895-ական
2021-ական թվականների համար 895-ական
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Department of the Treasury
Internal Revenue Service
2021
Instructions for Form 8915-B
Qualified 2017 Disaster Retirement Plan Distributions and Repayments
Section references are to the Internal Revenue Code
unless otherwise noted.
Qualified 2017 disaster distributions can't be
made in 2021.
received cannot be treated as a repayment
on your 2021 Form 8915-B. For example, if
your qualified 2017 disaster distribution was
received on October 4, 2018, and you
choose to repay the distribution, the
repayment must be made before October 5,
2021.
Note. Repayments of distributions from
retirement plans (other than IRAs) are
reported in Part I, and repayments of
distributions from IRAs are reported in Part II.
General Instructions
Future Developments
For the latest information about
developments related to Form 8915-B and
its instructions, such as legislation enacted
after they were published, go to IRS.gov/
For details on qualified 2017 disaster
If you choose, you can generally repay to an
eligible retirement plan any portion of a
qualified 2017 disaster distribution that is
eligible for tax-free rollover treatment. Also,
you can repay a qualified 2017 disaster
distribution from a retirement plan made on
account of hardship. However, see
distributions, see the 2018
Instructions for Form 8915B.
TIP
Who Must File
File 2021 Form 8915-B if you made a
repayment of a qualified 2017 disaster
distribution in 2021 that was not included on
your 2020 Form 8915-B.
What’s New
Exceptions below for qualified 2017 disaster
distributions you can’t repay.
Coronavirus-related distributions. Did
you repay coronavirus-related distributions in
2021? If you did, do not use 2021 Form
8915-B to report those repayments. Use new
Form 8915-F, Qualified Disaster Retirement
Plan Distributions and Repayments, instead.
We have retired Form 8915-E, Qualified
2020 Disaster Retirement Plan Distributions
and Repayments, which you used to report
coronavirus-related distributions and
You have 3 years from the day after the
date you received the distribution to make a
repayment. The amount of your repayment
cannot be more than the amount of the
original distribution. Amounts that are repaid
are treated as a trustee-to-trustee transfer
and are not included in income. Also, for
purposes of the one-rollover-per-year
limitation for IRAs, a repayment to an IRA is
not considered a rollover.
Include on 2021 Form 8915-B any
repayments you make during 2021 that were
not included on your 2020 Form 8915-B. Any
repayments may be carried back to your
2018, 2019, or 2020 return. See Amending
Form 8915-B, later.
When and Where To File
File 2021 Form 8915-B with your 2021 Form
1040, 1040-SR, or 1040-NR. If you are not
required to file an income tax return but are
required to file 2021 Form 8915-B, sign Form
8915-B and send it to the IRS at the same
time and place you would otherwise file 2021
Form 1040, 1040-SR, or 1040-NR.
repayments in 2020.
Repayments. The repayment period for a
qualified 2017 disaster distribution ends 3
years and 1 day after the distribution was
received. Repayments reported on 2021
Form 8915-B can be used to reduce the
income from qualified 2017 disaster
Qualified 2017 Disaster
Distribution
What 2017 Disasters Are
Covered?
distributions made in 2018 and reportable on
your 2018, 2019, or 2020 tax return. The
amounts from lines 5 and 10 of 2021 Form
8915-B can only be carried back to reduce
that income. If you have already filed your tax
return for the year in question, you will need
to amend that return.
In order to have a qualified 2017 disaster
distribution, you must have been adversely
affected by:
Exceptions. You cannot repay the
following types of distributions.
1. Qualified 2017 disaster distributions
received as a beneficiary (other than a
surviving spouse).
Hurricane Harvey (which includes
•
Tropical Storm Harvey),
Hurricane Irma,
•
•
•
Hurricane Maria, or
The California wildfires.
2. Required minimum distributions.
Last revision. The 2021 revision is the last
revision of Form 8915-B and these
instructions.
3. Any distribution (other than from an
IRA) that is one of a series of substantially
equal periodic payments made (at least
annually) for:
How Is a Qualified 2017
Disaster Distribution Taxed?
Purpose of Form
Generally, a qualified 2017 disaster
distribution is included in your income in
equal amounts over 3 years. However, if you
elected, you could have included the entire
distribution in your income in the year of the
distribution. If you received more than one
distribution during 2018, you must have
treated all the distributions for that year the
same way. Qualified 2017 disaster
Use 2021 Form 8915-B if you were
a. A period of 10 years or more,
b. Your life or life expectancy, or
adversely affected by a 2017 disaster listed
and you received a distribution that qualifies
for favorable tax treatment. For distributions
for qualified 2018, 2019, and 2020 disasters,
see Form 8915-C, Qualified 2018 Disaster
Retirement Plan Distributions and
c. The joint lives or joint life
expectancies of you and your beneficiary.
Eligible retirement plan. An eligible
retirement plan can be any of the following.
A qualified pension, profit-sharing, or
•
Repayments; Form 8915-D, Qualified 2019
Disaster Retirement Plan Distributions and
Repayments; and new Form 8915-F,
Qualified Disaster Retirement Plan
distributions aren’t subject to the additional
10% tax (or the 25% additional tax for certain
distributions from SIMPLE IRAs) on early
distributions.
stock bonus plan (including a 401(k) plan).
A qualified annuity plan.
•
•
•
A tax-sheltered annuity contract.
A governmental section 457 deferred
Distributions and Repayments, respectively,
and their instructions.
compensation plan.
Repayment of a Qualified 2017
Disaster Distribution
A traditional, SEP, SIMPLE, or Roth IRA.
•
Use Form 8915-B only to report
repayments of qualified 2017 disaster
distributions made in 2021 that were not
included on your 2020 Form 8915-B.
Amending Form 8915-B
An amount paid more than 3 years
File Form 1040-X, Amended U.S. Individual
Income Tax Return, to amend a return you
and 1 day after the distribution was
!
CAUTION
Jan 14, 2022
Cat. No. 71194R
have already filed. Generally, Form 1040-X
must be filed within 3 years after the date the
original return was filed, or within 2 years
after the date the tax was paid, whichever is
later.
may also be able to complete Part I if you
have an excess repayment from Part I of a
2020 Form 8915-B, but see the example
Disaster Distribution, earlier, for limitations.
the amount of tax. For more information, see
Amending Form 8915-B, earlier.
If the amount on both line 5 and line 10 is
zero, do not file a 2021 Form 8915-B.
Part II—Qualified 2017
Disaster Distributions
From Traditional, SEP,
SIMPLE, and Roth IRAs
If, after filing a 2018, 2019, or 2020 Form
1040 with a Form 8915B or 8915-B, you
make a repayment, the repayment may
reduce the amount of your qualified 2017
disaster distributions reported on the earlier
return.
Line 2b. Enter the amount from line 2a that
you have already carried back to a prior year.
See the example below.
Example. You received a qualified 2017
disaster distribution from your 401(k)
retirement plan in the amount of $90,000 on
January 15, 2018. This is the only qualified
2017 disaster distribution you have ever
received. You chose to spread the $90,000
over 3 years ($30,000 in income for 2018,
2019, and 2020). You did not make a
repayment until November 10, 2020, when
you made a repayment of $40,000. On your
2020 Form 8915-B, you entered $40,000 on
lines 5 and 6 and $30,000 on line 1. On
December 1, 2020, you filed an amended
2019 return carrying back the excess
repayment of $10,000 ($40,000 − $30,000)
to line 7 in Part I of your 2019 Form 8915-B.
You transfer the amounts on lines 6 and 1 of
your 2020 Form 8915-B to your 2021 Form
8915-B, entering $40,000 on line 1a and
$30,000 on line 1b of your 2021 Form
8915-B. You entered $10,000 on line 2a of
your 2021 Form 8915-B. Because you have
already carried back the full $10,000, you
would include $10,000 on 2021 Form
8915-B, line 2b.
Complete Part II if you made a repayment in
2021 of qualified 2017 disaster distribution
amounts from line 25 of 2018 Form 8915B.
See the examples under Amending Form
may also be able to complete Part II if you
have an excess repayment from Part II of a
2020 Form 8915-B, but see the example
If you make any repayments during 2021,
include the repayments on your 2021 Form
8915-B if they were not included on your
2020 Form 8915-B. If you make a repayment
reported on your 2021 Form 8915-B, you
must file an amended 2018 Form 8915B, an
amended 2019 or 2020 Form 8915-B, or a
combination of these forms to reduce the
qualified 2017 disaster distributions reported
on them. (But see the examples below. Also,
see the Caution under Repayment of a
Qualified 2017 Disaster Distribution, earlier,
for limitations.)
Example 1. You received a qualified
2017 disaster distribution in the amount of
$90,000 on November 15, 2018. You choose
to spread the $90,000 over 3 years ($30,000
in income for 2018, 2019, and 2020). On
November 10, 2021, you make a repayment
of $40,000, which you report on line 9 of your
2021 Form 8915-B. The repayment of
$40,000 can be carried back to 2018, 2019,
or 2020.
Disaster Distribution, earlier, for limitations.
Line 7b. Enter the amount from line 7a that
you have already carried back to a prior year.
See the example below.
Example. You received a qualified 2017
disaster distribution from an IRA in the
amount of $90,000 on January 15, 2018.
This is the only qualified 2017 disaster
distribution you have ever received. You
chose to spread the $90,000 over 3 years
($30,000 in income for 2018, 2019, and
2020). You did not make a repayment until
November 10, 2020, when you made a
repayment of $40,000. On your 2020 Form
8915-B, you entered $40,000 on lines 12 and
13 and $30,000 on line 8. On December 1,
2020, you filed an amended 2019 return
carrying back the excess repayment of
$10,000 ($40,000 − $30,000) to line 16 in
Part II of your 2019 Form 8915-B. You
transfer the amounts on lines 13 and 8 of
your 2020 Form 8915-B to your 2021 Form
8915-B, entering $40,000 on line 6a and
$30,000 on line 6b of your 2021 Form
8915-B. You entered $10,000 on line 7a of
your 2021 Form 8915-B. Because you have
already carried back the full $10,000, you
would include $10,000 on 2021 Form
8915-B, line 7b.
Line 4. At any time during the 3-year period
beginning 1 day after the date you received a
qualified 2017 disaster distribution, you can
repay any portion of the distribution to an
eligible retirement plan that accepts rollover
contributions. You cannot, however, repay
more than the amount of the original
Example 2. The facts are the same as in
Example 1, except the repayment was made
on December 20, 2021. The $40,000 can't
be treated as a repayment because it was
made after the 3-year period for making a
repayment had passed.
distribution. See Repayment of a Qualified
2017 Disaster Distribution, earlier, for details.
Specific Instructions
Enter on line 4 the amount of any
repayments you made during 2021. Don't
include any repayments you included on
your 2020 Form 8915-B. Do not include any
repayments of nontaxable amounts.
Married filers. If both you and your spouse
are required to file 2021 Form 8915-B, file a
separate Form 8915-B for each of you.
Name and social security number (SSN).
If you file a joint return, enter only the name
and SSN of the spouse whose information is
being reported on the 2021 Form 8915-B.
Repayments made after the due date of your
2020 return (including extensions) but before
2022 will generally be reported on your 2021
earlier. For a discussion of repayments made
more than 3 years and 1 day after the
Line 9. At any time during the 3-year period
beginning 1 day after the date you received a
qualified 2017 disaster distribution, you can
repay any portion of the distribution to an
eligible retirement plan that accepts rollover
contributions. You cannot, however, repay
more than the amount of the original
Foreign address. If you have a foreign
address, enter the city name on the
qualified 2017 disaster distribution to which
the repayment relates was received, see the
Caution under Repayment of a Qualified
2017 Disaster Distribution, earlier.
Example. You received a $90,000
qualified 2017 disaster distribution on May 7,
2018, from your 401(k) plan. You had an
economic loss due to Hurricane Harvey. On
April 1, 2021, you repay $30,000 to your
401(k) plan. You file your return on April 10,
2021. Since the repayment was made within
the 3-year period beginning 1 day after the
distribution was received, you would enter
the $30,000 repayment on line 4.
appropriate line. Do not enter any other
information on that line, but also complete
the spaces below that line. Do not abbreviate
the country name. Follow the country's
practice for entering the postal code and the
name of the province, county, or state.
distribution. See Repayment of a Qualified
2017 Disaster Distribution, earlier, for details.
Enter on line 9 the amount of any
repayments you made during 2021. Don't
include any repayments you included on
your 2020 Form 8915-B. Do not include any
repayments of nontaxable amounts.
Part I—Qualified 2017
Disaster Distributions
From Retirement Plans
(Other Than IRAs)
Repayments made after the due date of your
2020 return (including extensions) but before
2022 will generally be reported on your 2021
earlier. For a discussion of repayments made
more than 3 years and 1 day after the
Complete Part I if you made a repayment in
2021 of qualified 2017 disaster distribution
amounts from line 10 of 2018 Form 8915B.
See the examples under Amending Form
Line 5. If you have an amount on line 5, you
may be able to carry this amount back to
your 2018, 2019, or 2020 return and reduce
qualified 2017 disaster distribution to which
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Instructions for Form 8915-B (2021)
the repayment relates was received, see the
Caution under Repayment of a Qualified
2017 Disaster Distribution, earlier.
this form to carry out the Internal Revenue
laws of the United States. We need this
information to ensure that you are complying
with these laws and to allow us to figure and
collect the right amount of tax. You are
required to give us this information if you
made certain contributions or received
certain distributions from qualified plans,
including IRAs, and other tax-favored
are confidential, as required by section 6103.
However, we may give this information to the
Department of Justice for civil and criminal
litigation, and to cities, states, the District of
Columbia, and U.S. commonwealths and
possessions to carry out their tax laws. We
may also disclose this information to other
countries under a tax treaty, to federal and
state agencies to enforce federal nontax
criminal laws, or to federal law enforcement
and intelligence agencies to combat
terrorism.
Example. You received a $60,000
qualified 2017 disaster distribution on
November 1, 2018, from your traditional IRA.
You had an economic loss due to the
California wildfires. On October 1, 2021, you
repay $30,000 to your traditional IRA.
Because the repayment was made within the
3-year period beginning 1 day after the
distribution was received, you would enter
the $30,000 repayment on line 9.
accounts. Our legal right to ask for the
information requested on this form is
sections 6001, 6011, 6012(a), and 6109 and
their regulations. If you don’t provide this
information, or you provide incomplete or
false information, you may be subject to
penalties. You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB control
number. Books or records relating to a form
or its instructions must be retained as long as
their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information
The average time and expenses required
to complete and file this form will vary
depending on individual circumstances. For
the estimated averages, see the instructions
for your income tax return.
Line 10. If you have an amount on line 10,
you may be able to carry this amount back to
your 2018, 2019, or 2020 return and reduce
the amount of tax. For more information, see
Amending Form 8915-B, earlier.
If you have suggestions for making this
form simpler, we would be happy to hear
from you. See the instructions for your
income tax return.
If the amount on both line 5 and line 10 is
zero, do not file a 2021 Form 8915-B.
Privacy Act and Paperwork Reduction
Act Notice. We ask for the information on
Instructions for Form 8915-B (2021)
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