PDF document

- 1 -

Qualified Disaster Retirement Plan OMB No. 1545-0074
(Rev. January 2023)
Form 8915-F Distributions and Repayments Attachment
Department of the Treasury Go to www.irs.gov/Form8915F for instructions and the latest information. Sequence No.915
Internal Revenue Service Attach to Form 1040, 1040-SR, or 1040-NR.
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.
• Form 8915-F is also used for 2021 and later disaster distributions.
• See Appendix B in the instructions for the list of qualified disasters and their FEMA numbers for the year you check in item B next.
• “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 disaster occurred (check only one box): 2020 2021 2022 2023 Other
C FEMA number for each of your 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 disaster 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 a
for repayments? ▶ disaster distributions? 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)

- 2 -

Enlarge image

Form 8915-F (Rev. 1-2023)                                                                                                             Page 2
Part I   Total Distributions From All Retirement Plans (Including IRAs) (see instructions)
         Provide the information requested below for the disasters in item C earlier for which you are reporting qualified disaster 
         distributions in this part. 
           Disaster FEMA number*                       Disaster beginning date*                            Disaster ending date*

* See Appendix B at the end of the instructions for the FEMA number, and for disaster beginning and ending dates. If more than two 
disasters, see instructions and check this box . . . . .      .   . .   . . . .       . .   .      . . . . . .        . .   . . .   . .
Date first distribution made this year                                                                       (a)                  (b) 
Date last distribution made this year                                                                      Available        Qualified disaster 
                                                                                                         distributions        distributions for 
                                                                                                         for this year        the disasters in 
Complete lines 1a through 1e first. If line 1e is zero, stop. Do not complete Part I.                    (see instructions)     item C     
                                                                                                                              (see instructions)
1  Qualified disaster distribution limits (see instructions). 
a  Do the following.
   • Skip lines 1a through 1d. And, on line 1e, enter $100,000 times the number of disasters 
       you entered in item C earlier if:
       • You checked 2020 in item B earlier and either you didn’t file 2020 Form 8915-E or you 
       only reported the coronavirus disaster on 2020 Form 8915-E, or
       • You checked a year other than 2020 in item B and this is the first year you are filing a 
       Form 8915-F for disasters for the year checked in item B.
   • Otherwise, on line 1a, enter $100,000 times the number of different qualified disasters 
       you have reported in item C on prior-year Forms 8915-F for disasters for the year you 
       checked in item B. (Include, in your disaster number, if you checked 2020 in item B, 
       qualified disaster(s) (other than the coronavirus) reported in Part I of 2020 Form 8915-E.) 
       Also, complete lines 1b through 1e   .  . . . . .      .   . .   . . . .       . .   .        1a
b  Enter the total qualified disaster distributions made to you in prior year(s) for all disasters 
   (except the coronavirus) for the year you checked in item B    . .   . . . .       . .   .        1b
c  Subtract line 1b from line 1a  .     . . .  . . . . .      .   . .   . . . .       . .   .        1c
d  Enter $100,000 times the number of qualified disasters, for the year checked in item B, 
   that you reported in item C but didn’t report 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. Don’t count the coronavirus in 
   the number of qualified disasters .    . .  . . . . .      .   . .   . . . .       . .   .        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, do NOT complete Part I  .       . .   .        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  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.
       • See instructions if the years checked in items A and B are the same; more than one 
       disaster is listed in item C; and the total on line 5, column (a), exceeds $100,000.
       • Otherwise, enter on line 5, column (b), the smaller of the amount on line 5, column (a), 
       or line 1e. Then 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)

- 3 -

Enlarge image

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
Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.
Part III Qualified Disaster Distributions From Traditional, SEP, SIMPLE, and Roth IRAs for the Coronavirus and 
         Disaster(s) Listed in Item C
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)

- 4 -

Enlarge image

Form 8915-F (Rev. 1-2023)                                                                                                            Page 4
Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.
Part IV Qualified Distributions for the Purchase or Construction of a Main Home in the Area of Disaster(s) 
        Listed in Item C
        Caution: Complete Part IV if, this year, you received a qualified distribution (as defined in the instructions) for a disaster listed in 
        item C earlier. If you 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.
         Disaster FEMA number*                           Disaster beginning date*                          Disaster ending date*

* See Appendix B at the end of the instructions for the FEMA number, and for disaster beginning and ending dates.
Date first distribution received this year                        Date last distribution received this year
27 Did you receive a qualified distribution from a traditional, SEP, SIMPLE, or Roth IRA 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.  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)

PDF file checksum: 2147420673

(Plugin #1/9.12/13.0)