This form is used when you want to move money from another Health Savings Account (HSA) or Medical Savings Account (MSA) into a new HSA managed by DataPath Financial Services. You can either do a direct transfer between custodians (called a “trustee-to-trustee transfer”) or a rollover, where you’ve already received a check and want to deposit it into your new account. The form asks for your personal details, the type of transfer, and information about your current HSA or MSA provider.
It also includes a few important rules: You must complete a rollover within 60 days of receiving the funds, and you can only do one rollover per year from the same account. If you’re doing a direct transfer, you’ll need to provide the name and contact info of your current HSA provider. Once completed, you sign the form and send it to DFS. They’ll handle the rest and confirm they’ve accepted your account. This form helps make sure your transfer follows IRS rules and keeps your HSA funds tax-free.