5498-SA with QR Code

Example Form Data as JSON (Encoded to QR)
{
  "tax5498Sa" : {
    "taxYear" : 2020,
    "taxFormDate" : "2021-03-30",
    "additionalInformation" : "FDX v4.6",
    "taxFormType" : "Tax5498Sa",
    "trusteeNameAddress" : {
      "line1" : "12020 Sunrise Valley Dr",
      "city" : "Reston",
      "state" : "VA",
      "postalCode" : "20191",
      "name1" : "Financial Data Exchange"
    },
    "trusteeTin" : "12-3456789",
    "participantTin" : "XXX-XX-1234",
    "participantNameAddress" : {
      "line1" : "1 Main St",
      "city" : "Melrose",
      "state" : "NY",
      "postalCode" : "12121",
      "name1" : "Kris Q. Public"
    },
    "accountNumber" : "123-1234567",
    "totalContributions" : 3000.0,
    "totalPostYearEnd" : 300.0,
    "rolloverContributions" : 200.0,
    "fairMarketValue" : 10000.0,
    "hsa" : true
  }
}

 

© Copyright 2021. All Rights Reserved.