5498-SA Participant Copy B

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5498-SA [B] Participant Copy B - Laser Forms

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5498-SA Participant Copy B - Laser Forms. Print and mail this 5498-SA Copy B form to report HSA, Archer MSA, or Medicare Advantage information to the participant. Forms are 3-up on an 8½” x 11” sheet with a ½” side perforation and are printed on 20# laser paper. Order the quantity equal to the number of recipients for which you need to file (in lots of 25).

Quantity Lots as low as: $1.82

Starting Lots of 25 forms: $3.30

This item has been designed to be used for the Tax Year: 2023

Availability:: Usually Ships Within 3 Business Days
Product Code: L54SX3B

Lot(s)	1	2	3	4	5	6	7	8	9	10
Qty	25	50	75	100	125	150	175	200	225	250
Lot Price	$3.30	$5.61	$6.93	$7.26	$9.08	$10.89	$12.71	$14.52	$16.34	$18.15

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Lot Price	$36.30	$54.45	$72.60	$145.20	$181.50	$290.40	$290.40	$363.00	$544.50	$726.00

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5498-SA Participant Copy B - Laser Forms - HSA, Archer MSA, or Medicare Advantage

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