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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  
under Line 2b next. Also, see the Caution  
Disaster Distribution, earlier, for limitations.  
the amount of tax. For more information, see  
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  
8915-B, earlier, and under Line 9 below. You  
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  
under Line 7b next. Also, see the Caution  
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  
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  
Form 8915-B. See Amending Form 8915-B,  
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  
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  
Form 8915-B. See Amending Form 8915-B,  
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  
8915-B, earlier, and under Line 4, later. You  
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  
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  
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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