Form 5498-Sa - Hsa, Archer Msa, Or Medicare Advantage Msa Information - 2012

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Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website,
is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or
Order Information
Returns and Employer Returns
Online, and we’ll mail you the scannable forms and other
products.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

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