| # | Id | Type | Description |
| 1 | accountNumber | string | Account number |
| 2 | msaContributions | number | Box 1, Employee or self-employed person's Archer MSA contributions made in current and following years for current year |
| 3 | totalContributions | number | Box 2, Total contributions made in current year |
| 4 | totalPostYearEnd | number | Box 3, Total HSA or Archer MSA contributions made in following year for current year |
| 5 | rolloverContributions | number | Box 4, Rollover contributions |
| 6 | fairMarketValue | number | Box 5, Fair market value of HSA, Archer MSA, or Medicare Advantage (MA) MSA |
| 7 | hsa | boolean | Box 6a, HSA |
| 8 | archer | boolean | Box 6b, Archer MSA |
| 9 | maMsa | boolean | Box 6c, Medicare Advantage (MA) MSA |