RC728-SCH-A Schedule A, 2023 Excess FHSA Amounts

If you have an excess FHSA amount, use this schedule to determine the excess FHSA amounts that are subject to the 1% tax.

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (rc728-sch-a-fill-23e.pdf)

• Print and fill out by hand

  • Standard print PDF (rc728-sch-a-23e.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities