Form 5498-QA

2021

Cat. No. 67556T

ABLE Account 

Contribution 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2262

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2021 General

Instructions for

Certain Information

Returns.

2A2A VOID CORRECTED

ISSUER’S name, street address, city or town, state or province, country, 

and ZIP or foreign postal code

ISSUER’S TIN BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 ABLE contributions

$

2 ABLE to ABLE Rollovers

$

3 Cumulative contributions

$

4 Fair market value 

$

5 Check if account opened 

in 2021

6 Basis of eligibility 

7 Code

Form 5498-QA www.irs.gov/Form5498QA

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
 

Form 5498-QA

ABLE Account 

Contribution 

Information

Copy B

For Beneficiary

Department of the Treasury - Internal Revenue Service

This information 

is being furnished 

to the IRS.

OMB No. 1545-2262

CORRECTED

ISSUER’S name, street address, city or town, state or province, country, 

and ZIP or foreign postal code

ISSUER’S TIN BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 ABLE contributions

$

2 ABLE to ABLE Rollovers

$

3 Cumulative contributions

$

4 Fair market value 

$

5 If checked, account was 

opened in 2021

6 Basis of eligibility 

7 Code 

2021

Form 5498-QA (keep for your records) www.irs.gov/Form5498QA
Instructions for Beneficiary

The information on Form 5498-QA is furnished to you by the issuer of your 

Achieving a Better Life Experience (ABLE) savings account. Form 5498-

QA reports contributions, rollovers, and program-to-program transfers to 

this ABLE account for 2021. For more information, see Pub. 907. 

Beneficiary’s taxpayer identification number (TIN). For your 

protection, this form may show only the last four digits of your TIN 

(social security number (SSN), individual taxpayer identification 

number (ITIN), or adoption taxpayer identification number (ATIN)). 

However, the issuer has reported your complete TIN to the IRS.

Account number. May show an account or other unique number the 

issuer assigned to distinguish your account.

Box 1. Shows the amount of contributions made to this ABLE account 

in 2021. Include all cash contributions and Qualified Tuition Plan (QTP) 

to ABLE account rollovers, and QTP to ABLE program-to-program 

transfers. Do not deduct these amounts on your income tax return.

If the total contributions (including any contributions from a section 

529 program/QTP), but not including contributions of the designated 

beneficiary’s compensation income made under section 529A(b)(2)(B)

(ii) made to your ABLE account for 2021 exceeded $15,000, or if the 

contributions of an employed designated beneficiary’s compensation 

income exceeded the applicable amount under section 529A(b)(2)(B)

(ii), the excess contributions, plus the earnings on them, must be 

returned by the date your tax return is due (including extensions), or 

you may owe a penalty. Check with your ABLE program to verify that 

excess contributions and earnings are returned timely. You must keep 

track of your ABLE account basis (contributions and distributions).

Box 2. Shows the amount of any rollover or program-to-program 

transfer made to this ABLE account from another ABLE account in 

2021. Generally, any amount rolled over from one ABLE account to 

another ABLE account for the benefit of the named beneficiary or of 

an eligible individual who is a member of the beneficiary’s family who 

is described in section 152(d)(2)(B) is not taxable.

Box 3. May show the cumulative amount contributed since the 

establishment of the ABLE account (or of an ABLE account of the same 

designated beneficiary that was rolled over, or directly transferred (in a 

program-to-program transfer), to the current ABLE account).

Box 4. Shows the FMV of the ABLE account as of the end of the year.

Box 5. The ABLE account was opened in 2021 if the box is checked.

Box 6. These codes show the basis for your ABLE account eligibility. 

A—eligibility established under 529A(e)(1)(A), SSDI, Title II SSA. 

B—eligibility established under 529A(e)(1)(A), SSI, Title XVI SSA. 

C—eligibility established by disability certification under section 

529A(e)(1)(B). 

Box 7. These codes show the type of disability for which you are 

receiving ABLE account qualifying benefits. 1—developmental 

disorders (including autism); 2—intellectual disability; 3—psychiatric 

disorders; 4—nervous disorders (including blindness and deafness); 

5—congenital anomalies (including Down syndrome); 6—respiratory 

disorders; 7—other.

Future developments. For the latest information about developments 

related to Form 5498-QA and its instructions, such as legislation 

enacted after they were published, go to www.irs.gov/Form5498QA.

FreeFile. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online 

federal tax preparation, e-filing, and direct deposit or payment options.
 

Form 5498-QA

2021

ABLE Account 

Contribution 

Information

Copy C

For Issuer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2262

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2021 General

Instructions for

Certain 

Information

Returns.

VOID CORRECTED

ISSUER’S name, street address, city or town, state or province, country, 

and ZIP or foreign postal code

ISSUER’S TIN BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 ABLE contributions

$

2 ABLE to ABLE Rollovers

$

3 Cumulative contributions

$

4 Fair market value 

$

5 Check if account opened 

in 2021

6 Basis of eligibility 

7 Code 

Form 5498-QA www.irs.gov/Form5498QA
Instructions for Issuer

To complete Form 5498-QA, use: 

• The 2021 General Instructions for Certain Information 

Returns, and 

• The 2021 Instructions for Form 5498-QA.

To get or to order these instructions, go to 

www.irs.gov/Form5498QA.

Due dates. Furnish Copy B of this form to the

beneficiary (participant) by March 15, 2022.

File Copy A of this form with the IRS by May 31, 2022.

Need help? If you have questions about reporting on

Form 5498-QA, call the information reporting customer

service site toll free at 866-455-7438 or 304-263-8700 

(not toll free). Persons with a hearing or speech 

disability with access to TTY/TDD equipment can call 

304-579-4827 (not toll free).