Form 8915-D

 2020

Qualified 2019 Disaster Retirement 

Plan Distributions and Repayments

Department of the Treasury 

Internal Revenue Service 

▶ Go to www.irs.gov/Form8915D for instructions and the latest information.

▶ For coronavirus-related distributions, see Form 8915-E.

▶ Attach to 2020 Form 1040, 1040-SR, or 1040-NR. 

OMB No. 1545-0074

Attachment 

Sequence No. 915

Name. If married, file a separate form for each spouse required to file 2020 Form 8915-D. See instructions. Your social security number

Fill in Your Address Only 

if You Are Filing This 

Form by Itself and Not 

With Your Tax Return ▲

Home address (number and street, or P.O. box if mail is not delivered to your home) Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, also complete the spaces 

below. See instructions. If this is an amended 

return, check here ▶

Foreign country name Foreign province/state/county Foreign postal code

Before you begin:

• Qualified 2019 disaster distributions are limited to $100,000 per disaster. If your qualified 2019 disaster distributions made in 2019 for a disaster 

totaled $100,000, you do not have qualified 2019 disaster distributions available for that disaster in 2020 and should not include distributions in 

Part I below for that disaster. See instructions.

• Complete 2020 Form 8915-C, Qualified 2018 Disaster Retirement Plan Distributions and Repayments, if applicable.

• If you completed Part I of 2020 Form 8915-C, see the Caution in Column (a) in the instructions to figure the amounts for column (a).

• See Table 1 in the instructions for the list of qualified 2019 disasters. The Puerto Rico Earthquakes disaster (DR-4473-PR) has been added.

• If you are reporting distributions in Part I for more than one qualified 2019 disaster, see the instructions to determine whether you should use 

Worksheet 2 to figure the amounts to enter in Part I, column (b), below. If you must use Worksheet 2, check this box ▶

Part I Total Distributions From All Retirement Plans (Including IRAs)

Complete line 1 first. Then, complete lines 2 through 5 of one column before going to the next column.

Caution: A 2020 distribution (for a disaster other than the Puerto Rico Earthquakes disaster) can’t be a 

qualified 2019 disaster distribution unless it was made before June 17, 2020. See instructions.

Disaster name ▶

Date last distribution made ▶

(a) 

Total 

distributions 

in 2020

(b) 

Qualified 2019 

disaster 

distributions 

(see instructions)

(c) 

Allocation of 

column (b) 

(see instructions)

1 If you are reporting only one disaster for 2020, enter in columns (b) and (c) the amount 

described below for your situation. Otherwise, see Worksheet 2 in the instructions. 

• If you didn’t file 2019 Form 8915-D, enter -0-. 

• If you filed 2019 Form 8915-D, and the disaster for which you are reporting distributions on this form is 

different from the disaster(s) for which you reported distributions on 2019 Form 8915-D, enter -0-.

• If you filed 2019 Form 8915-D, you reported distributions for only one disaster on that 

form, and you are reporting distributions for that same disaster on this form, enter the 

amount from your 2019 Form 8915-D, line 4, column (b). 

• If you filed 2019 Form 8915-D on which you reported distributions for more than one disaster and one 

of those disasters is the disaster for which you are reporting distributions on this form, enter the 

amount for that disaster from line 4 of column (X) in Worksheet 2 in the 2019 Form 8915-D instructions.

• If your situation isn’t described above, see Worksheet 2 in the instructions. 

If you are reporting only one disaster for 2020 and the amount you are entering in 

column (b) is $100,000 or more, do not complete this part; you have no qualified 2019 

disaster distributions in 2020 . . . . . . . . . . . . . . . . . .

2 Distributions from retirement plans (other than IRAs) made in 2020 . . . . . .

3 Distributions from traditional, SEP, and SIMPLE IRAs made in 2020 . . . . . .

4 Distributions from Roth IRAs made in 2020 . . . . . . . . . . . . .

5 Totals. Add lines 1 through 4 in columns (a) and (b). If line 5, column (b), is more than 

$100,000 and you did not use Worksheet 2, you must complete column (c). Otherwise, 

leave column (c) blank. See Column (c) in the instructions . . . . . . . . . 100,000

6 Subtract line 1 in column (c) from $100,000 . . . . . . . . . . . . .

7 If you completed column (c), enter the excess of the amount on line 5, column (a), over the amount on line 6, 

column (c). Otherwise, enter the excess of the amount on line 5, column (a), over the sum of the amounts on 

lines 2 through 4 in column (b). Report these distributions under the normal rules in accordance with the 

instructions for your tax return . . . . . . . . . . . . . . . . . . . . . . . . . 7

Part II Qualified 2019 Disaster Distributions From Retirement Plans (Other Than IRAs)

8 Did you enter an amount on line 2, column (b)?

No. Skip lines 8 through 11, and go to line 12.

Yes. If you completed line 2, column (c), enter that amount. Otherwise, enter the amount from line 2, column (b) 8

9 Enter the applicable cost of distributions, if any. See instructions . . . . . . . . . . . . . . . 9

10 Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 If you elect NOT to spread the taxable amount over 3 years, check this box ▶ and enter the amount from line

10 (see instructions). You must check this box if you check the box on line 26. Otherwise, divide line 10 by 3.0 11

For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 73793G Form 8915-D (2020)
Form 8915-D (2020) Page 2

Part II Qualified 2019 Disaster Distributions From Retirement Plans (Other Than IRAs) (continued)

12 Enter the amount, if any, from your 2019 Form 8915-D, line 9. If you checked the box on that line, enter -0- . 12

13 Add lines 11 and 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Enter the amount, if any, from your 2019 Form 8915-D, line 10 . . . . . . . . . 14

15 Enter the amount, if any, from your 2019 Form 8915-D, line 9 . . . . . . . . . . 15

16 Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 16

17 Enter the total amount of any repayments you made before filing your 2020 tax return. But don’t include 

repayments made later than the due date (including extensions) for that return. Don’t use this form to report 

repayments of qualified 2016, 2017, 2018, or 2020 disaster distributions. See instructions . . . . . . . 17

18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Amount subject to tax in 2020. Subtract line 18 from line 13. If zero or less, enter -0-. Include this amount in 

the total on 2020 Form 1040, 1040-SR, or 1040-NR, line 5b . . . . . . . . . . . . . . . . 19

Before you begin: Complete 2020 Form 8606, Nondeductible IRAs, if required.

Part III Qualified 2019 Disaster Distributions From Traditional, SEP, SIMPLE, and Roth IRAs

20 Did you enter an amount on line 3, column (b), or line 4, column (b)?

Yes. Go to line 21.

No. Skip lines 21 through 26, and go to line 27.

21 Did you receive a qualified 2019 disaster distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required 

to be reported on 2020 Form 8606?

Yes. Go to line 22.

No. Skip lines 22 and 23, and go to line 24.

22 Enter the amount, if any, from 2020 Form 8606, line 15b. But if you are entering amounts here and on 2020 

Form 8915-C, line 23, or Form 8915-E, line 13, only enter on line 22 the amount on Form 8606, line 15b, 

attributable to Form 8915-D distributions. See the instructions for Form 8606, line 15b . . . . . . . . 22

23 Enter the amount, if any, from 2020 Form 8606, line 25b. But if you are entering amounts here and on 2020 

Form 8915-C, line 24, or Form 8915-E, line 14, only enter on line 23 the amount on Form 8606, line 25b, 

attributable to Form 8915-D distributions. See the instructions for Form 8606, line 25b . . . . . . . . 23

24 If you completed line 3, column (c), enter that amount. Otherwise, enter the amount from line 3, column (b), if 

any. Don’t include on line 24 any amounts reported on 2020 Form 8606 . . . . . . . . . . . . 24

25 Add lines 22, 23, and 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

26 If you elect NOT to spread the taxable amount over 3 years, check this box ▶ and enter the amount from line

25 (see instructions). You must check this box if you check the box on line 11. Otherwise, divide line 25 by 3.0 26

27 Enter the amount, if any, from your 2019 Form 8915-D, line 17. If you checked the box on that line, enter -0- . 27

28 Add lines 26 and 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

29 Enter the amount, if any, from your 2019 Form 8915-D, line 18 . . . . . . . . . 29

30 Enter the amount, if any, from your 2019 Form 8915-D, line 17 . . . . . . . . . 30

31 Subtract line 30 from line 29. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 31

32 Enter the total amount of any repayments you made before filing your 2020 tax return. But don’t include any 

repayments made later than the due date (including extensions) for that return. Don’t use this form to report 

repayments of qualified 2016, 2017, 2018, or 2020 disaster distributions. See instructions . . . . . . . 32

33 Add lines 31 and 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

34 Amount subject to tax in 2020. Subtract line 33 from line 28. If zero or less, enter -0-. Include this amount in 

the total on 2020 Form 1040, 1040-SR, or 1040-NR, line 4b . . . . . . . . . . . . . . . . 34

Part IV Qualified Distributions for the Purchase or Construction of a Main Home in Qualified 2019 Disaster Areas

Caution: Do not complete Part IV unless you are reporting a qualified distribution (as defined in the instructions) that was received in 

2020 for the Puerto Rico Earthquakes disaster and that was repaid, in whole or in part, before June 26, 2021. See instructions for 

allowable repayments. For qualified distributions received in 2018 or 2019, see Part IV under Specific Instructions in the instructions.

35 Taxable amount. Enter the amount from Worksheet 3, line 6, in the instructions. If the distribution is:

• From an IRA, include this amount in the total on 2020 Form 1040, 1040-SR, or 1040-NR, line 4b.

• From a retirement plan (other than an IRA), include this amount in the total on 2020 Form 1040, 1040-SR, 

 or 1040-NR, line 5b. 

Note: You may be subject to an additional tax on the amount on line 35. See instructions. }. . . . 35

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Are Filing This Form 

by Itself and Not With 

Your Tax Return

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belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

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Form 8915-D (2020)