Forms Checklist

IRA, Coverdell ESA, HSA, and SEP and SIMPLE IRA Plan

IMPORTANT NOTE TO ELECTRONIC FORMS USERS
Updated forms and potential changes are delivered to you in periodic, electronic form updates. In certain instances, the most current version of an electronic form may vary from a printed form. To determine the most current version of an electronic form, please contact eforms@ascensus.com.

 

Ascensus’ forms and documents are constantly monitored to accommodate changes brought about by new tax laws and, equally important, to respond to your requests and needs. This Forms Checklist provides you with the date of the most current version of the designated form or document. Versions which are technically inaccurate because of subsequent law changes or IRS pronouncements are listed in the column entitled “Obsolete Version.” If no date appears in the obsolete column, all existing versions may be used—and so, the current version of pre-printed forms are generally available upon the depletion of existing inventory supplies. This checklist will be updated periodically.

If you need assistance or would like to update your forms inventory, contact a Customer Service Representative at 800-346-3860, option 2, suboption 1.

 

Account Establishment: Opening Documents

No. Name Current Version Obsolete Version
Traditional IRA
97 Traditional IRA Simplifier Trust – 5305 10/2018 A, B
98 Traditional IRA Simplifier Custodial – 5305-A 10/2018 A
100 Traditional IRA Simplifier Self-Directed Custodial – 5305-A 10/2018 A
97-IH Inherited Traditional IRA Simplifier Trust – 5305 9/2017 Any prior to 1/2009 B, C
98-IH Inherited Traditional IRA Simplifier Custodial – 5305-A 9/2017 Any prior to 1/2009 C
100-IH Inherited Traditional IRA Simplifier Self-Directed Custodial – 5305-A 9/2017 Any prior to 1/2009 C
Roth IRA
6097 Roth IRA Simplifier Trust – 5305-R 3/2018 A, B
6098 Roth IRA Simplifier Custodial – 5305-RA 3/2018 A
6100 Roth IRA Simplifier Self-Directed Custodial – 5305-RA 3/2018 A
6097-IH Inherited Roth IRA Simplifier Trust – 5305-R 9/2017 Any prior to 1/2009 B, C
6098-IH Inherited Roth IRA Simplifier Custodial – 5305-RA 9/2017 Any prior to 1/2009 C
6100-IH Inherited Roth IRA Simplifier Self-Directed Custodial – 5305-RA 9/2017 Any prior to 1/2009 C
SIMPLE IRA
1097 SIMPLE IRA Simplifier Trust – 5305-S 10/2018 A, B
1098 SIMPLE IRA Simplifier Custodial – 5305-SA 10/2018 A
1100 SIMPLE IRA Simplifier Self-Directed Custodial – 5305-SA 10/2018 A
Coverdell Education Savings Account (ESA)
5097 Coverdell ESA Simplifier Trust – 5305-E 10/2018 B, D
5098 Coverdell ESA Simplifier Custodial – 5305-EA 10/2018 D
Health Savings Account (HSA)
3499 HSA Simplifier Trust – 5305-B 10/2018 E
3500 HSA Simplifier Custodial – 5305-C 10/2018 E

 

IRA Maintenance Forms

No. Name Current Version Obsolete Version
IRA Contributions
106 Special Contributions 10/2018 Any prior obsolete
107 Traditional IRA Contribution and Investment Selection 10/2018 Any prior to 10/2014
109 Traditional IRA Contribution Eligibility 10/2018
110 Conduit IRA Notice and Election
135 IRA Certification for Late Rollover Contribution 4/2017
489 IRA Automatic Rollover Agreement 3/2014
1107 SIMPLE IRA Contribution and Investment Selection 10/2018 Any prior to 10/2014
1109 SIMPLE IRA Contribution Eligibility 10/2018
6107 Roth Contribution and Investment Selection 3/2018 Any prior to 10/2014
6109 Roth Contribution Eligibility 10/2018
IRA Portability
302 Traditional and SIMPLE IRA Transfer Request 10/2017 Any prior to 5/2002
305 IRA Recharacterization Election 10/2018 Any prior obsolete
487 IRA Direct Rollover Request 3/2016 Any prior to 1/2002
6302 Roth IRA Transfer Request 10/2017 Any prior to 5/2002
6305 Roth IRA Direct Conversion Request 10/2018 Any prior obsolete
IRA Distributions and Withholding
22 IRA Charitable Distribution Request 3/2014
123 IRA Excess Removal Worksheet 10/2015 Any prior to 1/2002
314 IRA Withdrawal Authorization 10/2018 Any prior to 10/2004
317 IRA Withholding Notice and Election (with current election included) 10/2015 3/87
319 IRA Substantially Equal Periodic Payment Election 10/2015 Any prior to 11/2002
321 IRA Beneficiary Required Election 10/2015 Any prior to 11/2002
322 IRA Required Minimum Distribution Scheduled Payment Election 10/2018 Any prior to 8/2002
323 IRA Required Minimum Distribution Notice 3/2014
324 IRA Scheduled Payment Election 10/2015
324-IH Inherited IRA Scheduled Payment Election 3/2016
6123 Roth IRA Excess Removal Worksheet 10/2015 Any prior to 1/2004
6314 Roth IRA Withdrawal Authorization 10/2018 Any prior to 10/2004
80024 IRA State Income Tax Withholding Election 1/2019 Any prior obsolete
IRA Beneficiary Designations
121 IRA Beneficiary Reminder Notice 3/2014
301 IRA Beneficiary Designation 4/2015
301-SU IRA Beneficiary Designation Addendum 4/2015
307 Inherited IRA Beneficiary Designation 4/2015
IRA Changes
311 IRA Change of Account Information 3/2014
2310 Investment Change 3/2014

 

Coverdell ESA Maintenance Forms

No. Name Current Version Obsolete Version
ESA Contributions
106 Special Contributions 4/2017 Any prior to 3/2016
5107 Coverdell ESA Contribution and Investment Selection 10/2014 Any prior obsolete
5109 Coverdell ESA Contribution Eligibility 10/2015
ESA Portability
5302 Coverdell ESA Transfer Request 7/2013 Any prior to 7/2001
ESA Distributions
5123 Coverdell ESA Excess Removal Worksheet 10/2015
5314 Coverdell ESA Withdrawal Authorization 10/2018 Any prior to obsolete
ESA Death Beneficiary Designations
5301 Coverdell ESA Death Beneficiary Designation 4/2015 Any prior to 1/2002
5301-SU Coverdell ESA Death Beneficiary Designation Addendum 4/2015
ESA Changes
5311 Coverdell ESA Change of Account Information 3/2014

 

HSA Maintenance Forms

No. Name Current Version Obsolete Version
HSA Contributions
3107 HSA Contribution and Investment Selection 10/2015 Any prior to 10/2004
3109 HSA Contribution Eligibility 10/2018
3315 HSA Mistaken Distribution Payment 3/2014
3322 Qualified HSA Funding Distribution Request 7/2013 Any prior to 10/2004
HSA Portability
3302 HSA Transfer Request 7/2013 Any prior to 10/2004
HSA Withdrawals
3123 HSA Excess Removal Worksheet 10/2015
3314 HSA Withdrawal Authorization 4/2015 Any prior to 10/2004
HSA Beneficiary Designations
3121 HSA Beneficiary Reminder Notice 3/2014
3301 HSA Beneficiary Designation 4/2015 Any prior to 10/2004
3301-SU HSA Beneficiary Designation Addendum 4/2015
HSA Changes
2310 Investment Change 3/2014
3311 HSA Information Change 3/2014

 

SEP Plan Establishment

No. Name Current Version Obsolete Version
407 SEP Contribution Statement 1/2016 Any prior to 9/2002
Standard SEP Plan Prototype (Kit #400)
400CW About the Standard SEP/Adoption Agreement Instructions 10/2017 Any prior to 9/2002
418 Standard SEP Adoption Agreement 9/2002 Any prior obsolete
419 Standard SEP Plan Document 9/2002 Any prior obsolete
422 Standard SEP Summary for Employees 10/2017 Any prior to 9/2002
423 SEP Employer Eligibility Form 1/2016 Any prior to 9/2002
Universal SEP Plan Prototype (Kit #410)
408 Universal SEP Adoption Agreement 9/2002 Any prior obsolete
409 Universal SEP Plan Document 9/2002 Any prior obsolete
412 Universal SEP Salary Reduction Agreement 1/2016 Any prior to 9/2002
413 Universal SEP Summary for Employees 10/2017 Any prior to 9/2002
414 Universal SEP Discrimination Test Worksheet 1/2016 Any prior to 12/96
423 SEP Employer Eligibility Form 1/2016 Any prior to 9/2002
424 About the Universal SEP 10/2017 Any prior to 9/2002
425 Adoption Agreement Instructions 10/2017 Any prior to 9/2002
426 Universal SEP Top-Heavy Test Worksheet 1/2016 Any prior to 4/2013
428 Notification of Excess Elective Deferrals/Notification of Disallowed Deferrals 1/2016 Any prior obsolete
SEP Plan Prototype Employee Information Booklets
411 Universal SEP Employee Information Booklet 10/2017 Any prior to 1/2016
421 Standard SEP Employee Information Handbook 10/2017 Any prior to 1/2016
Government SEP Plan Booklet
416 5305-SEP Plan Kit 10/2017 Any prior to 4/2002

 

SIMPLE IRA Plan Establishment

No. Name Current Version Obsolete Version
SIMPLE IRA Plan Prototype (Kit #600)
600CW About the SIMPLE IRA plan/Adoption Agreement Instructions 10/2017
615 SIMPLE IRA Plan Eligibility Form 10/2012
616 SIMPLE IRA Plan Salary Reduction Agreement 10/2017 Any prior to 9/2001
617 SIMPLE IRA Plan Participation Notice & Summary Description 10/2017 Any prior to 3/2016
618 SIMPLE IRA Plan Adoption Agreement 9/2002 Any prior obsolete
619 SIMPLE IRA Plan Basic Plan Document 9/2002 Any prior obsolete
Government SIMPLE IRA Plan Booklets
516 5305-SIMPLE – For use with a DFI 10/2017 Any prior to 3/2016
517 5304-SIMPLE – Not subject to DFI rules 10/2017 Any prior to 3/2016

 

Key
A Any prior to 10/2006 obsolete; versions dated 5/2002 through 3/2018 are obsolete unless accompanied by the appropriate disclosure statement amendment; strongly recommend the current version
B Include use for managed and self-directed trust accounts.
C Versions dated 1/2009 through 7/2013 require a disclosure statement amendment; strongly recommend the current version.
D Any prior to 10/2014 are obsolete unless accompanied by the appropriate disclosure statement amendment; strongly recommend the current version.
E Any prior to 5/2012 are obsolete unless accompanied by the appropriate disclosure statement amendment; strongly recommend the current version.
Versions prior to 3/2016 should be used with caution regarding rollovers to SIMPLE IRAs.
Versions prior to 4/2008 should be used with caution regarding automatic rollovers to inherited IRAs.
Versions prior to 4/2006 should not be used for Roth IRAs.
Versions prior to 10/2006 do not contain instruction for use with qualified reservist distributions and, versions prior to 3/2018 do not contain instructions for use with distributions taken due to certain federally-declared disasters.
Versions prior to 8/2005 should be used with caution regarding revocations.
Versions prior to 1/2007 should not be used to request or to certify a rollover of inherited retirement plan assets into an inherited IRA.
Prior versions should be used with caution regarding recharacterizations.
Versions prior to 4/2008 should be used with caution regarding rollovers of designated Roth contributions.
10/2018 versions should not be used until January 1, 2019. All prior versions are obsolete after December 31, 2018.

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