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Qualified Disaster Retirement Plan OMB No. 1545-0074
(Rev. January 2023)
Form 8915-F Distributions and Repayments Attachment
Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 915
Internal Revenue Service Go to www.irs.gov/Form8915F for instructions and the latest information.
Name. If married, file a separate form for each spouse required to file Form 8915-F. See instructions. Your social security number

Before you begin (see instructions for details):
• Form 8915-F replaces Form 8915-E for 2021 and later years. Form 8915-E was used for coronavirus-related and other 2020 disaster distributions.
• Also use Form 8915-F for 2021 and later disaster distributions. Qualified disaster recovery distributions are qualified disaster distributions.
• Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the only qualified disasters and their FEMA numbers for item C.
• “This year” (as used on this form) is the year of the form you check in item A next. For example, if you check 2022, “this year” is 2022.
Complete items A and B below. Complete item C and check the box in item D for the coronavirus, as applicable.
A Tax year for which you are filing form (check only one box): 2021 2022 2023 2024 Other
B Calendar year in which qualified disaster(s) began (check only one box): 2020 2021 2022 2023 Other
C FEMA number for each of your qualified disasters for the year checked in item B above. Use item D, not item C, for the coronavirus.
(1) (2) (3) (4) (5) (6)
D If your only disaster, or one of your disasters, is the coronavirus, check this box Don’t list the coronavirus in item C.

Which lines on this form should I use? See CHARTS 1 and 2 below.
CHART 1: Use if you checked the box for coronavirus in item D above and you don’t have any disaster in item C.
▲
No ▶
Start Did you claim coronavirus-related distributions on 2020 Form 8915-E? ▶ STOP! You can’t use Form 8915-F.
here
▶ Yes ▶
No
No In item A, did you check the box for
In item A above, did you check the box for tax year 2021 or 2022? ▶ tax year 2023?
▶ Yes ▶ Yes

Yes Are you repaying coronavirus-related No
Did you check the box on line 9 or 17 on 2020 Form 8915-E? ▶ distributions?
▶ No ▶ Yes

Complete lines 12 through 15 and lines Complete lines 14 and 25, as applicable.
23 through 26, as applicable.

CHART 2: Use if CHART 1 doesn’t apply to you. See the instructions for specific details.
▲
Start Were qualified disaster distributions made to you No Is the year in item A after the last year in which you can Yes
here this year for a disaster listed in item C above? ▶ make repayments? See instructions.
▶ Yes
▶ No
Complete Part I and, as applicable, Parts II, III, and IV.
Did you claim qualified disaster distributions on a prior
Did you check the box on line 11 or 22 on that prior year’s ▶ Yes year’s Form 8915-F (or on 2020 Form 8915-E if you checked
Form 8915-F (or on line 9 or 17 of 2020 Form 8915-E if 2020 in item B above) for disasters listed in item C?
you checked 2020 in item B) for disasters listed in item C? ▶ No
▶ No ▶ Yes
Did you receive qualified distributions this year for the
Is this the last year Yes Are you repaying qualified No purchase or construction of a main home in the area of
for repayments? ▶ disaster distributions? a disaster listed in item C?
▶ No ▶ Yes
▶ Yes
No
Complete lines 12 through Complete lines 14 ▶
15 and lines 23 through 26, and 25, as applicable. Complete Part IV.
as applicable. Complete Complete Part IV if ▶
STOP! You can’t use
Part IV if applicable. applicable. ▶ Form 8915-F.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 75585Y Form 8915-F (Rev. 1-2023)

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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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Form 8915-F (Rev. 1-2023)                                                                                                                 Page 3
Part II  Qualified Disaster Distributions From Retirement Plans (Other Than IRAs) for the Coronavirus and 
         Disaster(s) Listed in Item C
8  Did you enter an amount on line 2, column (b)?
         No. Skip lines 8 through 11, and go to line 12.   Yes. Enter the amount from line 2, column (b) .    .                8
9  Enter the applicable cost of distributions, if any. See instructions . . . .   .   . . . . . .         . . .                9
10 Subtract  line  9  from  line  8.  This  is  the  taxable  amount  of  your  other-than-IRA  retirement  plan  qualified 
   disaster distributions     . . .   .   . . . . .      . . .   .   .    . . .   .   . . . . . .         . . .                10
11 The entire taxable amount on line 10 will be spread over 3 years unless you elect to have it taxed in this year.
   If you elect NOT to spread the taxable amount over 3 years, check this box            and enter the amount
   from  line  10  (see  instructions).  Otherwise,  enter  the  amount  from  line  10  divided  by  3.0.  You  must 
   check the box on this line if you check the box on line 22  . .   .    . . .   .   . . . . . .         . . .                11
12 Enter  the  amount,  if  any,  from  Worksheet  2  in  the  instructions.  This  is  your  income  for  prior  years  from 
   other-than-IRA retirement plan qualified disaster distributions . .    . . .   .   . . . . . .         . . .                12
13 Add  lines  11  and  12.  This  is  your  total  income  this  year  from  other-than-IRA  retirement  plan  qualified 
   disaster distributions     . . .   .   . . . . .      . . .   .   .    . . .   .   . . . . . .         . . .                13
14 Total repayment. Enter the amount, if any, from Worksheet 3. This is your total repayment for this year of 
   other-than-IRA retirement plan qualified disaster distributions . .    . . .   .   . . . . . .         . . .                14
15 Amount  subject  to  tax  this  year.  Subtract  line  14  from  line  13.  If  zero  or  less,  enter  -0-.  Include  this 
   amount in the total on line 5b of this year’s Form 1040, 1040-SR, or 1040-NR. See instructions  .      . . .                15
Part III Qualified Disaster Distributions From Traditional, SEP, SIMPLE, and Roth IRAs for the Coronavirus and 
         Disaster(s) Listed in Item C
Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.
16 Did you enter an amount on line 3, column (b), or line 4, column (b)?
         Yes. Go to line 17.          No. Skip lines 17 through 22, and go to line 23.
17 Did you receive a qualified disaster distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required 
   to be reported on this year’s Form 8606?
         Yes. Go to line 18.          No. Skip lines 18 and 19, and go to line 20.
18 Enter the amount, if any, from this year’s Form 8606, line 15b. But if you are entering amounts here and on 
   other Forms 8915-F for this year, only enter on line 18 the amount on Form 8606, line 15b, attributable to 
   Form 8915-F distributions for this form. See the instructions for Form 8606, line 15b  . . . .         . . .                18
19 Enter the amount, if any, from this year’s Form 8606, line 25b. But if you are entering amounts here and on 
   other Forms 8915-F for this year, only enter on line 19 the amount on Form 8606, line 25b, attributable to 
   Form 8915-F distributions for this form. See the instructions for Form 8606, line 25b  . . . .         . . .                19
20 Enter the amount from line 3, column (b), if any. Don’t include on line 20 any amounts reported on Form 
   8606      . .  .       . . . . .   .   . . . . .      . . .   .   .    . . .   .   . . . . . .         . . .                20
21 Add lines 18, 19, and 20. This is the taxable amount of your IRA qualified disaster distributions  .   . . .                21
22 The entire taxable amount on line 21 will be spread over 3 years unless you elect to have it taxed in this year.
   If you elect NOT to spread the taxable amount over 3 years, check this box            and enter the amount
   from  line  21  (see  instructions).  Otherwise,  enter  the  amount  from  line  21  divided  by  3.0.  You  must 
   check the box on this line if you check the box on line 11  . .   .    . . .   .   . . . . . .         . . .                22
23 Enter the amount, if any, from Worksheet 4 in the instructions. This is your income for prior years from IRA 
   qualified disaster distributions . .   . . . . .      . . .   .   .    . . .   .   . . . . . .         . . .                23
24 Add lines 22 and 23. This is your total income this year from IRA qualified disaster distributions  .  . . .                24
25 Total repayment. Enter the amount, if any, from Worksheet 5. This is your total repayment for this year of 
   IRA qualified disaster distributions  .  . . . .      . . .   .   .    . . .   .   . . . . . .         . . .                25
26 Amount subject to tax. Subtract line 25 from line 24. If zero or less, enter -0-. Include this amount in the 
   total on line 4b of this year’s Form 1040, 1040-SR, or 1040-NR. See instructions .   . . . . .         . . .                26
                                                                                                                               Form 8915-F (Rev. 1-2023)

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Form 8915-F (Rev. 1-2023) Page 4
Part IV Qualified Distributions for the Purchase or Construction of a Main Home in the Area of Disaster(s)
Listed in Item C
Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.
Caution: Complete Part IV if, this year, you received a qualified distribution (as defined in the instructions) for the purchase or construction of
a main home in the area of a disaster listed in item C earlier. You can only repay the distribution during the disaster’s qualified distribution
repayment period (see Qualified distribution repayment period in the instructions). If you are allowed to repay the distribution, in whole or in
part, after this year, see the instructions. For the applicability of Part IV to other years for disasters listed in item C, see the instructions.
Part IV Disaster Table. Provide the information requested below for the disaster(s) in item C earlier for which you are reporting qualified distributions in this part.
Disaster FEMA number* Disaster beginning date* Disaster ending date*

*Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the FEMA number, Disaster beginning date, and Disaster ending date
for the disaster(s) listed in item C.

Date first distribution received this year Date last distribution received this year

27 Did you receive a qualified distribution, for the purchase or construction of a main home in the area of a
disaster listed in the Part IV Disaster Table earlier, that is from a traditional, SEP, SIMPLE, or Roth IRA and
that is required to be reported on this year’s Form 8606?
Yes. Complete lines 28 through 32 only if you also had qualified distributions not required to be
reported on this year’s Form 8606; otherwise, stop here.
No. Go to line 28.
28 Enter the total amount of qualified distributions you received this year for the purchase or construction of a
main home in the area of disaster(s) listed in the Part IV Disaster Table. Don’t include any amounts reported
on this year’s Form 8606. Also, don’t include any distributions you reported on line 8 or 20, or on other
Forms 8915 for this year, if any . . . . . . . . . . . . . . . . . . . . . . . . 28
29 Enter the applicable cost of distributions, if any. See instructions . . . . . . . . . . . . . . 29
30 Subtract line 29 from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Enter the total amount of any repayments you made. See instructions for allowable repayments. Don’t
include any repayments treated as rollovers on this year’s Form 8606. See instructions . . . . . . . 31
32 Taxable amount. Subtract line 31 from line 30. If the distribution is:
• From an IRA, include this amount in the total on line 4b of this year’s Form 1040, 1040-SR, or
1040-NR. . . . 32
• From a retirement plan (other than an IRA), include this amount in the total on line 5b of this
year’s Form 1040, 1040-SR, or 1040-NR.
Note: You may be subject to an additional tax on the amount on line 32. See instructions. }
Form 8915-F (Rev. 1-2023)

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