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Department of the Treasury
Internal Revenue Service
2021

Instructions for Form 8915-B

Qualified 2017 Disaster Retirement Plan Distributions and Repayments

Section references are to the Internal Revenue Code Qualified 2017 disaster distributions can't be received cannot be treated as a repayment
unless otherwise noted. made in 2021. on your 2021 Form 8915-B. For example, if
your qualified 2017 disaster distribution was
Note. Repayments of distributions from received on October 4, 2018, and you
General Instructions retirement plans (other than IRAs) are choose to repay the distribution, the
reported in Part I, and repayments of repayment must be made before October 5,
Future Developments distributions from IRAs are reported in Part II. 2021.
For the latest information about For details on qualified 2017 disaster
developments related to Form 8915-B and TIP distributions, see the 2018 If you choose, you can generally repay to an
its instructions, such as legislation enacted Instructions for Form 8915B. eligible retirement plan any portion of a
after they were published, go to IRS.gov/ qualified 2017 disaster distribution that is
Form8915B. eligible for tax-free rollover treatment. Also,
Who Must File you can repay a qualified 2017 disaster
What’s New File 2021 Form 8915-B if you made a distribution from a retirement plan made on
repayment of a qualified 2017 disaster account of hardship. However, see
Coronavirus-related distributions. Did distribution in 2021 that was not included on Exceptions below for qualified 2017 disaster
you repay coronavirus-related distributions in your 2020 Form 8915-B. distributions you can’t repay.
2021? If you did, do not use 2021 Form You have 3 years from the day after the
8915-B to report those repayments. Use new When and Where To File date you received the distribution to make a
Form 8915-F, Qualified Disaster Retirement repayment. The amount of your repayment
Plan Distributions and Repayments, instead. File 2021 Form 8915-B with your 2021 Form
We have retired Form 8915-E, Qualified 1040, 1040-SR, or 1040-NR. If you are not cannot be more than the amount of the
2020 Disaster Retirement Plan Distributions required to file an income tax return but are original distribution. Amounts that are repaid
and Repayments, which you used to report required to file 2021 Form 8915-B, sign Form are treated as a trustee-to-trustee transfer
coronavirus-related distributions and 8915-B and send it to the IRS at the same and are not included in income. Also, for
repayments in 2020. time and place you would otherwise file 2021 purposes of the one-rollover-per-year
Form 1040, 1040-SR, or 1040-NR. limitation for IRAs, a repayment to an IRA is
Repayments. The repayment period for a not considered a rollover.
qualified 2017 disaster distribution ends 3 Qualified 2017 Disaster Include on 2021 Form 8915-B any
years and 1 day after the distribution was repayments you make during 2021 that were
received. Repayments reported on 2021 Distribution not included on your 2020 Form 8915-B. Any
Form 8915-B can be used to reduce the repayments may be carried back to your
income from qualified 2017 disaster What 2017 Disasters Are 2018, 2019, or 2020 return. See Amending
distributions made in 2018 and reportable on Covered? Form 8915-B, later.
your 2018, 2019, or 2020 tax return. The In order to have a qualified 2017 disaster
amounts from lines 5 and 10 of 2021 Form distribution, you must have been adversely Exceptions. You cannot repay the
8915-B can only be carried back to reduce affected by: following types of distributions.
that income. If you have already filed your tax • Hurricane Harvey (which includes 1. Qualified 2017 disaster distributions
return for the year in question, you will need Tropical Storm Harvey), received as a beneficiary (other than a
to amend that return. • Hurricane Irma, surviving spouse).
Last revision. The 2021 revision is the last • Hurricane Maria, or 2. Required minimum distributions.
revision of Form 8915-B and these • The California wildfires. 3. Any distribution (other than from an
instructions. How Is a Qualified 2017 IRA) that is one of a series of substantially
equal periodic payments made (at least
Disaster Distribution Taxed?
Purpose of Form annually) for:
Use 2021 Form 8915-B if you were Generally, a qualified 2017 disaster a. A period of 10 years or more,
adversely affected by a 2017 disaster listed distribution is included in your income in
in What 2017 Disasters Are Covered, later, equal amounts over 3 years. However, if you b. Your life or life expectancy, or
and you received a distribution that qualifies elected, you could have included the entire c. The joint lives or joint life
for favorable tax treatment. For distributions distribution in your income in the year of the expectancies of you and your beneficiary.
for qualified 2018, 2019, and 2020 disasters, distribution. If you received more than one
see Form 8915-C, Qualified 2018 Disaster distribution during 2018, you must have Eligible retirement plan. An eligible
Retirement Plan Distributions and treated all the distributions for that year the retirement plan can be any of the following.
Repayments; Form 8915-D, Qualified 2019 same way. Qualified 2017 disaster • A qualified pension, profit-sharing, or
Disaster Retirement Plan Distributions and distributions aren’t subject to the additional stock bonus plan (including a 401(k) plan).
Repayments; and new Form 8915-F, 10% tax (or the 25% additional tax for certain • A qualified annuity plan.
Qualified Disaster Retirement Plan distributions from SIMPLE IRAs) on early • A tax-sheltered annuity contract.
Distributions and Repayments, respectively, distributions. • A governmental section 457 deferred
compensation plan.
and their instructions. Repayment of a Qualified 2017 • A traditional, SEP, SIMPLE, or Roth IRA.
Use Form 8915-B only to report Disaster Distribution
repayments of qualified 2017 disaster An amount paid more than 3 years Amending Form 8915-B
File Form 1040-X, Amended U.S. Individual
included on your 2020 Form 8915-B. CAUTION
distributions made in 2021 that were not ! and 1 day after the distribution was Income Tax Return, to amend a return you

Jan 14, 2022 Cat. No. 71194R

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have already filed. Generally, Form 1040-X may also be able to complete Part I if you the amount of tax. For more information, see
must be filed within 3 years after the date the have an excess repayment from Part I of a Amending Form 8915-B, earlier.
original return was filed, or within 2 years 2020 Form 8915-B, but see the example If the amount on both line 5 and line 10 is
after the date the tax was paid, whichever is under Line 2b next. Also, see the Caution zero, do not file a 2021 Form 8915-B.
later. under Repayment of a Qualified 2017
Disaster Distribution, earlier, for limitations.
If, after filing a 2018, 2019, or 2020 Form Part II—Qualified 2017
1040 with a Form 8915B or 8915-B, you Line 2b. Enter the amount from line 2a that
make a repayment, the repayment may you have already carried back to a prior year. Disaster Distributions
reduce the amount of your qualified 2017 See the example below. From Traditional, SEP,
disaster distributions reported on the earlier Example. You received a qualified 2017 SIMPLE, and Roth IRAs
return. disaster distribution from your 401(k) Complete Part II if you made a repayment in
retirement plan in the amount of $90,000 on 2021 of qualified 2017 disaster distribution
If you make any repayments during 2021, January 15, 2018. This is the only qualified amounts from line 25 of 2018 Form 8915B.
include the repayments on your 2021 Form 2017 disaster distribution you have ever See the examples under Amending Form
8915-B if they were not included on your received. You chose to spread the $90,000 8915-B, earlier, and under Line 9 below. You
2020 Form 8915-B. If you make a repayment over 3 years ($30,000 in income for 2018, may also be able to complete Part II if you
reported on your 2021 Form 8915-B, you 2019, and 2020). You did not make a have an excess repayment from Part II of a
must file an amended 2018 Form 8915B, an repayment until November 10, 2020, when 2020 Form 8915-B, but see the example
amended 2019 or 2020 Form 8915-B, or a you made a repayment of $40,000. On your under Line 7b next. Also, see the Caution
combination of these forms to reduce the 2020 Form 8915-B, you entered $40,000 on under Repayment of a Qualified 2017
qualified 2017 disaster distributions reported lines 5 and 6 and $30,000 on line 1. On Disaster Distribution, earlier, for limitations.
on them. (But see the examples below. Also, December 1, 2020, you filed an amended
see the Caution under Repayment of a 2019 return carrying back the excess Line 7b. Enter the amount from line 7a that
Qualified 2017 Disaster Distribution, earlier, repayment of $10,000 ($40,000 − $30,000) you have already carried back to a prior year.
for limitations.) to line 7 in Part I of your 2019 Form 8915-B. See the example below.
Example 1. You received a qualified You transfer the amounts on lines 6 and 1 of Example. You received a qualified 2017
2017 disaster distribution in the amount of your 2020 Form 8915-B to your 2021 Form disaster distribution from an IRA in the
$90,000 on November 15, 2018. You choose 8915-B, entering $40,000 on line 1a and amount of $90,000 on January 15, 2018.
to spread the $90,000 over 3 years ($30,000 $30,000 on line 1b of your 2021 Form This is the only qualified 2017 disaster
in income for 2018, 2019, and 2020). On 8915-B. You entered $10,000 on line 2a of distribution you have ever received. You
November 10, 2021, you make a repayment your 2021 Form 8915-B. Because you have chose to spread the $90,000 over 3 years
of $40,000, which you report on line 9 of your already carried back the full $10,000, you ($30,000 in income for 2018, 2019, and
2021 Form 8915-B. The repayment of would include $10,000 on 2021 Form 2020). You did not make a repayment until
$40,000 can be carried back to 2018, 2019, 8915-B, line 2b. November 10, 2020, when you made a
or 2020. Line 4. At any time during the 3-year period repayment of $40,000. On your 2020 Form
Example 2. The facts are the same as in beginning 1 day after the date you received a 8915-B, you entered $40,000 on lines 12 and
Example 1, except the repayment was made qualified 2017 disaster distribution, you can 13 and $30,000 on line 8. On December 1,
on December 20, 2021. The $40,000 can't repay any portion of the distribution to an 2020, you filed an amended 2019 return
be treated as a repayment because it was eligible retirement plan that accepts rollover carrying back the excess repayment of
made after the 3-year period for making a contributions. You cannot, however, repay $10,000 ($40,000 − $30,000) to line 16 in
repayment had passed. more than the amount of the original Part II of your 2019 Form 8915-B. You
distribution. See Repayment of a Qualified transfer the amounts on lines 13 and 8 of
2017 Disaster Distribution, earlier, for details. your 2020 Form 8915-B to your 2021 Form
8915-B, entering $40,000 on line 6a and
Specific Instructions Enter on line 4 the amount of any $30,000 on line 6b of your 2021 Form
Married filers. If both you and your spouse repayments you made during 2021. Don't 8915-B. You entered $10,000 on line 7a of
are required to file 2021 Form 8915-B, file a include any repayments you included on your 2021 Form 8915-B. Because you have
separate Form 8915-B for each of you. your 2020 Form 8915-B. Do not include any already carried back the full $10,000, you
repayments of nontaxable amounts. would include $10,000 on 2021 Form
Name and social security number (SSN). Repayments made after the due date of your 8915-B, line 7b.
If you file a joint return, enter only the name 2020 return (including extensions) but before
and SSN of the spouse whose information is 2022 will generally be reported on your 2021 Line 9. At any time during the 3-year period
being reported on the 2021 Form 8915-B. Form 8915-B. See Amending Form 8915-B, beginning 1 day after the date you received a
Foreign address. If you have a foreign earlier. For a discussion of repayments made qualified 2017 disaster distribution, you can
address, enter the city name on the more than 3 years and 1 day after the repay any portion of the distribution to an
appropriate line. Do not enter any other qualified 2017 disaster distribution to which eligible retirement plan that accepts rollover
information on that line, but also complete the repayment relates was received, see the contributions. You cannot, however, repay
the spaces below that line. Do not abbreviate Caution under Repayment of a Qualified more than the amount of the original
the country name. Follow the country's 2017 Disaster Distribution, earlier. distribution. See Repayment of a Qualified
2017 Disaster Distribution, earlier, for details.
practice for entering the postal code and the Example. You received a $90,000
name of the province, county, or state. qualified 2017 disaster distribution on May 7, Enter on line 9 the amount of any
2018, from your 401(k) plan. You had an repayments you made during 2021. Don't
Part I—Qualified 2017 economic loss due to Hurricane Harvey. On include any repayments you included on
April 1, 2021, you repay $30,000 to your your 2020 Form 8915-B. Do not include any
Disaster Distributions 401(k) plan. You file your return on April 10, repayments of nontaxable amounts.
From Retirement Plans 2021. Since the repayment was made within Repayments made after the due date of your
(Other Than IRAs) the 3-year period beginning 1 day after the 2020 return (including extensions) but before
distribution was received, you would enter 2022 will generally be reported on your 2021
Complete Part I if you made a repayment in the $30,000 repayment on line 4. Form 8915-B. See Amending Form 8915-B,
2021 of qualified 2017 disaster distribution earlier. For a discussion of repayments made
amounts from line 10 of 2018 Form 8915B. Line 5. If you have an amount on line 5, you more than 3 years and 1 day after the
See the examples under Amending Form may be able to carry this amount back to qualified 2017 disaster distribution to which
8915-B, earlier, and under Line 4, later. You your 2018, 2019, or 2020 return and reduce

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the repayment relates was received, see the this form to carry out the Internal Revenue are confidential, as required by section 6103.
Caution under Repayment of a Qualified laws of the United States. We need this However, we may give this information to the
2017 Disaster Distribution, earlier. information to ensure that you are complying Department of Justice for civil and criminal
Example. You received a $60,000 with these laws and to allow us to figure and litigation, and to cities, states, the District of
qualified 2017 disaster distribution on collect the right amount of tax. You are Columbia, and U.S. commonwealths and
November 1, 2018, from your traditional IRA. required to give us this information if you possessions to carry out their tax laws. We
You had an economic loss due to the made certain contributions or received may also disclose this information to other
California wildfires. On October 1, 2021, you certain distributions from qualified plans, countries under a tax treaty, to federal and
repay $30,000 to your traditional IRA. including IRAs, and other tax-favored state agencies to enforce federal nontax
Because the repayment was made within the accounts. Our legal right to ask for the criminal laws, or to federal law enforcement
3-year period beginning 1 day after the information requested on this form is and intelligence agencies to combat
distribution was received, you would enter sections 6001, 6011, 6012(a), and 6109 and terrorism.
the $30,000 repayment on line 9. their regulations. If you don’t provide this
information, or you provide incomplete or The average time and expenses required
Line 10. If you have an amount on line 10, false information, you may be subject to to complete and file this form will vary
you may be able to carry this amount back to penalties. You are not required to provide the depending on individual circumstances. For
your 2018, 2019, or 2020 return and reduce information requested on a form that is the estimated averages, see the instructions
the amount of tax. For more information, see subject to the Paperwork Reduction Act for your income tax return.
Amending Form 8915-B, earlier. unless the form displays a valid OMB control
If the amount on both line 5 and line 10 is number. Books or records relating to a form If you have suggestions for making this
zero, do not file a 2021 Form 8915-B. or its instructions must be retained as long as form simpler, we would be happy to hear
their contents may become material in the from you. See the instructions for your
Privacy Act and Paperwork Reduction administration of any Internal Revenue law. income tax return.
Act Notice. We ask for the information on Generally, tax returns and return information

Instructions for Form 8915-B (2021) -3-

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