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employee of the State or its agency or instrumentality

Box 5.

having control of the qualified ABLE program, or the

Check the box if the ABLE account was opened in 2016.

officer’s or employee’s designee.

Box 6. Basis of Eligibility

Statements to Beneficiaries

You must enter one code letter in box 6.

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

also must furnish a statement to the designated

beneficiary by March 15, 2017. Furnish a copy of Form

CAUTION

Report the basis of the designated beneficiary's eligibility

5498-QA or an acceptable substitute statement to each

using the codes below.

beneficiary. See part M in the 2016 General Instructions

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

for Certain Information Returns.

(A), SSDI, Title II SSA.

Truncating beneficiary’s identification number on

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

payee statements. Pursuant to Treasury Regulations

(A), SSI, Title XVI SSA.

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

Code C—Designated beneficiary is the subject of a

beneficiary’s identification number (social security number

disability certification filed with the IRS for 2016.

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

Box 7.

adoption taxpayer identification number (ATIN), or

employer identification number (EIN)) on payee

The following information will only be used for

statements. Truncation is not allowed on any documents

aggregate reporting purposes as required by law.

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

may not be truncated on any form. See part J in the 2016

CAUTION

Report only one primary code number for the type of

General Instructions for Certain Information Returns.

disability for which the designated beneficiary is receiving

ABLE qualifying benefits. If more than one code applies,

Account Number

select the most significant code.

The IRS encourages you to designate an account number

Code 1—Developmental Disorders: Autistic Spectrum

for all Forms 5498-QA that you file. See part L in the 2016

Disorder, Asperger’s Disorder, Developmental Delays and

General Instructions for Certain Information Returns.

Learning Disabilities.

Code 2—Intellectual Disability: May be reported as

Box 1. ABLE Contributions

mild, moderate, or severe intellectual disability.

Enter the total amount of contributions made to the ABLE

Code 3—Psychiatric Disorders: Schizophrenia; Major

account in 2016, net of any excess contributions returned

depressive disorder; Post-traumatic stress disorder

to the contributor. Do not include the amount of any

(PTSD); Anorexia nervosa; Attention deficit/hyperactivity

rollover or program-to-program transfer. If no contributions

disorder (AD/HD); Bipolar disorder.

were made in 2016, enter zero in this box.

Code 4—Nervous Disorders: Blindness, Deafness,

Cerebral Palsy, Muscular Dystrophy, Spina Bifida

Box 2. Rollover Contributions

Juvenile-onset Huntington's disease; Multiple sclerosis;

Enter the amount of any rollover or program-to-program

Severe sensorineural hearing loss; Congenital cataracts.

transfer to this ABLE account in 2016. See Rollovers and

Code 5—Congenital Anomalies: Chromosomal

program-to-program transfers, earlier.

abnormalities, including Down Syndrome, Osteogenesis

imperfecta; Xeroderma pigmentosum; Spinal muscular

Box 3. Cumulative Contributions

atrophy; Fragile X syndrome; Edwards syndrome.

You may but are not required to enter the amount of

Code 6—Respiratory Disorders: Cystic Fibrosis.

cumulative contributions to this ABLE account. This

Code 7—Other: Includes Tetralogy of Fallot;

amount is the total of amounts contributed since the

Hypoplastic left heart syndrome; End-stage liver disease;

establishment of the ABLE account, including amounts

Juvenile-onset rheumatoid arthritis; Sickle cell disease;

contributed to an ABLE account for the same designated

Hemophilia; and any other disability not listed under

beneficiary that was rolled over, or directly transferred (in

Codes 1–6.

a program-to-program transfer), to the current ABLE

account.

Box 4. Fair Market Value

Enter the FMV of the account as of December 31, 2016.

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Instructions for Forms 1099-QA and 5498-QA (2016)

Instructions For Forms 1099-Qa And 5498-Qa - Distributions From Able Accounts And Able Account Contribution Information - 2016 Page 5

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