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Form 8915-F (Rev. 1-2023) Page 2
Part I Total Distributions From All Retirement Plans (Including IRAs) (see instructions)
Caution: Complete Part I if, this year, you have qualified disaster distributions (see instructions) for disasters listed in item C earlier.
Part I Disaster Table. Provide the information requested below for the disaster(s) in item C earlier for which you are reporting qualified disaster distributions in this part.
Disaster FEMA number* Disaster declaration date* Disaster beginning date*
* Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the FEMA number, Disaster declaration date, and Disaster
beginning date for the disaster(s) listed in item C. If more than two disasters, see instructions and check this box . . . . . . . . .
(a) (b)
Date(s) of distribution(s) made this year Available Qualified disaster
If you completed Part I of two or more Forms 8915-F on which you checked the same year in distributions distributions for
for this year the disasters
item A but different years in item B, see Part I in the instructions to figure the amount for lines (see instructions) in item C
2, 3, and 4 in column (a). (see instructions)
1 See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
However, you can always choose to use Worksheet 1B.
a (i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• If all of the distributions for this year occurred within the qualified disaster
distribution period (see Qualified disaster distribution period in instructions) for each
of the disasters listed in the Part I Disaster Table, complete lines 1a through 1e,
entering on line 1a $22,000 times the number of disasters you entered in the Part I
Disaster Table that were also entered in item C on a prior year’s Form 8915-F.
• Otherwise, for lines 1a through 5, you must use Worksheet 1B in the instructions . 1a
b Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See Part I in the instructions . . . . . . . . . . 1b
c Subtract line 1b from line 1a . . . . . . . . . . . . . . . . . . . 1c
d Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B . . 1d
e Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d. If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table . . . . . . . . . . . . . . . 1e
2 Enter, in column (a), distributions from retirement plans (other than IRAs) made this year 2
3 Enter, in column (a), distributions from traditional, SEP, and SIMPLE IRAs made this year 3
4 Enter, in column (a), distributions from Roth IRAs made this year . . . . . . . . 4
5 Do (1) through (3) below in the order indicated.
(1) Enter on line 5, column (a), the sum of lines 2 through 4 in column (a) reduced by the
total distributions from lines 2 through 4 in column (a) that aren’t qualified disaster
distributions.
(2) Enter on line 5, column (b), the smaller of the amount on line 5, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a) allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5, column (b) . . . . . . . . 5
6 Total qualified disaster distributions. Enter the amount from line 5, column (b). The 10% additional tax
(25% for SIMPLE IRAs) for early withdrawals is waived for this amount. See Parts II and III, later, for the tax
on this amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Form 8915-F (Rev. 1-2023)
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