gross distribution paid to you this year from an Achieving a
Box 6. The designated beneficiary is the individual named in the document
Better Life Experience (ABLE) savings account in 2017. Gross distribution
creating the ABLE account to receive the benefit of the funds in the account. If
includes distributions from the ABLE account for both qualified and
this box is checked, you are not the designated beneficiary of this ABLE
nonqualified disability expenses. The gross distribution also includes amounts
account. You and/or the designated beneficiary may be subject to additional
distributed that the designated beneficiary intends to roll over to another ABLE
taxes and/or penalties on the box 1 gross distribution. See Form 5329 and its
account, but does not include program-to-program transfers. A gross
separate instructions and the Instructions for Form 1040 (line 21, “Other
distribution also includes a withdrawal of excess contributions plus earnings.
income”).
Box 2. Shows the earnings part of the gross distribution shown in box 1.
Generally, amounts distributed that are used to pay for qualified disability
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