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Downloadable HSA Forms

We've made it easy to open and manage your Health Savings Account. Download some of the most commonly used forms right here.

Account Setup Forms

HSA Eligibility and Information
Use this form to determine your eligibility to open an HSA.

Health Savings Account Application
Use this form to open an HSA.

Authorized Signer Agreement
There can be only one owner of an HSA. If you would like for your spouse or third party to transact on the HSA, you will need to complete this form.

Designation of Beneficiaries
If you wish to designate beneficiaries to your HSA, please complete this form.

Contribution Forms

Contribution
Use this form to make a contribution to your HSA.  

Withdrawal Forms

Excess Removal
Complete this form when you have gone over your contribution limit and need to remove the excess funds to avoid incurring the tax penalties associated with exceeding the annual limit.

HSA Withdrawal
This form should be used to withdraw funds from your account.  

Transfer Request

Health Savings Account Transfer Request
Use this form to move HSA assets from another financial organization to your HSA at SEFCU.