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                                                                                                          Department of the Treasury
                                                                                                          Internal Revenue Service
Instructions for Form 8915-F

(Rev. January 2023)
Qualified Disaster Retirement Plan Distributions and Repayments

Section references are to the Internal Revenue Code                        distributions, qualified 2023 disaster distributions, etc.) 
unless otherwise noted.                                                    are also called qualified disaster recovery distributions.
Contents                                                          Page     Dollar limit. For qualified 2021 and later disasters, the 
General Instructions  . . . . . . . . . . . . . . . . . . . . . . . . . 1  dollar limit on Form 8915-F for retirement plan 
Future Developments         . . . . . . . . . . . . . . . . . . . . .   1  distributions is $22,000 per disaster. It was $100,000 but 
Helpful Hints   . . . . . . . . . . . . . . . . . . . . . . . . . . .   1  that was for qualified 2020 disasters.
How Do I Distinguish My Form 8915-F and Its                                Determining the qualified disaster distribution peri-
Disasters From Other Forms 8915-F?                      . . . . . . .   2  od, in Part I, for a disaster. The qualified disaster 
Purpose of Form       . . . . . . . . . . . . . . . . . . . . . . . .   2  distribution period for each disaster still begins on the day 
Purpose of These Instructions . . . . . . . . . . . . . . .             2  the disaster began. The last day of the qualified disaster 
                                                                           distribution period for most qualified 2021 disasters and 
When Should I Not Use a Form 8915-F?                  . . . . . . . .   2
                                                                           many qualified 2022 disasters is June 26, 2023. But the 
Who Must File   . . . . . . . . . . . . . . . . . . . . . . . . . .     2  last day of the qualified disaster distribution period for 
When and Where To File          . . . . . . . . . . . . . . . . . . .   3  qualified 2023 and later disasters, some qualified 2022 
What Is a Qualified Disaster Distribution? . . . . . . .                3  disasters, and perhaps even a few qualified 2021 
Qualified Disaster Distribution         . . . . . . . . . . . . . . .   3  disasters will have to be separately calculated. See 
Qualified Distribution for the Purchase or                                 Qualified disaster distribution period, later.
Construction of a Main Home in Qualified                                   Determining the qualified distribution repayment pe-
Disaster Areas        . . . . . . . . . . . . . . . . . . . . . . . .   6  riod, in Part IV, for a disaster.  The qualified distribution 
Amending Form 8915-F            . . . . . . . . . . . . . . . . . . .   7  repayment period for each disaster still begins on the day 
Specific Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 9  the disaster began. The last day of the qualified 
Required General Information            . . . . . . . . . . . . . . .   9  distribution repayment period for most qualified 2021 
                                                                           disasters and many qualified 2022 disasters is June 27, 
Part I—Total Distributions From All 
                                                                           2023. But the last day of the qualified distribution 
Retirement Plans (Including IRAs)                 . . . . . . . . . .   9
                                                                           repayment period for qualified 2023 and later disasters, 
Part II—Qualified Disaster Distributions From                              some qualified 2022 disasters, and perhaps even a few 
Retirement Plans (Other Than IRAs)                    . . . . . . .     17 qualified 2021 disasters will have to be separately 
Part III—Qualified Disaster Distributions From                             calculated. See Qualified disaster distribution period, 
Traditional, SEP, SIMPLE, and Roth IRAs                     . . . .     19 later.
Part IV—Qualified Distributions for the 
Purchase or Construction of a Main Home                                    Determining the disaster's FEMA number and other 
in Qualified Disaster Areas             . . . . . . . . . . . . . .     21 information.  Appendix B, Qualified Disaster Areas by 
                                                                           Year, is being discontinued. See Qualified disaster area, 
Appendix A, Which Lines Should I Use? . . . . . . .                     23 later, for information on where to find a disaster’s FEMA 
Appendix B, Worksheets . . . . . . . . . . . . . . . . . .              27 number, beginning date, and declaration date.
                                                                           New line 1a.  New Line 1a explains the criteria set forth 
General Instructions                                                       in Form 8915-F, line 1a, including “If all of the distributions 
                                                                           for this year occurred within the qualified disaster 
Future Developments                                                        distribution period for each of the disasters listed” in the 
For the latest information about developments related to                   table at the top of Part I.
Form 8915-F and its instructions, such as legislation 
                                                                           New Worksheet 1B.   New Worksheet 1B is a tool you 
enacted after they were published, go to IRS.gov/
                                                                           may have to use in figuring amounts for lines 1a through 5 
Form8915F.
                                                                           of Form 8915-F. See Worksheet 1B, later, to determine 
What’s New                                                                 whether you must use Worksheet 1B. You can choose to 
                                                                           use Worksheet 1B even if you are not required to do so.
Qualified 2021 and later disaster distributions (also 
known as qualified disaster recovery distributions).                       Helpful Hints
As a result of section 331 of the Secure 2.0 Act of 2022, 
                                                                           Form 8915-F can be e-filed.    Form 8915-F can be 
enacted December 29, 2022, you are now eligible for the 
                                                                           completed electronically and e-filed with your tax return.
benefits of Form 8915-F if you were adversely affected by 
a qualified 2021 or later disaster and you received a                      Form 8915-F is a forever form.     Form 8915-F is a 
distribution described in Qualified Disaster Distribution                  redesigned Form 8915. Beginning in 2021, additional 
Requirements or Qualified Distribution Requirements,                       alphabetical Forms 8915 (that is, Form 8915-G, Form 
later. Qualified disaster distributions (such as qualified                 8915-H, etc.) will not be issued. The same Form 8915-F 
2021 disaster distributions, qualified 2022 disaster                       will be used for distributions for qualified 2020 disasters 

Mar 30, 2023                                                      Cat. No. 37509G

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(and qualified 2021 and later disasters, if enacted) and for • A qualified distribution described in Qualified 2021 and
each year of reporting of income and repayments of those later disaster areas under Qualified Distribution for the
distributions. The boxes you check in items A and B will Purchase or Construction of a Main Home in Qualified
help us determine the exact year of the form you are filing, Disaster Areas, later, that you received on January 1,
and the year of the qualified disasters, qualified disaster 2021, for the Washington (8593-DR-WA) disaster.
distributions, and qualified distributions you are reporting.
Earlier Forms 8915 had a different alphabetical Form See Amending Form 8915-F, later.
8915 for each year of disasters and a different form for
each year the alphabetical form existed. See How Do I Purpose of These Instructions
Distinguish My Form 8915-F and Its Disasters From Other These instructions provide detailed information for use
Forms 8915-F and When Should I Not Use a Form with your Form 8915-F. For your convenience, Appendix
8915-F, later. A, Which Lines Should I Use, later, provides, as well, the
lines you should complete on your Form 8915-F for all tax
This year. "This year" (as used on Form 8915-F and in years applicable to 2020 and later disasters.
these instructions) is the year of the form you check in
item A of your Form 8915-F. For example, if you check When Should I Not Use a Form 8915-F?
2022, "this year" is 2022.
Reporting coronavirus-related and other distribu-
How Do I Distinguish My Form 8915-F and Its tions for qualified 2020 disasters made or received in
Disasters From Other Forms 8915-F? 2020. This form replaces Form 8915-E for tax years
beginning after 2020. Do not use a Form 8915-F to
Name of form. These instructions will use different report, in Part I, qualified 2020 disaster distributions made
names to refer to your Form 8915-F depending on the in 2020 or, in Part IV, qualified distributions received in
boxes you check in items A and B at the top of page 1 of 2020 for qualified 2020 disasters.
your Form 8915-F. For example, if you checked the 2022
box in item A and the 2021 box in item B, your form will be You will still use 2020 Form 8915-E to report
referred to in these instructions and elsewhere as “2022 ! coronavirus-related and other qualified disaster
Form 8915-F (2021 disasters).” See Names of disasters CAUTION distributions made in 2020 and to report qualified
and distributions next. distributions received in 2020 for qualified 2020 disasters.

Names of disasters and distributions. Except when Qualified 2019 and earlier disasters. Do not use Form
referring to them generally, these instructions will refer to 8915-F to report repayments or income from qualified
the different qualified disasters and qualified disaster disaster distributions for 2019 and earlier disasters.
distributions by their specific names using the year(s) you
checked in item A and item B at the top of page 1 of your Who Must File
Form 8915-F. For example, if you checked 2022 in item B, File Form 8915- F for the year you checked in item A at
your qualified disasters are referred to as “qualified 2022 the top of page 1 of the form if any of the following apply to
disasters” and your qualified disaster distributions are you for that year for the disasters listed in items C and D.
referred to as “qualified 2022 disaster distributions.” • A qualified disaster distribution was made to you from
an eligible retirement plan.
Purpose of Form • You received a qualified distribution.
If you were adversely affected by a qualified 2021 or later • A qualified disaster distribution was made to you in a
disaster, use Form 8915-F to report: prior year that you are including in income in equal
• A qualified disaster distribution described in Qualified amounts over 3 years and the 3-year period has not yet
disaster distribution requirements, later, that was made to lapsed.
you this year; • You made a repayment of a qualified disaster
• A repayment of, or income from, a qualified disaster distribution.
distribution reported on Part I of a Form 8915-F from this
or an earlier year; or Which Lines Should I Complete?
• Income in 2021 and later years from qualified 2020 and If you e-file your return, the software you use may
later disaster distributions; and TIP determine which lines you need.
• A qualified distribution described in Qualified 2021 and
later disaster areas under Qualified Distribution for the Fill in your name and social security number at the top
Purchase or Construction of a Main Home in Qualified of page 1 of your Form 8915-F. As indicated earlier,
Disaster Areas, later, that you received this year. complete items A and B, selecting the item A tax year and
If you were adversely affected by a qualified 2020 the item B disaster year. Also, complete items C and D, as
disaster, use Form 8915-F to report: applicable.
• A qualified disaster distribution described in Qualified
disaster distribution requirements, later, that was made to You might not need to enter amounts on each line of
you in 2021 (coronavirus-related distributions can't be your Form 8915-F. Appendix A, Which Lines Should I
made after December 30, 2020); Use, later, provides the lines you need to complete on
• A repayment of, or income from, a qualified disaster Form 8915-F for each year relating to your disasters. The
distribution (including a coronavirus-related distribution) in lines you use will depend on:
this year; or • Whether qualified disaster distributions were made to
you,

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• Whether you have received qualified distributions, you elect, you can include the entire distribution in your
• Whether you are recognizing income from distributions, income in the year of the distribution.
and
• Whether you are repaying distributions. Any repayments made before you file your return and
by the due date (including extensions) reduce the amount
When and Where To File of the distribution included in your income.
File your Form 8915-F with your Form 1040, 1040-SR, or Also, qualified disaster distributions aren't subject to
1040-NR for the year checked in item A at the top of the additional 10% tax (or the 25% additional tax for
page 1 of your Form 8915-F. For example, you will file certain distributions from SIMPLE IRAs) on early
your 2023 Form 8915-F (2021 disasters) with your 2023 distributions.
Form 1040, 1040-SR, or 1040-NR.
The timing of your distributions and repayments will If a taxpayer who spread the income from a
determine whether you need to file an amended return to ! qualified disaster distribution over 3 years dies
claim them. To determine whether you need to amend CAUTION before the last tax year of that 3-year period, the
your Form 8915-F, see Amending Form 8915-F, later. distribution may no longer be spread over 3 years. The
remainder of the distribution must be reported on the
What Is a Qualified Disaster return of the deceased taxpayer. Include the remainder in
the line 13 and/or line 24 totals, as applicable, of the Form
Distribution? 8915-F for the year of their last tax return.
The distributions that are a qualified disaster distributions
for tax years 2021 or later follow. Qualified Disaster Distribution Requirements
For 2021, qualified disaster distributions are:
• The qualified 2019 disaster distributions for the Puerto A coronavirus-related distribution can't be made
Rico Earthquakes (DR-4473-PR) reported on 2021 Form ! after 2020. See Qualified disaster distribution
8915-D, CAUTION period, later, to figure when your qualified disaster
• The qualified 2020 disaster distributions for qualified distribution can be made. Also, a distribution is not a
2020 disasters reported on 2021 Form 8915-F (2020 qualified disaster distribution if it is listed in Distributions
disasters), and that are not qualified disaster distributions, later. See
• The qualified 2021 disaster distributions for qualified Limit, later, for the dollar limit on qualified disaster
2021 disasters reported on 2021 Form 8915-F (2021 distributions.
disasters).
Qualified disaster distribution requirements.
For 2022, qualified disaster distributions are: Qualified disaster distributions must meet the following
• The qualified 2021 disaster distributions for qualified criteria. (Coronavirus-related distributions can't be made
2021 disasters reported on 2022 Form 8915-F (2021 in 2021 or later years.) You must meet these requirements
disasters), or separately for each of your disasters that you are
• The qualified 2022 disaster distributions for qualified reporting on Form 8915-F.
2022 disasters reported on 2022 Form 8915-F (2022 1. The distribution was made:
disasters). For 2020 disasters (other than the coronavirus), no later
•
For 2023, qualified disaster distributions are: than June 24, 2021; or
• The qualified 2021 disaster distributions for qualified • For 2021 and later disasters, within the disaster's
2020 disasters reported on 2023 Form 8915-F (2021 qualified disaster distribution period. See Qualified
disasters), disaster distribution period, later.
• The qualified 2022 disaster distributions for qualified 2. Your main home was located in a qualified disaster
2022 disasters reported on 2023 Form 8915-F (2022 area at any time during the disaster period shown for that
disasters), and area. See Main home, later. The qualified disaster area is
• The qualified 2023 disaster distributions for qualified the state, territory, or tribal government in which the
2023 disasters reported on 2023 Form 8915-F (2023 disaster occurs.
disasters).
3. You sustained an economic loss because of the
Qualified disaster distributions for 2024 and later years disaster(s) in (2) above. Examples of an economic loss
are the distributions reported, like those for other years, in include, but aren't limited to, (a) loss, damage to, or
Part I of a Form 8915-F for the year because they meet destruction of real or personal property from fire, flooding,
the criteria in the next section. In all cases, the year looting, vandalism, theft, wind, or other cause; (b) loss
checked in item B of your Form 8915-F is the year in related to displacement from your home; or (c) loss of
which the disaster began. There are always qualified livelihood due to temporary or permanent layoffs.
disaster distributions that can be made for a disaster in
the year the disaster began and, for certain disasters, in If (1) through (3) apply, you can generally designate
the year or 2 after the disaster began. any distribution (including periodic payments and required
minimum distributions) from an eligible retirement plan as
Qualified Disaster Distribution a qualified disaster distribution, regardless of whether the
distribution was made on account of a qualified disaster.
How Is a Qualified Disaster Distribution Taxed? Qualified disaster distributions are permitted without
Generally, a qualified disaster distribution is included in regard to your need or the actual amount of your
your income in equal amounts over 3 years. However, if economic loss. See Eligible retirement plan, later, for the

Instructions for Form 8915-F (Rev. 1-2023) -3-

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list of plans from which qualified disaster distributions can distributions can be made for this disaster through June
be made. 27, 2023, even though this is a 2022 disaster. June 27,
A reduction or offset of your account balance in an 2023, is exactly 179 days after December 30, 2022.
eligible retirement plan (other than an IRA) in order to Example 3. Sam was eligible for qualified 2023
repay a loan can also be designated as a qualified disaster distributions for the Georgia Severe Weather
disaster distribution. See Distribution of plan loan offsets, disaster (DR-4685-GA) (beginning date January 12, 2023)
later. (declaration date January 16, 2023). Qualified disaster
Qualified disaster distribution period. As a result of distributions can be made for this disaster through July
the Secure 2.0 Act of 2022, enacted December 29, 2022, 14, 2023. July 14, 2023, is exactly 179 days after January
the period for making qualified disaster distributions for 16, 2023.
qualified disasters that begin after 2020 does not have a Distributions that are not qualified disaster distribu-
set ending date based on the year of the disaster, but tions. The following distributions are not qualified
must be separately calculated for each of your qualified disaster distributions.
disasters. The qualified disaster distribution period for a • Corrective distributions of elective deferrals and
qualified disaster will begin on the date the disaster employee contributions that are returned to the employee
begins and will end 179 days after whichever of the (together with the income allocable thereto) in order to
following occurs the latest. comply with the section 415 limitations.
• Disaster beginning date. • Excess elective deferrals under section 402(g), excess
• Disaster declaration date. contributions under section 401(k), and excess aggregate
• December 29, 2022. contributions under section 401(m).
You will need to calculate the qualified disaster • Loans that are treated as deemed distributions
distribution ending date for your disaster in order to pursuant to section 72(p).
determine whether your distributions are qualified disaster • Dividends paid on applicable employer securities under
distributions. section 404(k).
All 2020 disasters. For 2020 disasters, these • The cost of current life insurance protection.
instructions replace Form 8915-E for 2021 and later tax • Prohibited allocations that are treated as deemed
years. The distribution period for all qualified 2020 distributions pursuant to section 409(p).
disasters (other than coronavirus-related distributions) • Distributions that are permissible withdrawals from an
ended on June 24, 2021. The distribution period for eligible automatic contribution arrangement within the
coronavirus-related distributions ended December 30, meaning of section 414(w).
2020. • Distributions of premiums for accident or health
Most, but not all, 2021 and 2022 disasters. If your insurance under Treasury Regulations section
disaster began in 2021 (or 2022 on or before December 1.402(a)-1(e)(1)(i).
30, 2022) and your disaster was declared as a major Limit. For each qualified 2020 disaster, the total of your
disaster on or before December 29, 2022, then the period qualified disaster distributions from all plans is limited to
for making qualified disaster distributions for that disaster $100,000. For each qualified 2021 or later disaster, the
will end on June 26, 2023. June 26, 2023, is exactly 179 total of your qualified disaster distributions from all plans is
days after December 29, 2022. limited to $22,000. You may allocate the amount among
Example. Mosley was eligible for qualified 2022 the plans by any reasonable method when determining
disaster distributions for the following 2022 disaster. the amounts on lines 2, 3, and 4 of column (b) if all three
Disaster: Virginia Severe Winter Storm and Snowstorm of the following apply.
disaster (DR-4644-VA) (beginning date January 2, 2022). 1. You are not using Worksheet 1B.
Qualified disaster distributions can be made through June
2. You have distributions from more than one type of
26, 2023, for that disaster.
plan, such as a 401(k) plan and an IRA.
All other disasters, including some 2022 disasters.
For all other disasters, the qualified disaster distribution 3. The total on line 5, column (a), of your Form 8915-F
period will end 179 days after the disaster beginning date exceeds your total available qualified disaster distribution
or the disaster declaration date, whichever is later. amount from line 1e of your Form 8915-F.
Example 1. Mosley was eligible for qualified 2022 Distribution of plan loan offsets. A distribution of a
disaster distributions for the Washington Severe Winter plan loan offset is a distribution that occurs when, under
Storm, Straight-line Winds, Flooding, Landslides, and the terms of a plan, the participant’s accrued benefit is
Mudslides disaster (DR-4682-WA) (beginning date reduced (offset) in order to repay a loan. A distribution of a
November 3, 2022) (declaration date January 12, 2023). plan loan offset amount can occur for a variety of reasons,
Qualified disaster distributions can be made for this such as when a participant terminates employment or
disaster through July 10, 2023, even though this is a 2022 doesn’t comply with the terms of repayment. Plan loan
disaster. July 10, 2023, is exactly 179 days after January offsets are treated as actual distributions and are reported
12, 2023. in box 1 of Form 1099-R.
Example 2. Alex was eligible for qualified 2022 Main home. Generally, your main home is the home
disaster distributions for the Havasupai Tribe Flooding where you live most of the time. A temporary absence due
Event disaster (DR-4681) (beginning date Oct 1, 2022) to special circumstances, such as illness, education,
(declaration date December 30, 2022). Qualified disaster

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business, military service, evacuation, or vacation, won’t to the additional tax. See the Instructions for Form 5329
change your main home. on how to figure the additional tax on your distributions.

Qualified disaster area. For qualified 2020 disasters, Note. If you choose to treat a distribution as a qualified
the list of qualified disaster areas is in Appendix B in the disaster distribution, it is not eligible for the 20% capital
Instructions for Form 8915-F (Rev. February 2022). For gain election or the 10-year tax option. For information on
qualified 2021 and later disasters, the qualified disaster those options, see the instructions for Form 4972.
area is the state, territory, or tribal government in which a
qualified disaster, described next, occurred. Repayment of a Qualified Disaster Distribution
Qualified disaster. A qualified disaster is a disaster If you choose, you can generally repay any portion of a
that the President has declared as a major disaster. It is qualified disaster distribution that is eligible for tax-free
also know as a federally declared major disaster. The rollover treatment to an eligible retirement plan. Also, you
FEMA numbers for these major disasters include the can repay a qualified disaster distribution made on
letters "DR" in capital letters. To determine whether the account of hardship from a retirement plan. However, see
President has declared a disaster as a major disaster, go Exceptions, later, for qualified disaster distributions you
to FEMA.gov/disaster/declarations. On that page, make can’t repay.
the four selections below and then click the Search and
Filter Disasters box. The Declared Disasters table in these Your repayment can't be made any earlier than the day
instructions displays how that FEMA page appears. after the date you received the qualified disaster
1. In the State/Tribe box, select the state, territory, or distribution. You have 3 years from the day after the date
tribal government in which your disaster occurred. you received the distribution to make a repayment. The
amount of your repayment cannot be more than the
2. In the Year(s) box, select the year in which your amount of the original distribution. Amounts that are
disaster began (and the 2 years after that to the extent repaid are treated as a trustee-to-trustee transfer and are
available). not included in income. Also, for purposes of the
3. In the Declaration Type box, select Major Disaster one-rollover-per-year limitation for IRAs, a repayment to
Declaration. an IRA is not considered a rollover.
4. In the Incident Type box, select Any, or the type of Include on this year's Form 8915-F any repayments
disaster if you want to be more specific. you made before filing this year's return. Any repayments
If your disaster is among the results for that search, place you made will reduce the amount of qualified disaster
the FEMA number for your qualified disaster in item C on distributions reported on this year's return. Do not include
page 1 of your Form 8915-F, and in the table at the top of on this year's Form 8915-F any repayments you made
Part I and the table at the top of Part IV, as applicable. If later than the due date (including extensions) for filing this
your disaster is not among the results, your disaster is not year's return. However, you may report those repayments
a qualified disaster and you can't include that disaster on on next year's return or carry the repayments back to this
a Form 8915-F. on an earlier year as applicable. See Carrybacks under
Amending Form 8915-F, later.
Declared Disasters Example 1. In 2021, Rudy made a qualified 2021
disaster distribution from their traditional IRA. Rudy did
not check the box on line 22, choosing instead to spread
the income from the distribution over 3 years (2021, 2022,
State/Tribe Year(s)
and 2023). Rudy didn't repay any portion of the
–Any– ▲ 2023 x 2022 x 2021 x ▲ distribution until 2023 when Rudy made a repayment of
▼ 2020 x 2019 x ▼ that distribution before timely filing their 2022 return. Rudy
TIP: Add years to broaden search. includes those repayments on their 2022 Form 8915-F
(2021 disasters). Those repayments reduced the amount
Declaration Type Incident Type of qualified 2021 disaster distributions reported on Rudy's
–Any– ▲ –Any– ▲ return for 2022 and any excess may be carried back to
2021 on an amended 2021 Form 8915-F or forward to
▼ ▼ 2023.
Example 2. The facts are the same as in Example 1,
Search and Filter except Rudy made the repayments in 2023, after the due
Disasters date (including extensions) of their 2022 return. Rudy
cannot include those repayments on their 2022 Form
8915-F (2021 disasters). The repayments will reduce the
amount of their qualified 2021 disaster distributions made
The Additional Tax and Qualified Disaster for 2023 and included in income on their 2023 return and
Distributions any excess may be carried back on an amended 2021 or
Qualified disaster distributions aren’t subject to the 2022 Form 8915-F to reduce income on their 2021 or
additional 10% tax (or the 25% additional tax for certain 2022 return.
distributions from SIMPLE IRAs) on early distributions and Eligible retirement plan. An eligible retirement plan
aren’t required to be reported on Form 5329. However, can be any of the following.
the amount on line 7 of your Form 8915-F may be subject

Instructions for Form 8915-F (Rev. 1-2023) -5-

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• A qualified pension, profit-sharing, or stock bonus plan annuity contract, or a qualified first-time homebuyer
(including a 401(k) plan). distribution from an IRA.
• A qualified annuity plan. 3. The distribution was received on January 1, 2021.
• A tax-sheltered annuity contract.
4. The distribution was to be used to purchase or
• A governmental section 457 deferred compensation
construct a main home in Alaska and the main home was
plan.
not purchased or constructed because of the disaster.
• A traditional, SEP, SIMPLE, or Roth IRA.
See Main home, earlier. The disaster area is the state,
Exceptions. You cannot repay the following types of
territory, or tribal government in which the disaster occurs.
distributions.
1. Qualified disaster distributions received as a Qualified 2021 and later disaster areas. A qualified
beneficiary (other than a surviving spouse). distribution for the purchase or construction of a main
2. Required minimum distributions. home in a qualified 2021 or later disaster area must meet
all of the following requirements. See Main home and
3. Any distribution (other than from an IRA) that is one
Qualified disaster area, earlier.
of a series of substantially equal periodic payments made
(at least annually) for: 1. For qualified 2021 disasters, the first day of the
disaster can be no earlier than January 26, 2021. For
a. A period of 10 years or more, disasters with beginning dates after 2021, there is no
b. Your life or life expectancy, or restriction on when the disaster must begin.
c. The joint lives or joint life expectancies of you and 2. The distribution was a hardship distribution from a
your beneficiary. 401(k) plan, a hardship distribution from a tax-sheltered
annuity contract, or a qualified first-time homebuyer
Qualified Distribution for the distribution from an IRA.
Purchase or Construction of a Main 3. The distribution was received no more than 180
days before the first day of the disaster and no later than
Home in Qualified Disaster Areas 30 days after the last day of the disaster.
How Is a Qualified Distribution Taxed? 4. The distribution was to be used to purchase or
A qualified distribution is included in your income in the construct a main home in the disaster's qualified disaster
year of the distribution. Any repayments made before you area and the main home must not have been purchased
timely file your return for that year (including extensions) or constructed because of the disaster. See Main home
reduce the amount of the distribution included in your and Qualified disaster area, earlier.

income on that return. Repayments made during the The Additional Tax and Qualified Distributions.
qualified distribution repayment period for the disaster, but Qualified distributions aren't subject to the additional 10%
after the year of the distribution, can be carried back to tax (or the 25% additional tax for certain distributions from
reduce the income from the distribution. Unlike with SIMPLE IRAs) on early distributions and aren't required to
qualified disaster distributions, the income can't be spread be reported on Form 5329. However, the amount on
over 3 years and the repayment period is much shorter line 32 of your Form 8915-F may be subject to the
than 3 years. See Qualified distribution repayment period, additional tax. See the Instructions for Form 5329 on how
later. to figure the additional tax on your distributions.
Also, qualified distributions aren't subject to the If the qualified distribution was received in 2020
additional 10% tax (or the 25% additional tax for certain ! for a 2021 disaster, see Amending Form 8915-F,
distributions from SIMPLE IRAs) on early distributions. CAUTION later.

Qualified Distribution Requirements
Repayment of a Qualified Distribution for the
Qualified 2020 disaster areas. The earliest tax year in Purchase or Construction of a Main Home
item A on Form 8915-F is 2021. Qualified distributions for
only one 2020 disaster can be made in 2021, the Alaska Qualified distribution repayment period. As a result of
Severe Storm, Flooding, Landslides, and Mudslides the Secure 2.0 Act of 2022, enacted December 29, 2022,
(4585-DR-AK). To be a qualified distribution on 2021 the period for repaying a qualified distribution for a
Form 8915-F (2020 disasters) for the purchase or disaster that begins after 2020 does not have a set ending
construction of a main home in a qualified 2020 disaster date, but must be calculated. The qualified distribution
area, the distribution must meet all of the following period for each of those qualified disasters will begin on
requirements. the date the disaster begins and will end 180 days after
1. The disaster was the Alaska Severe Storm, whichever of the following occurs the latest.
Flooding, Landslides, and Mudslides (4585-DR-AK). • Disaster beginning date.
Leave 2021 Form 8915-F (2020 disasters), Part IV, blank • Disaster declaration date.
if your only qualified 2020 disaster was any other 2020 • December 29, 2022.
disaster (including the coronavirus). The last day of the repayment period for 2020 and later
2. The distribution is a hardship distribution from a disasters is below.
401(k) plan, a hardship distribution from a tax-sheltered 2020 disasters. The repayment period for a qualified
distribution for the Alaska Severe Storm, Flooding,

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Landslides, and Mudslides (4585-DR-AK) disaster on                 1. The distribution (or any portion thereof) is not repaid 
January 1, 2021, to purchase or construct a main home in           on or before the last day of the qualified distribution 
Alaska ended on June 25, 2021.                                     repayment period for the disaster.
Most, but not all, 2021 and 2022 disasters.       If your          2. The distribution can otherwise be treated as a 
disaster began in 2021 or 2022 (on or before December              qualified disaster distribution. See Qualified disaster 
30, 2022) and your disaster was declared as a major                distribution requirements, earlier.
disaster on or before December 29, 2022, then the period 
for repaying qualified distributions for that disaster will end    Amending Form 8915-F
on June 27, 2023. June 27, 2023, is exactly 180 days               File Form 1040-X, Amended U.S. Individual Income Tax 
after December 29, 2022.                                           Return, to amend a return you have already filed. 
Example.      Taylor was eligible for qualified distributions      Generally, Form 1040-X must be filed for a credit or refund 
for the Virginia Severe Winter Storm and Snowstorm                 within 3 years after the date the original return was filed, or 
(DR-4644-VA) disaster (beginning date January 2, 2022).            within 2 years after the date the tax was paid, whichever is 
Taylor made a qualified distribution on December 5, 2021.          later.
Taylor has until June 27, 2023, to repay the qualified             Qualified disaster distributions.    Depending on when a 
distribution.                                                      repayment is made, you may need to file an amended tax 
All other disasters, including some 2022 disasters.                return to refigure your taxable income.
For all other disasters, the qualified distribution period will 
end 180 days after the disaster beginning date or the              Include on this year's Form 8915-F any timely 
disaster declaration date, whichever is later.                     repayments you made before filing this year's tax return. 
                                                                   Do not include on that Form 8915-F any repayments you 
Example 1.      Mosley was eligible for qualified                  made later than the due date (including extensions) for 
distributions for the Washington Severe Winter Storm,              filing that return.
Straight-line Winds, Flooding, Landslides, and Mudslides 
                                                                   If you make a timely repayment after timely filing this 
(DR-4682-WA) disaster (beginning date November 3, 
                                                                   year's tax return but by the due date of that return 
2022) (declaration date January 12, 2023). Qualified 
                                                                   (including extensions), include the repayment on an 
distributions can be repaid for this disaster through July 
                                                                   original or amended, as applicable, Form 8915-F for this 
11, 2023, even though this is a 2022 disaster. July 11, 
                                                                   year.
2023, is exactly 180 days after January 12, 2023.
                                                                   If you make a timely repayment after the due date of 
Example 2.      Alex was eligible for qualified                    this year's return (including extensions) but before the due 
distributions for the Havasupai Tribe Flooding Event               date of next year's return (including extensions), include 
(DR-4681) disaster (beginning date October 1, 2022)                the repayment on next year's Form 8915-F. However, you 
(declaration date December 30, 2022). Qualified                    may file a Form 1040-X amending this year's or an earlier 
distributions can be repaid for this disaster through June         year's Form 8915-F or a 2020 Form 8915-E, as 
28, 2023, even though this is a 2022 disaster. June 28,            applicable.
2023, is exactly 180 days after December 30, 2022.
                                                                   Example 1. You received a coronavirus-related 
Example 3.      Sam was eligible for qualified distributions       distribution in the amount of $9,000 on November 19, 
for the Georgia Severe Weather (DR-4685-GA) disaster               2020. You choose to spread the $9,000 over 3 years 
(beginning date January 12, 2023) (declaration date                ($3,000 in income for 2020, 2021, and 2022). On 
January 16, 2023). Qualified distributions can be repaid           November 6, 2023, you make a repayment of $4,500. For 
for this disaster through July 15, 2023. July 15, 2023, is         2023, all of the $4,500 is an excess repayment. You carry 
exactly 180 days after January 16, 2023.                           back $3,000 to 2022. The remaining excess repayment of 
Qualified disaster areas. You can choose to repay your             $1,500 ($4,500 − $3,000) can be carried back to 2021. 
qualified distribution to an eligible retirement plan at any       Also, instead of carrying that portion of the excess 
time during the qualified disaster repayment period for the        repayment back to 2021, you can choose to carry it back 
disaster. See Eligible retirement plan and Qualified               to 2020.
distribution repayment period, earlier. Amounts that are           Example 2.         You received a qualified 2020 disaster 
repaid, during the qualified distribution repayment period         distribution in the amount of $90,000 in 2021. You elected 
for the disaster are treated as a trustee-to-trustee transfer      to have the full income from the distribution recognized in 
and are not included in income. For purposes of the                2021. On November 6, 2023, you make a repayment of 
one-rollover-per-year limitation for IRAs, a repayment to          $45,000. The entire $45,000 is carried back to 2021.
an IRA is not considered a rollover.
                                                                   Example 3. You received a qualified 2021 disaster 
If the qualified distribution (or any portion thereof) is not      distribution in the amount of $90,000 in December 2022. 
repaid on or before the last day of the qualified distribution     You choose to spread the $90,000 over 3 years ($30,000 
repayment period for the disaster, it may be taxable and           in income for 2022, 2023, and 2024). On November 6, 
may be subject to the additional 10% tax (or the additional        2024, you make a repayment of $45,000. For 2024, none 
25% tax for certain SIMPLE IRAs) on early distributions.           of the qualified 2021 disaster distribution is included in 
See the Instructions for Form 5329 to figure any tax.              income. The excess repayment of $15,000 ($45,000 − 
You may be able to designate a qualified distribution for          $30,000) can be carried back to 2023 or 2022.
a disaster as a qualified disaster distribution if all of the 
following apply.

Instructions for Form 8915-F (Rev. 1-2023)                      -7-

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Carrybacks. Follow Step 1 and Step 2 below when 2022 disaster distribution from your 401(k) plan in the
carrying back amounts. These steps are followed by amount of $75,000 on April 29, 2023. On your 2023 Form
examples. 8915-F, you elected to recognize the income from the full
Step 1. Determine the line(s) to use. If the original $75,000 in 2023, checking the check box on line 11 of that
distribution was not an IRA distribution and you are form. You filed your 2023 tax return on April 10, 2024. You
carrying an excess repayment back to: made a repayment of $65,000 on April 29, 2024. You
• 2020, include the carried back amount on 2020 Form report the full $65,000 of the repayment on your 2024
8915-E, line 10; Form 8915-F (2022 disasters). It is all excess repayment,
• 2021 or later, include the carried back amount on the as you have no income from the distribution for that year.
Form 8915-F, line 14 of the Form 8915-F back to which You carry back the full $65,000 to 2023 Form 8915-F
you are carrying the excess payment. (2022 disasters), line 14. On the dotted line to the left of
2023 Form 8915-F (2022 disasters), line 14, you write
If the original distribution was an IRA distribution and "$65,000 excess repayment from 2024 Form 8915-F
you are carrying an excess repayment back to: (2022 disasters)."
• 2020, include the carried back amount on 2020 Form
8915-E, line 18; Qualified distributions for qualified 2021 and later
• 2021 or later, include the carried back amount on the disasters. You may reduce the amount of a qualified
Form 8915-F, line 25 of the Form 8915-F back to which distribution included in income for a qualified disaster by
you are carrying the excess payment. the amount of a repayment made during the qualified
Step 2. Add this sentence. Write "$_______ distribution repayment period. (See Part IV—Qualified
carryback from [enter here the year the excess carryback Distributions for the Purchase or Construction of a Main
occurred] Form 8915-[E or F, as applicable]" on the dotted Home in Qualified Disaster Areas, later, for details on
line to the left of the line on which you are including the qualified distributions for qualified 2021 and later
carried back amount. disasters.)
Qualified distributions received in 2020 for
Example 1. On your 2020 Form 8915-E, you reported
qualified 2021 disasters. If, in 2020, you received a
a coronavirus-related distribution of $9,000 made to you
qualified distribution for a qualified 2021 disaster, you may
from your traditional IRA on April 14, 2020. You spread
reduce the amount of a qualified distribution included in
the income over 3 years ($3,000 in each of 2020, 2021,
income in 2020 by the amount of a repayment made
and 2022). You made no repayments of the distribution in
before June 28, 2023. (See Part IV—Qualified
2020 or 2021. In 2022, you made a repayment of $4,500.
Distributions for the Purchase or Construction of a Main
You will report $3,000 of the repayment on your 2022
Home in Qualified Disaster Areas, later, for details on
Form 8915-F (2020 disasters). The excess repayment of
2020 qualified distributions for qualified 2021 disasters.)
$1,500 can be carried back to 2021 and reported on your
Because a qualified distribution can be received up to 180
2021 Form 8915-F (2020 disasters), line 25, or carried
days before the disaster began and repayments for that
back to 2020 and reported on your 2020 Form 8915-E,
distribution can be made from the beginning date of the
line 18. On the dotted line to the left of your 2021 Form
disaster and up to June 27, 2023, you may have a
8915-F (2020 disasters), line 25, or your 2020 Form
qualified distribution received in 2020 for which you are
8915-E, line 18, whichever is applicable, you write
making repayments in 2021, 2022, or 2023. If you have
"$1,500 excess repayment from 2022 Form 8915-F (2020
already filed your 2020 return on which you reported the
disasters)."
distribution, you should file an amended 2020 return to
Example 2. You suffered economic losses in 2022 as report the repayment. On your amended return (Form
the result of DR-4649-PR. Your main home was in Puerto 1040-X), you will enter 2020 as the calendar year or the
Rico when that disaster occurred. You received a qualified 2020 fiscal year at the top of page 1 and enter, in
2022 disaster distribution from your traditional IRA in the parentheses in column B of line 1, the amount of the
amount of $75,000 on April 29, 2022 spreading the repayment. In the Explanation of Changes section enter:
income over 3 years (2022, 2023, and 2024). You filed "The amount I reported on [2020 Form 1040 or 1040-NR,
your 2023 tax return on April 10, 2024. You made a line 4b, as applicable] is being reduced by a contribution
repayment of $65,000 on April 29, 2024. You report made [mm/dd/2021, 2022, or 2023] to an eligible
$25,000 of the repayment on your 2024 Form 8915-F retirement plan in repayment of a qualified distribution
(2022 disasters). You report the excess repayment of made [mm/dd/2020] under section 331(b) of the Secure
$40,000 as follows. You carry back $25,000 to 2023 Form 2.0 Act of 2022. The disaster was the [name of the
8915-F (2022 disasters), line 25, and $15,000 back to qualified 2021 disaster from FEMA.gov/disaster/
2022 Form 8915-F (2022 disasters), line 25. On the declarations.] " Use the full name of the disaster. Include
dotted line to the left of line 25 of your: the state, territory, or tribal government and the FEMA DR
• 2023 Form 8915-F (2022 disasters), you write "$25,000 number from FEMA.gov/disaster/declarations.
excess repayment from 2024 Form 8915-F (2022
Example. You received a distribution from a traditional
disasters)."; and
IRA on December 14, 2020, to construct a home in the
• 2022 Form 8915-F (2022 disasters), you write "$15,000
Mississippi Severe Winter Storms (DR-4598-MS) disaster
excess repayment from 2024 Form 8915-F (2022
area which you did not construct because of that disaster.
disasters)."
The disaster began February 11, 2021, and the
Example 3. You suffered economic losses in 2022 as distribution now qualifies as a qualified distribution. On
the result of DR-4649-PR. Your main home was in Puerto April 14, 2022, you made a contribution that qualifies as a
Rico when that disaster occurred. You received a qualified

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repayment of the distribution. You have already filed your • Worksheet 2 in Part II.
2020 return, a Form 1040. You will need to file a Form • Worksheet 3 in Part II.
1040-X for 2020 to claim the repayment. On your Form • Worksheet 4 in Part III.
1040-X, you enter "2020" on the line for the calendar year • Worksheet 5 in Part III.
at the top of page 1 because you are a calendar year filer Complete each worksheet on the last pages of these
and, in parentheses in column B of line 1, you enter the instructions that you use in determining amounts on your
amount of the repayment. In the Explanation of Changes Form 8915-F. In the spaces provided at the top of each
section of your amended return, enter "The amount I worksheet you complete, be sure to enter your name and
reported on 2020 Form 1040, line 4b, is being reduced by social security number as they appear on your Form
a contribution made 04/14/2022 to an eligible retirement 8915-F. Attach your completed worksheet(s) to the back
plan in repayment of a qualified distribution made of your Form 8915-F.
12/14/2020 under section 331(b) of the Secure 2.0 Act of
2022. The disaster was the Mississippi Severe Winter Required General Information
Storms (DR-4598-MS) disaster." Item A. Check the box that describes the tax year of the
Other qualified distributions received for qualified return to which you will be attaching your Form 8915-F.
2021 disasters and qualified distributions received You can only check one box in item A. If the tax year of
for qualified 2022 and later disasters. Because a the return to which you are attaching your Form 8915-F is
qualified distribution can be received up to 180 days 2023, check the "2023" box in item A on your Form
before the disaster began, you may have a qualified 8915-F.
distribution received in the year before the disaster began.
If that happens, you will use a Form 8915-F on which the Item B. Check the box that describes the calendar year
year in which the tax year of the qualified distribution was in which the disaster(s) for which you are reporting
made is checked in item A, and the year in which the distributions on your Form 8915-F began. You can only
disaster began is checked in item B. If you need to report check one box in item B. The disasters for which you are
repayments of the distribution, you will not need to follow reporting distributions, repayments, and/or income on
the special steps in Qualified distributions received in your Form 8915-F must have all started in the same
2020 for qualified 2021 disasters, earlier, to file an calendar year. If the disasters all started in 2023, check
amended return. However, you will need to make the the box for "2023" in item B of your Form 8915-F.
repayments during the qualified distribution repayment Item C. Enter the FEMA DR number from Major
period for the disaster. See Repayment of a Qualified Disasters Declarations at FEMA.gov/disaster/
Distribution for the Purchase or Construction of a Main declarations. See Qualified disaster, earlier, for details.
Home in Qualified Disaster Areas, earlier. For example, for the 2021 Louisiana Hurricane Ida
Form 1040-NR. If you are amending a Form 1040-NR, disaster, you would enter DR-4611-LA.
see the Instructions for Form 1040-X for which portions of
Do not enter the coronavirus in item C.
Form 1040-X you will need to complete.
CAUTION!

Specific Instructions Item D. Check the box in item D if the coronavirus is a
Married filers. If both you and your spouse are required disaster you are reporting on your Form 8915-F.
to file Form 8915-F, file a separate Form 8915-F for each
of you. If you and your spouse are both filing Forms Part I—Total Distributions From All
8915-F, the $22,000 limits on qualified 2021 and later Retirement Plans (Including IRAs)
disaster distributions and the elections on lines 11 and 22
to include all qualified disaster distributions in income Coronavirus-related distributions. You can only report
(and not spread them over 3 years) are determined qualified disaster distributions for disasters listed in item
separately for each spouse. Similarly, if you and your C. Coronavirus-related distributions can’t be made after
spouse are both filing Forms 8915-F, the $100,000 limits December 30, 2020.
on qualified 2020 disaster distributions made in 2021 and Part I disasters. List in the table at the top of Part I all the
the elections on lines 11 and 22 to include all those qualified disasters in item C for which qualified disaster
qualified disaster distributions in income (and not spread distributions have been made to you this year. Only those
them over 3 years) are determined separately for each disasters and those distributions can be considered in
spouse. Part I.
Name and social security number (SSN). If you file a List of disasters. If you are reporting no more than two
joint return, enter only the name and SSN of the spouse disasters, list the FEMA number, the disaster declaration
whose information is being reported on that Form 8915-F. date, and the disaster beginning date for each disaster in
Attach your completed worksheets. There are a total the spaces provided under the Part I header. If you have
of 7, applicable worksheets in these instructions. Blank more than two disasters, attach to the back of your Form
worksheets are in Appendix B, Worksheets, at the end of 8915-F a statement with your name and SSN, and, for
these instructions. each disaster, the FEMA number, the disaster declaration
• Worksheet 1A-1 in Part I. date, and the disaster beginning date.
• Worksheet 1A-2 in Part I.
• Worksheet 1B in Part I.

Instructions for Form 8915-F (Rev. 1-2023) -9-

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If you are using Worksheet 1B, leave lines 1a you in prior year(s) for all disasters in the table at the top
! through 1e blank and complete lines 2 through 5 of Part I.
CAUTION as that worksheet directs. See Worksheet 1B.
Line 1d. If you are required to complete line 1d, complete
line 1d as follows.
Lines 1a through 1d. You may not need to complete
lines 1a through 1d. See Form 8915-F, line 1; also see • Count the disasters reported in the table at the top of
Part I on your 2021 Form 8915-F (2020 disasters) that
When to leave lines 1a through 1d blank next.
were not reported on your 2020 Form 8915-E. Enter, on
When to leave lines 1a through 1d blank. Leave
line 1d, the product of that number and $100,000.
lines 1a through 1d blank on your 2021 Form 8915-F
• For 2021 and later disasters, count the disasters
(2020 disasters) if either you didn’t file 2020 Form 8915-E
reported in the table at the top of Part I of this year's Form
or the only disaster you reported on 2020 Form 8915-E
8915-F that were not reported on an earlier Form 8915-F.
was the coronavirus. Leave lines 1a through 1d blank on
Enter, on line 1d, the product of that number and $22,000.
other Forms 8915-F if you listed only one disaster in the
table at the top of Part I and a prior year's Form 8915-F Line 1e. Complete line 1e as follows.
doesn'tt list that disaster in item C. Also leave lines 1a • If you have been instructed above to leave lines 1a
through 1d blank if you are using Worksheet 1B. through 1d blank, enter on line 1e the product of $22,000
Otherwise, enter amounts on lines 1a through 1d as ($100,000 if you checked 2020 in item B on Form 8915-F)
indicated later. For example, you would leave lines 1a times the number of disasters you reported in the table at
through 1d blank when you have checked the same year the top of Part I of this year’s Form 8915-F.
in item A and item B. • Otherwise, enter the sum of lines 1c and 1d on line 1e.
Example. You checked the 2023 checkbox in both Examples for lines 1a through 1e.
item A and item B of your 2023 Form 8915-F because Example 1. You had an economic loss as the result of
$20,000 in qualified disaster distributions were made to Remnants of Tropical Storm Fred (DR-4625-NY)
you in 2023. You will leave lines 1a through 1d blank, and (beginning August 18, 2021). Qualified disaster
enter $20,000 on line 1e of your Form 8915-F. distributions can be made through June 26, 2023, for that
Line 1a. If you are required to complete line 1a, disaster. In May of 2023, qualified disaster distributions
complete line 1a as follows. were made to you totalling $9,000 that you report on a
• For 2020 disasters, multiply $100,000 by the disasters 2023 Form 8915-F (2021 disasters). Earlier, in January of
reported on your 2020 Form 8915-E that you are reporting 2022, qualified disaster distributions were made to you
in the table at the top of Part I on your 2021 Form 8915-F totalling $10,000 that you report on a 2022 Form 8915-F
(2020 disasters). Enter that product on line 1a. (2021 disasters). On line 1a of your 2023 Form 8915-F
• For 2021 and later disasters: (2021 disasters), you enter $22,000. On line 1b, you enter
If you only list one disaster in the table at the top of $10,000. On line 1c, you enter $12,000 ($22,000 minus
Part I on this year's Form 8915-F and that disaster was $10,000). On line 1d, you enter -0- and on line 1e you
also reported in item C of a prior year's Form 8915-F, enter $12,000.
enter, on line 1a, $22,000. Example 2. You had an economic loss as the result of
If you list more that one disaster in the table at the top Remnants of Tropical Storm Fred (DR-4625-NY)
of Part I and all of your distributions for this year (beginning August 18, 2021) and Severe Winter Storm
occurred within the qualified disaster distribution and Snowstorm (DR-4694-NY) (beginning December 23,
period (see Qualified disaster distribution period, 2022). Qualified disaster distributions can be made from
earlier) for each of the disasters listed in the table at August 18, 2021, through June 26, 2023, for the first
the top of Part I, enter, on line 1a, $22,000 times the disaster and December 23, 2022, through September 10,
number of disasters you entered both in the table at 2023, for the second disaster. You had an economic loss
the top of Part and in item C on a prior year's Form as the result of each of these disasters. In April of 2023
8915-F. and May of 2023, a $8,000 and a $21,000 qualified
disaster distribution were made to you, respectively. The
Line 1b. If you are required to complete line 1b, complete distributions both occurred within the qualified disaster
line 1b as follows. distribution period of each disaster and, therefore, could
• For 2020 disasters, enter, on line 1b, the amount on be qualified disaster distributions of either disaster.
2020 Form 8915-E, line 4, column (c), if you completed Earlier, in January of 2022, qualified disaster distributions
that line (otherwise from the amount on 2020 Form were made to you totalling $10,000 that you report on a
8915-E, line 4, column (b)) that reflects the distributions 2022 Form 8915-F (2021 disasters). You had listed one
for the disasters you reported on 2020 Form 8915-E that disaster, the Remnants of Tropical Storm Fred, as the
you are now reporting in the table at the top of Part I of disaster in the table at the top of Part I of your 2022 form.
your 2021 Form 8915-F (2020 disasters). If you used On line 1a of your 2023 Form 8915-F (2021 disasters),
Worksheet 2 in your 2020 Instructions for Form 8915-E, you enter $22,000 for DR-4625-NY. On line 1b, you enter
the amount for line 1b is figured by adding together the $10,000. On line 1c, you enter $12,000 ($22,000 minus
amounts in column (X), line 4, of that worksheet for the $10,000). On line 1d, you enter $22,000 for DR-4694-NY.
disasters you reported on 2020 Form 8915-E that you are On line 1e, you enter $34,000.
reporting in item C of your 2021 Form 8915-F (2020
disasters). Example 3. You had an economic loss as the result of
• For 2021 and later disasters, enter on line 1b, the Remnants of Tropical Storm Fred (DR-4625-NY)
amount the total qualified disaster distributions made to (beginning August 18, 2021). Qualified disaster

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distributions can be made through June 26, 2023, for that Are You Claiming Qualified Disaster
disaster. In May of 2023, qualified disaster distributions Distributions on Part I of more than one Form
were made to you totalling $9,000 that you report on a 8915 for this year?
2023 Form 8915-F (2021 disasters) listing the Remnants
of Tropical Storm Fred as your only disaster in the table at This section does not apply to you unless you are
the top of Part I. Earlier, in September of 2021, qualified ! completing Part I of Forms 8915-F having the
disaster distributions were made to you totalling $10,000 CAUTION same date checked in item A but different dates
that you report on a 2021 Form 8915-F (2021 disasters) checked in item B, or you are completing Part I of both a
again listing the Remnants of Tropical Storm Fred as your 2021 Form 8915-D and a 2021 Form 8915-F.
only disaster in the table at the top of Part I. On line 1a of Have you completed Part I of more than one Form
your 2023 Form 8915-F (2021 disasters), you enter 8915-F for this year? For example, you are completing a
$22,000. On line 1b, you enter $10,000. On line 1c, you 2022 Form 8915-F (2022 disasters) and a 2022 Form
enter $12,000 ($22,000 minus $10,000). On line 1d, you 8915-F (2021 disasters). The forms should be completed
enter -0- and, on line 1e, you enter $12,000. starting with the Form 8915-F for the oldest disasters and
Example 4. You've only had an economic loss as the ending with the Form 8915-F for the most recent
result of one qualified disaster: Remnants of Tropical disasters. Your available distributions for Part I of your 2nd
Storm Fred (DR-4625-NY) (beginning August 18, 2021). Form 8915-F for this year are the distributions left after
Qualified disaster distributions can be made through June completing Part I of the first Form 8915-F. If you are filing
26, 2023, for that disaster. In May of 2023, qualified three Forms 8915-F for this year, which could possibly
disaster distributions were made to you totalling $9,000 happen in 2023, your available distributions for your 3rd
that you report on a 2023 Form 8915-F (2021 disasters). Form 8915-F for this year are the distributions left after
You also made qualified disaster distributions in 2021 and completing Part I of the first two Forms 8915-F. See
2022 for this disaster. The qualified disaster distributions Line 7, later, for the amount to place on line 7 of your 1st
made to you for 2021 and 2022 for $5,000 and $2,000 are Form 8915-F (or your 1st and 2nd Form 8915-F if you are
on line 6 of your 2021 Form 8915-F (2021 disasters) and filing three Forms 8915-F for this year).
2022 Form 8915-F (2021 disasters), respectively. On
line 1a of your 2023 Form 8915-F (2021 disasters), you Are you completing Part I of both a 2021 Form 8915-D
enter $22,000. On line 1b, you enter $7,000 ($5,000 + and a 2021 Form 8915-F? If so, complete your forms in
$2,000). On line 1c, you enter $15,000 ($22,000 minus this order. First, complete 2021 Form 8915-D. Your
$7,000). On line 1d, you enter -0- and, on line 1e, you available distributions for your 2021 Form 8915-F (2020
enter $15,000. disasters) are the distributions left after completing Part I
of 2021 Form 8915-D. See Line 7, later, for the amount to
Column (a). Your available distributions for this year are place on line 7 of your 2021 Form 8915-F.
the distributions you received for a retirement plan
(including an IRA). See the Filled-in Worksheet 1A-1 and Worksheet 1A-2
Lines 2 through 4 in column (a). If you received a examples below for guidance. A blank Worksheet 1A-1
distribution from a retirement plan (including an IRA), you and Worksheet 1A-2 are at the end of the instructions
should receive a Form 1099-R. The amount of the under Appendix B, Worksheets.
distribution should be shown in box 1 of Form 1099-R. Example 1A-1. You suffered an economic loss as the
Enter the amounts from box 1 of all your Forms 1099-R on result of Remnants of Tropical Storm Fred (DR-4625-NY)
the lines 2 through 4 in column (a), as applicable. (beginning August 18, 2021) and Severe Winter Storm
and Snowstorm (DR-4694-NY) (beginning December 23,
Column (b). The disasters in item C that are relevant to
2022). Your main home was in New York during the
column (b) and to all of Part I are only the disasters you
disaster period for each disaster. Qualified disaster
listed in the table at the top of Part I .
distributions can be made from August 18, 2021, through
Lines 2 through 5 in column (b). If you are using June 26, 2023, for the first disaster and December 23,
Worksheet 1B follow the instructions for the worksheet 2022, through September 10, 2023, for the second
when completing these lines. disaster. No distributions were made until December 27,
The amounts entered on lines 2 through 5 in column (b) 2022, when a $40,000 qualified disaster distribution from
depend on whether the amount on line 5 in column (a) is your traditional IRA was made to you. The distribution
more than the amount on line 1e. The amount on line 5, occurred within the qualified disaster distribution period of
column (a), is the sum of lines 2 through 4 in column (a) each disaster and, therefore, could be a qualified disaster
reduced by the total distributions from lines 2 through 4 in distribution of either disaster. You are completing 2022
column (a) that aren’t qualified disaster distributions. Form 8915-F (2021 disasters) and 2022 Form 8915-F
• If the amount on line 5 in column (a) is equal to or less (2022 disasters). You must complete your Form 8915-F
than the amount on line 1e, enter the amounts on lines 2 reporting the older disasters first: 2022 Form 8915-F
through 5 in column (a) on lines 2 through 5 in column (b). (2021 disasters). You report $22,000 from the distribution
• If the amount on line 5 in column (a) is more than the as a qualified 2021 disaster distribution on 2022 Form
amount on line 1e, enter on lines 2 through 4 in column (b) 8915-F (2021 disasters). You report the remaining
the amounts on line 5 in column (a) adjusted by any $18,000 from the distribution as qualified 2020 disaster
reasonable means so that their sum on line 5 in column distributions in the 2022 Form 8915-F (2022 disasters)
(b) equals the amount on line 1e. portion of your Filled-in Worksheet 1A-1 for
Example 1A-1. On lines 2 through 4 of column (a) in Part I
of your 2022 Form 8915-F (2022 disasters), you enter the

Instructions for Form 8915-F (Rev. 1-2023) -11-

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Filled-in Worksheet 1A-1. Example 1A-1 for column (a).
(a) (b) (c)
First Form 8915-F Total distributions in this Qualified disaster distributions Allocation of column (b)
year
2 Distributions from retirement plans (other than
IRAs) made in this year -0- -0- -0-
3 Distributions from traditional, SEP, and SIMPLE
IRAs made in this year $40,000 $22,000 -0-
4 Distributions from Roth IRAs made this year -0- -0- -0-

(a)
Second Form 8915-F
Available distributions for this year
2 Enter, in column (a), distributions from retirement plans -0-
(other than IRAs) made this year.
3 Enter, in column (a), distributions from traditional, SEP, and $18,000
SIMPLE IRAs made this year.
4 Enter, in column (a), distributions from Roth IRAs made this -0-
year.

Filled-in Worksheet 1A-2. Example 1A-2 for column (a).
(a) (b) (c)
Form 8915-D Qualified 2019 disaster Allocation of column (b)
Total distributions in 2021 distributions
2 Distributions from retirement plans (other than
IRAs) made in 2021 -0- -0- -0-
3 Distributions from traditional, SEP, and SIMPLE
IRAs made in 2021 $140,000 $100,000 -0-
4 Distributions from Roth IRAs made in 2021 -0- -0- -0-

(a)
Form 8915-F (2020 disasters)
Available distributions for this year
2 Enter, in column (a), distributions from retirement plans -0-
(other than IRAs) made this year.
3 Enter, in column (a), distributions from traditional, SEP, and $40,000
SIMPLE IRAs made this year.
4 Enter, in column (a), distributions from Roth IRAs made this -0-
year.

amounts shown in column (a), lines 2 through 4, of 2022 Form 8915-D first. He reports $100,000 from the
Form 8915-F (2022 disasters) from your Filled-in distribution as a qualified 2019 disaster distribution on
Worksheet 1A-1 for Example 1A-1. Because the $18,000 Form 8915-D. He reports the remaining $40,000 from the
is being used on 2022 Form 8915-F (2022 disasters), it distribution as qualified 2020 disaster distributions in the
should not be counted on line 7 of your 2022 Form 8915-F 2021 Form 8915-F (2020 disasters) portion of his Filled-in
(2021 disasters) in determining the taxable amount of Worksheet 1A-2 for Example 1A-2. On lines 2 through 4 of
distributions on that form. column (a) in Part I of his 2021 Form 8915-F (2020
Example 1A-2. Arnell suffered economic losses as a disasters), Arnell enters the amounts shown in column (a),
result of the Puerto Rico Earthquakes (DR-4473-PR) lines 2 through 4, of 2021 Form 8915-F (2020 disasters)
disaster in 2019 and the Puerto Rico Hurricane Isaias from his Filled-in Worksheet 1A-2 for Example 1A-2.
(DR-4560-PR) disaster in 2020. His main home was in Because the $40,000 is being used on 2021 Form 8915-F
Puerto Rico during the disaster period for each disaster. (2020 disasters), it should not be counted on line 7 of his
These events were qualified 2019 and 2020 disasters, 2021 Form 8915-D in determining the taxable amount of
respectively. In 2021, he received a traditional IRA his distributions on that form.
distribution of $140,000. The distribution was made on The numbers on the left border of the Filled-in
May 26. He received no other distributions in 2019, 2020, TIP Worksheet are line numbers that correspond to
or 2021. He is completing 2021 Form 8915-D, and 2021 the lines on the indicated forms.
Form 8915-F (2020 disasters). He must complete his

-12- Instructions for Form 8915-F (Rev. 1-2023)

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Worksheet 1B 8915-F (2021 disasters) for Disaster 1. You complete
Worksheet 2. You apply the distributions up to the
If you use Worksheet 1B, you will leave lines 1a $22,000 limit against each available disaster. You apply
TIP through 1e of this year's Form 8915-F blank, but $2,000 of the April 30, 2022, distribution to Disaster 1 as
you will fill in the amounts for lines 2 through 4 in $20,000 of the $20,000 limit was used in 2021. You apply
column (a) on that form. $22,000 of the April 30 distribution to Disaster 2. In
column (b), lines 2 through 5, of your 2022 Form 8915-F
You can choose to use Worksheet 1B if your qualified (2022 disasters), you enter the amounts from lines 2
disasters began in 2021 or later years. However, you must through 5 of your filled-in Worksheet 1B, column (b). See
use Worksheet 1B to determine the amounts to place on Filled-in Worksheet 1B for Example 2.
lines 1 through 5 of this year's Form 8915-F if your Example 3. You have the same disasters as in
qualified disasters began in 2021 or later years unless: Example 1. You are filing 2021 Form 8915-F (2021
• You listed only one disaster in the table at the top of disasters). In 2021, two traditional IRA distributions were
Part I; or made to you: one on June 17 for $30,000 and one on
• All of the distributions for this year occurred within the September 17 for $14,000. You had no other distributions
qualified disaster distribution period (see Qualified in 2021. You complete Worksheet 2. You apply the
disaster distribution period, earlier) for each of the distribution up to the $22,000 limit against each available
disasters listed in the table at the top of Part I. disaster. You apply $22,000 of the June distribution to
Line 1a of Form 8915-F provides the instructions for those Disaster 1 and the entire $14,000 of the September
situations. distribution to Disaster 2. You can't apply any of the June
distribution to Disaster 2 as it was not made during the
In Worksheet 1B, column (a), enter your available qualified disaster distribution period for that disaster. In
distributions for this year for lines 2 through 4 from this column (b), lines 2 through 5, of your 2022 Form 8915-F
year's Form 8915-F. In Worksheet 2, column (X), start by (2021 disasters), you enter the amounts from lines 2
entering the amounts you are planning to claim as through 5 of your filled-in Worksheet 1B, column (b). See
qualified disaster distributions for each disaster listed in Filled-in Worksheet 1B for Example 2.
the table at the top of Part I on this year's Form 8915-F. A
distribution will not be a qualified disaster distribution for
this year unless the distribution is made within the
qualified disaster distribution period for a disaster listed in
the table at the top of Part I. Enter this year's distributions
for each qualified disaster, from the table at the top of Part
I, in a separate column. Your total qualified disaster
distributions for each disaster can't exceed $22,000. For
simplicity, apply your distributions in $22,000 amounts as
available to each available disaster, beginning with the
disaster with the earliest ending date for qualified disaster
distributions. Examples 1 through 3, later, provide
guidance. A blank Worksheet 1B is in Appendix B,
Worksheets, at the end of the instructions.
Example 1. You were eligible for qualified 2021
disaster distributions for the following disasters. Disaster
1: Louisiana Severe Storms, Tornadoes, and Flooding
(DR-4606-LA) (which began May 17, 2021). Disaster 2:
Louisiana Hurricane IDA (DR-4611-LA) (which began
August 26, 2021). Qualified disaster distributions can be
made from May 17, 2021, through June 26, 2023, for
Disaster 1 and August 26, 2021, through June 26, 2023,
for Disaster 2. In 2022, you received a traditional IRA
distribution of $30,000. The distribution was made on April
30. You had no distributions for 2021 and no other
distribution for 2022. You complete Worksheet 2. You
apply the distributions up to the $22,000 limit against each
available disaster. You apply $22,000 of the April 30
distribution to Disaster 1 and $8,000 of the April 30
distribution to Disaster 2. In column (b), lines 2 through 5,
of your 2022 Form 8915-F (2021 disasters), you enter the
amounts from lines 2 through 5 of your filled-in Worksheet
1B, column (b). See Filled-in Worksheet 1B for
Example 1.
Example 2. The facts are the same as in Example 1,
except you had a $20,000 qualified 2021 disaster
distribution from line 3, column (b), of your 2021 Form

Instructions for Form 8915-F (Rev. 1-2023) -13-

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Example 1 for Worksheet 1B: Use if you are directed on line 1a of your Form 8915-F to use Worksheet 1B or if 
you choose to use Worksheet 1B.
Worksheet 1B for Form 8915-F                                                                                                                                                                                                     (a)                    (X)                                       (b)
                                                                                                                                                                                                                                 Total      Qualified 2021 disaster distributions made in 20222 1 Qualified 2
                                                                                                                                                                                                                                 available                                                        2021   
                                                                                                                                                                                                                                                                                                  disaster 
                                                                                                                                                                                                                                 distributi                                                       distributions
                                                                                                                                                                                                                                 ons in 1                                                          made in 1
                                                                                                                                                                                                                                 _____                                                            2022
                                                                                                                                                                                                                                            Disaster  1 Disaster 2  Disaster 3 Disaster 4  (Total for all 
                                                                                                                                                                                                                                                      3 DR-4611-LA3 ________3  ________3          disasters)
                                                                                                                                                                                                                                            DR-4606-LA
                                                                                                                                                                                                                                            05/17/20214 08/26/20214 ________4  ________4
                                                                                                                                                                                                                                            06/26/20235 06/26/20235 ________5  ________5
     1 You do not need to use Worksheet 1B if you checked 
     2020 in item B of this year's Form 8915-F.
     • If you checked the same year in both item A and 
     item B on this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you did not enter in item C of a prior year's Form 
     8915-F any of the disasters listed in the table at the top 
     of Part I of this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you only entered one disaster in the table at the 
     top of Part I of this year's Form 8915-F and that was 
     the only disaster you listed in item C of the prior year's 
     Form 8915-F, enter the amount from line 6 of the prior 
     year's Form 8915-F.
     • For each Disaster listed in the table at the top of 
     Part I of this year's Form 8915-F that was not listed in 
     item C on a Form 8915-F for a prior year, enter -0- in 
     column (X).
     • If you listed two or more disasters in the table at the 
     top of Part I of this year's Form 8915-F and you filed a 
     Form 8915-F for a prior year on which you listed in 
     item C some or all of those disasters, enter in column 
     (X) the amounts from line 5 in column (X) of the prior 
     year's Worksheet 1B. If you did not use Worksheet 1B 
     in that prior year, allocate the amount from line 6 of 
     that prior year's Form 8915-F among the Disasters on 
     line 1 of this worksheet using any reasonable method, 
     except if all of the disasters listed on the prior year's 
     Form 8915-F are not listed on this year’s table at the 
     top of Part I. In the latter case, allocate the amount on 
     line 6 of that prior year's Form 8915-F first to the 
     disasters not listed in the table at the top of Part I of 
     this year's Form 8915-F, and allocate any remaining 
     amount among the Disasters on line 1 of this 
     Worksheet 1B using any reasonable method. 
      
     Note. If the amount on line 1 of this worksheet is 
     $22,000 or more for a disaster, you cannot have 
     qualified disaster distributions in this year for that 
     disaster. Remove that disaster from the list at the 
     top of Part I on page 1 of this year's Form 8915-F 
     and exclude it from your calculations for Part I of 
     this year's Form 8915-F.                                                                                                                                                                                                                  -0-      -0-                                              -0-
2    Distributions from retirement plans (other than IRAs)                                                                                                                                                                                     -0-      -0-                                              -0-
                                                                                                                                                                                                                                 $30,000
3    Distributions from traditional, SEP, and SIMPLE IRAs                                                                                                                                                                        04/22/22      $22,000  $8,000                                    $30,000
4    Distributions from Roth IRAs                                                                                                                                                                                                              -0-      -0-                                              -0-
5    Totals. Add lines 2 through 4.                                                                                                                                                                                              $30,000       $22,000  $8,000                                    $30,000

34521 Enter the date the distribution period for the disaster begins. Enter the disaster's FEMA number. Enter year checked in item B. Enter the date the distribution period for the disaster ends. Enter year checked in item A.

                                                                                                                                                                                                                                          -14-          Instructions for Form 8915-F (Rev. 1-2023)

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                                                                                                                                                                                                                                            the instructions for your tax return for reporting the 
Line 7. On line 7, enter the excess of the sum of lines 2 
                                                                                                                                                                                                                                            distributions included on line 7. See also the Instructions 
through 4 in column (a) over the amount on line 6, except 
                                                                                                                                                                                                                                            for Form 5329 for this year.
if you also are completing Part IV, or are claiming qualified 
disaster distributions on Part I of more than one Form                                                                                                                                                                                        Example.  You reported a total of $40,000 in 
8915 for this year. See If completing both Part I and Part                                                                                                                                                                                  distributions in 2022 on lines 3 and 5 in column (a). The 
IV or filing more than one Form 8915 below. The amount                                                                                                                                                                                      entire $40,000 in distributions were traditional IRA 
on line 7 should generally be apportioned into IRA and                                                                                                                                                                                      distributions. You reported $22,000 of those distributions 
pension and annuity amounts, as applicable, and reported                                                                                                                                                                                    on lines 3 and 5 in column (b) of this year's Form 8915-F. 
on your tax return as taxable distributions in accordance                                                                                                                                                                                   On line 7, you reported $18,000 ($40,000 minus $22,000). 
with Form 5329 and the instructions for that return. See                                                                                                                                                                                    You are not completing Part IV. You will refer to your tax 

Example 2 for Worksheet 1B: Use if you are directed on line 1a of your Form 8915-F to use Worksheet 1B or if 
you choose to use Worksheet 1B.
Worksheet 1B for Form 8915-F                                                                                                                                                                                                     (a)                    (X)                                        (b)
                                                                                                                                                                                                                                 Total      Qualified 2021 disaster distributions made in 20222 1 Qualified 2
                                                                                                                                                                                                                                 available                                                        2021   
                                                                                                                                                                                                                                                                                                  disaster 
                                                                                                                                                                                                                                 distributi                                                       distribution
                                                                                                                                                                                                                                 ons in 1                                                         s made in 1
                                                                                                                                                                                                                                 _____                                                            2022
                                                                                                                                                                                                                                            Disaster  1 Disaster 2  Disaster 3 Disaster 4         (Total for 
                                                                                                                                                                                                                                                      3 DR-4611-LA3 ________3  ________3           all 
                                                                                                                                                                                                                                            DR-4606-LA                                            disasters)
                                                                                                                                                                                                                                            05/17/20214 08/26/20214 ________4  ________4
                                                                                                                                                                                                                                            06/26/20235 06/26/20235 ________5  ________5
     1 You do not need to use Worksheet 1B if you checked 
     2020 in item B of this year's Form 8915-F.
     • If you checked the same year in both item A and 
     item B on this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you did not enter in item C of a prior year's Form 
     8915-F any of the disasters listed in the table at the 
     top of Part I of this year's Form 8915-F, enter -0- for 
     each listed Disaster in column X.
     • If you only entered one disaster in the table at the 
     top of Part I of this year's Form 8915-F and that was 
     the only disaster you listed in item C of the prior year's 
     Form 8915-F, enter the amount from line 6 of the prior 
     year's Form 8915-F.
     • For each Disaster listed in the table at the top of 
     Part I of this year's Form 8915-F that was not listed in 
     item C on a Form 8915-F for a prior year, enter -0- in 
     column (X).
     • If you listed two or more disasters in the table at 
     the top of Part I of this year's Form 8915-F and you 
     filed a Form 8915-F for a prior year on which you 
     listed in item C some or all of those disasters, enter in 
     column (X) the amounts from line 5 in column (X) of 
     the prior year's Worksheet 1B. If you did not use 
     Worksheet 1B in that prior year, allocate the amount 
     from line 6 of that prior year's Form 8915-F among the 
     Disasters on line 1 of this worksheet using any 
     reasonable method, except if all of the disasters listed 
     on the prior year's Form 8915-F are not listed on this 
     year’s table at the top of Part I. In the latter case, 
     allocate the amount on line 6 of that prior year's Form 
     8915-F first to the disasters not listed in the table at 
     the top of Part I of this year's Form 8915-F, and 
     allocate any remaining amount among the Disasters 
     on line 1 of this Worksheet 1B using any reasonable 
     method. 
      
     Note. If the amount on line 1 of this worksheet is 
     $22,000 or more for a disaster, you cannot have 
     qualified disaster distributions in this year for that 
     disaster. Remove that disaster from the list at the 
     top of Part I on page 1 of this year's Form 8915-F 
     and exclude it from your calculations for Part I of 
     this year's Form 8915-F.                                                                                                                                                                                                                 $20,000   -0-                                        $20,000
2    Distributions from retirement plans (other than IRAs)                                                                                                                                                                                                                                             -0-
                                                                                                                                                                                                                                 $30,000
3    Distributions from traditional, SEP, and SIMPLE IRAs                                                                                                                                                                        04/22/22     $2,000    $22,000                                    $24,000
4    Distributions from Roth IRAs                                                                                                                                                                                                                                                                      -0-
5    Totals. Add lines 2 through 4.                                                                                                                                                                                                           $22,000   $22,000                                    $24,000

34521 Enter the date the distribution period for the disaster begins. Enter the disaster's FEMA number. Enter year checked in item B. Enter the date the distribution period for the disaster ends. Enter year checked in item A.

Instructions for Form 8915-F (Rev. 1-2023)                                                                                                                                                                                                -15-

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Example 3 for Worksheet 1B: Use if you are directed on line 1a of your Form 8915-F to use Worksheet 1B or if 
you choose to use Worksheet 1B.
Worksheet 1B for Form 8915-F                                                                                                                                                                                                     (a)                             (X)                              (b)
                                                                                                                                                                                                                                 Total      Qualified 2021 disaster distributions made in 20212 1 Qualified 2
                                                                                                                                                                                                                                 available                                                        2021   
                                                                                                                                                                                                                                 distributi                                                       disaster 
                                                                                                                                                                                                                                 ons in 1                                                         distribution
                                                                                                                                                                                                                                 _____                                                            s made in 1
                                                                                                                                                                                                                                                                                                  2021
                                                                                                                                                                                                                                            Disaster  1 Disaster 2   Disaster 3 Disaster 4        (Total for 
                                                                                                                                                                                                                                                      3 DR-4611-LA3  ________3  ________3         all 
                                                                                                                                                                                                                                            DR-4606-LA                                            disasters)
                                                                                                                                                                                                                                            05/17/20214 08/26/20214  ________4  ________4
                                                                                                                                                                                                                                            06/26/20235 06/26/20235  ________5  ________5
     1 You do not need to use Worksheet 1B if you checked 
     2020 in item B of this year's Form 8915-F.
     • If you checked the same year in both item A and 
     item B on this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you did not enter in item C of a prior year's Form 
     8915-F any of the disasters listed in the table at the 
     top of Part I of this year's Form 8915-F, enter -0- for 
     each listed Disaster in column X.
     • If you only entered one disaster in the table at the 
     top of Part I of this year's Form 8915-F and that was 
     the only disaster you listed in item C of the prior year's 
     Form 8915-F, enter the amount from line 6 of the prior 
     year's Form 8915-F.
     • For each Disaster listed in the table at the top of 
     Part I of this year's Form 8915-F that was not listed in 
     item C on a Form 8915-F for a prior year, enter -0- in 
     column (X).
     • If you listed two or more disasters in the table at 
     the top of Part I of this year's Form 8915-F and you 
     filed a Form 8915-F for a prior year on which you 
     listed in item C some or all of those disasters, enter in 
     column (X) the amounts from line 5 in column (X) of 
     the prior year's Worksheet 1B. If you did not use 
     Worksheet 1B in that prior year, allocate the amount 
     from line 6 of that prior year's Form 8915-F among the 
     Disasters on line 1 of this worksheet using any 
     reasonable method, except if all of the disasters listed 
     on the prior year's Form 8915-F are not listed on this 
     year’s table at the top of Part I. In the latter case, 
     allocate the amount on line 6 of that prior year's Form 
     8915-F first to the disasters not listed in the table at 
     the top of Part I of this year's Form 8915-F, and 
     allocate any remaining amount among the Disasters 
     on line 1 of this Worksheet 1B using any reasonable 
     method. 
      
     Note. If the amount on line 1 of this worksheet is 
     $22,000 or more for a disaster, you cannot have 
     qualified disaster distributions in this year for that 
     disaster. Remove that disaster from the list at the 
     top of Part I on page 1 of this year's Form 8915-F 
     and exclude it from your calculations for Part I of 
     this year's Form 8915-F.                                                                                                                                                                                                                    -0-             -0-                                     -0-
2    Distributions from retirement plans (other than IRAs)                                                                                                                                                                                                                                               -0-
                                                                                                                                                                                                                                 $30,000 
                                                                                                                                                                                                                                 04/22/22
                                                                                                                                                                                                                                 $14,000 
3    Distributions from traditional, SEP, and SIMPLE IRAs                                                                                                                                                                        09/17/21     $22,000   $14,000                                   $36,000
4    Distributions from Roth IRAs                                                                                                                                                                                                                                                                        -0-
5    Totals. Add lines 2 through 4.                                                                                                                                                                                              $44,000      $22,000   $14,000                                   $36,000

34521 Enter the date the distribution period for the disaster begins. Enter the disaster's FEMA number. Enter year checked in item B. Enter the date the distribution period for the disaster ends. Enter year checked in item A.

return, Form 5329, and their instructions for directions on                                                                                                                                                                                 • On the dotted line to the left of line 7, write "$________ 
how to treat this $18,000 in IRA distributions.                                                                                                                                                                                             qualified distribution for Part IV, line 28."
     If completing both Part I and Part IV or filing more                                                                                                                                                                                     Step 2. If you are claiming qualified disaster 
than one Form 8915.                                                                                                                                                                                                                         distributions on Part I of more than one Form 8915 for this 
Step 1. If you are completing both Part I and Part IV on                                                                                                                                                                                    year and you aren't completing Part IV on this year's Form 
this year's Form 8915-F:                                                                                                                                                                                                                    8915:
•    On line 7, enter the excess of the sum of lines 2 through                                                                                                                                                                              • On line 7, enter -0- and use that dollar amount as your 
4 in column (a) over the amount on line 6 reduced by the                                                                                                                                                                                    available distributions on the other Form 8915 you are 
amount from line 7 that is included on line 28 in Part IV.                                                                                                                                                                                  filing for this year.

                                                                                                                                                                                                                                        -16-            Instructions for Form 8915-F (Rev. 1-2023)

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• On the dotted line to the left of line 7, write "$________ the box, you elect to include the entire amount in income
used as available distribution on Part I of **** Form 8915-F in the year of distribution. You cannot make or change this
(**** disasters)." election after the due date (including extensions) for your
Step 3. If you are claiming qualified disaster tax return. If you checked the box on line 22, you must
distributions on Part I of more than one Form 8915-F for check the box on line 11.
this year and you are completing Part IV on this year's If the taxpayer died after receiving a qualified disaster
Form 8915-F for the earliest disasters. distribution, the taxable amount of the distribution may not
• If, on the Form 8915-F for this year with the earliest be spread beyond the year in which they died. The
disasters, the amount on line 30 reduced by the amount remainder of the distribution must be reported on the tax
on line 31 is -0-, you don't have any available distributions return of the deceased taxpayer.
for the other Forms 8915-F you are filing this year.
Line 12. Use Worksheet 2 to figure the amount to enter
However, if the amount on line 30 reduced by the amount
on line 12 of your Form 8915-F.
on line 31 is a positive dollar amount, enter -0- on line 32

and use that dollar amount as your available distributions
on the other Form 8915-F you are filing for this year. Worksheet 2 for Line 12. Total Income From
• On the dotted line to the left of line 32, write Other- Than-IRA Distributions Made in Prior
"$________ used as available distribution on Part I of **** Years
Form 8915-F (**** disasters)." Keep for Your Records
Example. You reported a total of $40,000 in Before you begin.
distributions in 2022 on lines 3 and 5 in column (a). The From this year's form:
entire $40,000 in distributions were traditional IRA • Enter the disaster year you checked in item B _________
distributions. You reported $22,000 of those distributions • Enter the tax return year you checked in item A _________
on lines 3 and 5 in column (b) of this year's Form 8915-F. 1. Enter the amount from column (c) of
On line 7, you would report $18,000 ($40,000 minus Worksheet 2: Supplemental
$22,000), except you are also completing Part IV. In Part Information . . . . . . . . . . . . . . . . . . . . . . . 1.
IV, you are claiming, as qualified distributions, $10,000 of 2. Enter the amount from column (d) of
the traditional IRA distributions that you reported in Part I. Worksheet 2: Supplemental
On line 7, you will only report $8,000 ($18,000 minus Information . . . . . . . . . . . . . . . . . . . . . . . . 2.
$10,000). On the dotted line to the left of line 7, you will 3. Enter the total of lines 1 and 2 here and on
write "$10,000 qualified distribution for Part IV, line 28". line 12 of this year’s Form 8915-F . . . . . . . . 3.
You will refer to your tax return, Form 5329, and their
instructions for directions on how to treat this $8,000 in
IRA distributions.

Part II—Qualified Disaster
Distributions From Retirement Plans
(Other Than IRAs)
Line 9. Enter on line 9 your cost, if any. Your cost is
generally your net investment in the plan. It does not
include pre-tax contributions. If there is an amount in
box 2a of Form 1099-R, the difference between box 1 and
box 2a of Form 1099-R is usually your cost. Enter the
difference on line 9.
If there is no amount in box 2a of Form 1099-R and the
first box in box 2b is checked, the issuer of Form 1099-R
may not have had all the facts needed to figure the
taxable amount. You may want to get Pub. 575, Pension
and Annuity Income, to help figure your taxable amount.
Also see Pub. 575 if you use the Simplified Method
Worksheet to figure the taxable amount of your periodic
payments and you designated some of these payments
as qualified disaster distributions on the Form 8915-F you
are completing.
If you have a Form 1099-R with both qualified
! disaster distributions and nonqualified
CAUTION distributions, you must separately figure the cost
attributable to each distribution.

Line 11. If you don’t check the box on line 11, you must
spread the amount on line 10 over 3 years. By checking

Instructions for Form 8915-F (Rev. 1-2023) -17-

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Worksheet 2: Supplemental Information
This section provides the information you will need to complete lines 1 and 2 of Worksheet 2.
   (a)                           (b)                                      (c)                                                   (d)
Disaster Year (item Tax Return year                  Worksheet 2, line 1: Enter amount, if any, from your: Worksheet 2, line 2: Enter amount, if any, from your:
B)                  (item A)
                                 2021                2020 Form 8915-E, line 9 (if you checked the box on                        0
                                                     that line, enter -0-)
                                 2022                2021 Form 8915-F (2020 disasters), line 11 (if you    2020 Form 8915-E, line 9 (if you checked the box on 
   2020                                              checked the box on that line, enter -0-)              that line, enter -0-)
                                 2023                                     0                                2021 Form 8915-F (2020 disasters), line 11 (if you 
                                                                                                           checked the box on that line, enter -0-)
                                 2024                                     0                                                     0

                                                     Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (2021 disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                  (item A)                         Worksheet 2, line 1                                   Worksheet 2, line 2
                                 2021                                     0                                                     0
                                 2022                                     2021                                                  0
                                 2023                                     2022                                                  2021
   2021
                                 2024                                     2023                                                  2022
                                 2025                                     0                                                     2023
                                 2026                                     0                                                     0

                                                     Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (2022 disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                               (item A)            Worksheet 2, line 1                                   Worksheet 2, line 2
                                 2022                                     0                                                     0
                                 2023                                     2022                                                  0
                                 2024                                     2023                                                  2022
   2022
                                 2025                                     2024                                                  2023
                                 2026                                     0                                                     2024
                                 2027                                     0                                                     0

For Disasters that begin after 2023                  Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (______ * disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.

Disaster Year (item Tax Return year 
   B)                            (item A)            Worksheet 2, line 1                                   Worksheet 2, line 2
                                 ______*                                  0                                                     0
                                 ______**                                 ______*                                               0
                                 ______***                                ______**                                              _____*
   ______*
                                 ______****                               ______***                                             ______**
                                 ______*****                              0                                                     ______***
                    ______******                                          0                                                     0
* The year you checked in item B.
** Add 1 year to the year you checked in item B.
*** Add 2 years to the year you checked in item B.
**** Add 3 years to the year you checked in item B.
***** Add 4 years to the year you checked in item B.
****** Add 5 years to the year you checked in item B.

                                                                          -18-                             Instructions for Form 8915-F (Rev. 1-2023)

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Line 14. Enter on line 14 of your Form 8915-F your total            Part III—Qualified Disaster 
repayments—the sum of your excess repayments carried 
to this year and your repayments made for this year. See            Distributions From Traditional, SEP, 
Worksheet 3, later. A repayment is made in this year if it is       SIMPLE, and Roth IRAs
made before you filed your return for this year, and not 
later than the due date (including extensions).                     Line 22. If you don’t check the box on line 22, you must 
                                                                    spread the amount on line 21 over 3 years. By checking 
At any time during the 3-year period that begins the day 
                                                                    the box, you elect to include the entire amount in income 
after the date you received a qualified disaster 
                                                                    in the year of distribution. You cannot make or change this 
distribution, you can repay any portion of the distribution 
                                                                    election after the due date (including extensions) for your 
to an eligible retirement plan that accepts rollover 
                                                                    tax return. If you checked the box on line 11, you must 
contributions. You cannot, however, repay more than the 
                                                                    check the box on line 22.
amount of the original distribution. See Repayment of a 
Qualified Disaster Distribution, earlier, for details.                  If the taxpayer died after receiving a qualified disaster 
Worksheet 3  Use Worksheet 3 to figure the total                    distribution, the taxable amount of the distribution may not 
repayment to enter on line 14 of your Form 8915-F.                  be spread beyond the year in which they died. The 
                                                                    remainder of the distribution must be reported on the tax 
       Don’t use Worksheet 3 to report repayments of                return of the deceased taxpayer.
!      qualified 2018 or 2019 disaster distributions.               Line 23. Use Worksheet 4 to figure the amount to enter 
CAUTION
                                                                    on line 23 of your Form 8915-F.
Worksheet 3.                                                         
                                                                    Worksheet 4 for Line 23. Total Income From 
Keep for Your Records                                               IRA Distributions Made in Prior Years
1. Enter the amount, if any, from last year's Form                  Keep for Your Records
8915-F, line 14, except as follows.                                     Before you begin.
                                                                        From this year's form:
If you are completing 2021 Form 8915-F (2020                            • Enter the disaster year you checked in item B _________
disasters), enter the amount, if any, from your                         • Enter the tax return year you checked in item A _________
2020 Form 8915-E, line 10.
                                                                        1. Enter the amount from column (c) of 
If you are completing 2023 Form 8915-F (2021                              Worksheet 4: Supplemental 
disasters), enter the amount, if any, from your                           Information . . . . . . . . . . . . . . . . . . . . . . .   1.  
2022 Form 8915-F (2021 disasters), line 14, if                          2. Enter the amount from column (d) of 
you completed that form. If you didn't complete                           Worksheet 4: Supplemental 
that form, enter the amount, if any, from your                            Information . . . . . . . . . . . . . . . . . . . . . . . . 2.  
2021 Form 8915-F (2021 disasters), 
line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.       3. Enter the total of lines 1 and 2 here and on 
2. Enter the amount, if any, from last year's Form                        line 23 of this year’s Form 8915-F  . . . . . . . .         3.
8915-F, line 13, except as follows.
 
 If you are completing 2021 Form 8915-F (2020 
disasters), enter the amount, if any, from your 
2020 Form 8915-E, line 9. 
 
If you are completing 2023 Form 8915-F (2021 
disasters), enter the amount, if any, from your 
2022 Form 8915-F (2021 disasters), line 13, if 
you completed that form. If you didn't complete 
that form enter the amount, if any, from your 
2021 Form 8915-F (2021 disasters), 
line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.   
3a. Subtract line 2 from line 1. If zero or less, 
enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . .  3a.  
 b. Enter the amount from line 3a that you have 
already carried back to a prior year . . . . . . .             b.   
 c. Subtract line 3b from line 3a  . . . . . . . . . . . .     c.   
4. Enter the total amount of any repayments you 
made, with respect to this year's Form 8915-F, 
before filing this year's tax return . . . . . . . . .         4.   
5. Enter the total of lines 3c and 4 here and on 
line 14 of this year's Form 8915-F   . . . . . . . .           5.

Worksheet 3, line 4: Don't include these amounts. 
On line 4 of Worksheet 3, don't include any repayments 
made later than the due date (including extensions) for 
this year’s return or any repayments of nontaxable 
amounts.

Instructions for Form 8915-F (Rev. 1-2023)                          -19-

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Worksheet 4: Supplemental Information
This section provides the information you will need to complete lines 1 and 2 of Worksheet 4.
   (a)                            (b)                                     (c)                                                   (d)
Disaster Year (item Tax Return year                  Worksheet 4, line 1: Enter amount, if any, from your: Worksheet 4, line 2: Enter amount, if any, from your:
B)                  (item A)
                                  2021               2020 Form 8915-E, line 17 (if you checked the box on                       0
                                                     that line, enter -0-)
                                  2022               2021 Form 8915-F (2020 disasters), line 22 (if you    2020 Form 8915-E, line 17 (if you checked the box on 
   2020                                              checked the box on that line, enter -0-)              that line, enter -0-)
                                  2023                                    0                                2021 Form 8915-F (2020 disasters), line 22 (if you 
                                                                                                           checked the box on that line, enter -0-) 
                                  2024                                    0                                                     0

                                                     Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (2021 disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                  (item A)                         Worksheet 4, line 1                                   Worksheet 4, line 2
                                  2021                                    0                                                     0
                                  2022                                    2021                                                  0
                                  2023                                    2022                                                  2021
   2021
                                  2024                                    2023                                                  2022
                                  2025                                    0                                                     2023
                                  2026                                    0                                                     0

                                                     Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (2022 disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                                (item A)           Worksheet 4, line 1                                   Worksheet 4, line 2
                                  2022                                    0                                                     0
                                  2023                                    2022                                                  0
                                  2024                                    2023                                                  2022
   2022
                                  2025                                    2024                                                  2023
                                  2026                                    0                                                     2024
                                  2027                                    0                                                     0

For Disasters that begin after 2023                  Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (______* disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.

Disaster Year (item Tax Return year 
   B)                             (item A)           Worksheet 4, line 1                                   Worksheet 4, line 2
                                  ______*                                 0                                                     0
                                  ______**                                ______*                                               0
                                  ______***                               ______**                                              ______*
   ______*
                                  ______****                              ______***                                             ______**
                    ______*****                                           0                                                     ______***
                    ______******                                          0                                                     0
* The year you checked in item B. 
** Add 1 year to the year you checked in item B. 
*** Add 2 years to the year you checked in item B.
**** Add 3 years to the year you checked in item B.
***** Add 4 years to the year you checked in item B.
****** Add 5 years to the year you checked in item B.

                                                                          -20-                             Instructions for Form 8915-F (Rev. 1-2023)

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Line 25. Enter on line 25 of this year’s Form 8915-F your Part IV—Qualified Distributions for
total repayments—the sum of your excess repayments
carried to this year and your repayments made for this the Purchase or Construction of a
year. See Worksheet 5, later. A repayment is made in this Main Home in Qualified Disaster
year if it is made before you filed your return for this year,
and not later than the due date (including extensions). Areas
At any time during the 3-year period that begins the day 2021 Form 8915-F (2020 disasters). On 2021 Form
after the date you received a qualified disaster 8915-F (2020 disasters), qualified distributions can only
distribution, you can repay any portion of the distribution be reported for the Alaska (4585-DR-AK) disaster.
to an eligible retirement plan that accepts rollover Complete Part IV of 2021 Form 8915-F (2020
contributions. You cannot, however, repay more than the disasters) if, on January 1, 2021, you received a qualified
amount of the original distribution. See Repayment of a distribution described in Qualified 2020 disaster areas
Qualified Disaster Distribution, earlier, for details. under Repayment of a Qualified Distribution for the
Worksheet 5. Use Worksheet 5 to figure the total Purchase or Construction of a Main Home, earlier, for the
repayment to enter on line 25 of your Form 8915-F. Alaska (4585-DR-AK) disaster. You must complete the
Don’t use Worksheet 5 to report repayments of required lines of Part IV if you received a qualified
distribution for the Alaska (4585-DR-AK) disaster on
! qualified 2018 or 2019 disaster distributions. January 1, 2021, even if you made no repayments in
CAUTION
2021. Any portion of the qualified distribution not repaid
Worksheet 5 before June 26, 2021, for the Alaska (4585-DR-AK)
disaster will not be allowed the special tax benefits
1. Enter the amount, if any, from last year's Form available to qualified distributions.
8915-F, line 25, except as follows.
If you are required to file 2021 Form 8606, complete
If you are completing 2021 Form 8915-F (2020 that form before you complete Part IV.
disasters), enter the amount, if any, from your
2020 Form 8915-E, line 18. Note. A distribution for the purchase or construction of a
main home may be treated as a qualified 2020 disaster
If you are completing 2023 Form 8915-F (2021
disasters), enter the amount, if any, from your distribution in certain circumstances. See Qualified
2022 Form 8915-F (2021 disasters), line 25, if disaster areas under Repayment of a Qualified
you completed that form. If you didn't complete Distribution for the Purchase or Construction of a Main
that form, enter the amount, if any, from your Home, earlier.
2021 Form 8915-F (2021 disasters),
line 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Qualified distributions for 2021 and later disasters.
2. Enter the amount, if any, from last year's Form Qualified distributions can be reported for qualified 2021
8915-F, line 24, except as follows. and later disasters. Complete Part IV of this year's Form
8915-F for your disasters in item B if, this year, you
If you are completing 2021 Form 8915-F (2020 received a qualified distribution described in Qualified
disasters), enter the amount, if any, from your
2020 Form 8915-E, line 17. Distribution for the Purchase or Construction of a Main
Home, earlier, for the disasters you listed in the table at
If you are completing 2023 Form 8915-F (2021 the top of Part IV on page 4 of this year's Form 8915-F.
disasters), enter the amount, if any, from your You must complete the required lines of Part IV if you
2022 Form 8915-F (2021 disasters), line 24, if received a qualified distribution, even if you made no
you completed that form. If you didn't complete repayments this year. Any portion of the qualified
that form enter the amount, if any, from your
2021 Form 8915-F (2021 disasters), distribution not repaid by the end of the disaster's qualified
line 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. distribution repayment period will not be allowed the
3a. Subtract line 2 from line 1. If zero or less, special tax benefits available to qualified distributions. If
enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . 3a. the repayment period for a qualified distribution for a
b. Enter the amount from line 3a that you have disaster ends next year, repayments for that qualified
already carried back to a prior year . . . . . . . b. distribution can be made in the next year and will be
c. Subtract line 3b from line 3a . . . . . . . . . . . . c. reported on an amended return for this year.
4. Enter the total amount of any repayments you Example 1. A distribution Mosley received in February
made, with respect to this year's Form 8915-F,
before filing this year's tax return . . . . . . . . . 4. 2022 is a qualified distribution for the following 2022
5. Enter the total of lines 3c and 4 here and on disaster: the Virginia Severe Winter Storm and
line 25 of this year's Form 8915-F . . . . . . . . 5. Snowstorm disaster (DR-4644-VA) (beginning date
January 2, 2022). Mosley can make repayments for this
disaster through June 26, 2023. Mosley reports the
Worksheet 5, line 4: Don't include these amounts. distribution on Form 8915-F, Part IV, as a qualified
On line 4 of Worksheet 5, don't include any repayments distribution. Mosley doesn't make a repayment until May
made later than the due date (including extensions) for 2023. The repayment must be reported on an original or
this year’s return or any repayments of nontaxable amended 2022 Form 8915-F, as applicable.
amounts. Example 2. A distribution Mosley received in
September 2021 is a qualified distribution for the following

Instructions for Form 8915-F (Rev. 1-2023) -21-

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2022 disaster: the Virginia Severe Winter Storm and Enter on line 31 the amount of any repayments you
Snowstorm disaster (DR-4644-VA) (beginning date make within the time frame specified. Don't include any
January 2, 2022). Mosley can make repayments for this repayments treated as rollovers on this year’s Form 8606
disaster through June 26, 2023. Mosley reports the or any repayments of nontaxable amounts.
distribution on Form 8915-F, Part IV, as a qualified
Line 32. Most distributions from qualified retirement
distribution. Mosley doesn't make a repayment until May
plans (including IRAs) made to you before you reach age
2023. The repayment must be reported on an original or 1 2
59 / are subject to an additional tax on early distributions
amended 2022 Form 8915-F, as applicable.
and are reported on Form 5329. Qualified distributions for
If you are required to file this year's Form 8606, the purchase or construction of a main home in a qualified
complete that form before you complete Part IV. disaster area that were not repaid to an eligible retirement
plan within the time frame specified in Qualified
Note. A distribution for the purchase or construction of a
distribution repayment period under Repayment of a
main home may be treated as a qualified disaster
Qualified Distribution for the Purchase or Construction of a
distribution made in this year in certain circumstances.
Main Home, earlier, may be subject to this additional tax
See Qualified disaster areas under Repayment of a
unless you qualify for an exception. See the Instructions
Qualified Distribution for the Purchase or Construction of a
for Form 5329 for information on exceptions to this tax. If
Main Home, earlier.
you have not repaid the distribution before the specified
Lines 27 through 32 end date, you may be able to designate the qualified
distribution as a qualified disaster distribution. See
You must complete lines 27 and 28 and all other
Qualified disaster areas under Repayment of a Qualified
applicable lines of Part IV for your qualified distribution(s).
Distribution for the Purchase or Construction of a Main
Line 27. If you check the “Yes” box, but are not required Home, earlier.
to complete lines 28 through 32, you must still file the
required Form 8915-F to show that you received a Privacy Act and Paperwork Reduction
qualified distribution. Act Notice
Line 28. Enter on line 28 your qualified distributions. See We ask for the information on this form to carry out the
Qualified Distribution for the Purchase or Construction of a Internal Revenue laws of the United States. We need this
Main Home in Qualified Disaster Areas, earlier. information to ensure that you are complying with these
Don't include any distributions you designated as laws and to allow us to figure and collect the right amount
qualified disaster distributions reported on line 8 or line 20 of tax. You are required to give us this information if you
of your Form 8915-F. Also, don't include any amounts made certain contributions or received certain
reported on this year’s Form 8606. distributions from qualified plans, including IRAs, and
other tax-favored accounts. Our legal right to ask for the
If you are completing both Part I and Part IV on information requested on this form is sections 6001, 6011,
! this year's Form 8915-F, see Line 7, earlier. 6012(a), and 6109 and their regulations. If you don’t
CAUTION
provide this information, or you provide incomplete or
Line 29. Enter on line 29 your cost, if any. Your cost is false information, you may be subject to penalties. You
generally your net investment in the plan. It does not are not required to provide the information requested on a
include pre-tax contributions. If there is an amount in form that is subject to the Paperwork Reduction Act
box 2a of Form 1099-R, the difference between box 1 and unless the form displays a valid OMB control number.
box 2a of Form 1099-R is usually your cost. See Pub. 575 Books or records relating to a form or its instructions must
for more information about figuring your cost in the plan. be retained as long as their contents may become
In many cases, a hardship distribution from a 401(k) material in the administration of any Internal Revenue law.
plan or a tax-sheltered annuity contract will not have any Generally, tax returns and return information are
cost. confidential, as required by section 6103. However, we
may give this information to the Department of Justice for
If you received a first-time homebuyer distribution from civil and criminal litigation, and to cities, states, the District
an IRA, don't enter any amount on line 29. Any cost or of Columbia, and U.S. commonwealths and possessions
basis in an IRA is figured on this year’s Form 8606 if you to carry out their tax laws. We may also disclose this
made nondeductible contributions. information to other countries under a tax treaty, to federal
If you have a Form 1099-R with both qualified and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence
! distributions and nonqualified distributions, you
CAUTION must separately figure the cost attributable to agencies to combat terrorism.
each distribution.
The average time and expenses required to complete
Line 31. You can repay any portion of a qualified and file this form will vary depending on individual
distribution to an eligible retirement plan that accepts circumstances. For the estimated averages, see the
rollovers but the repayments must be made within the instructions for your income tax return.
time frame specified in Repayment of a Qualified
Distribution for the Purchase or Construction of a Main If you have suggestions for making this form simpler,
Home, earlier. You can't, however, repay more than the we would be happy to hear from you. See the instructions
amount of the original distribution. for your income tax return.

-22- Instructions for Form 8915-F (Rev. 1-2023)

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Appendix A, Which Lines Should I See Qualified 2020 disaster distribution
TIP requirements, earlier, under Qualified Disaster
Use? Distribution Requirements for the cutoff dates for
making these distributions and for other criteria for these
Form 8915-F (2020 Disasters): Lines To Use distributions.
Look for the year of the form you are filing.

2021 Form 8915-F (2020 Disasters)
IF . . . AND . . . THEN . . .
Complete Parts I, II, and III, as applicable. If you received qualified distributions for
the Alaska (4585-DR-AK) disaster on January 1, 2021, complete Part IV.
If you must complete Part III, complete 2021 Form 8606 if either of the following
applies.
Qualified 2020 disaster distributions were made to — • You received a qualified 2020 disaster distribution in 2021 from a traditional,
you in 2021
SEP, or SIMPLE IRA, and you have a basis in the IRA.
• You received a qualified 2020 disaster distribution from a Roth IRA.
For more information, see 2021 Form 8606 and its instructions.
You did NOT check the box Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2021
on line 9 or 17 on the 2020 Form 8915-F (2020 disasters). If you received qualified distributions for the Alaska
Form 8915-E (4585-DR-AK) disaster on January 1, 2021, complete Part IV.
If you are repaying those distributions, complete lines 14 and 25, as applicable, of
You claimed coronavirus-related or other qualified your 2021 Form 8915-F (2020 disasters). If you received qualified distributions for
2020 disaster distributions on a 2020 Form 8915-E the Alaska (4585-DR-AK) disaster on January 1, 2021, complete Part IV.
(2020 disasters), but qualified 2020 disaster You checked the box on If you aren’t repaying those distributions, but you received qualified distributions for
distributions were NOT made to you in 2021 line 9 or 17 on the 2020 the Alaska (DR-4585-AK) disaster on January 1, 2021, complete Part IV.
Form 8915-E
If you aren’t repaying those distributions and you did NOT receive any
qualified distributions, STOP. You can’t use 2021 Form 8915-F (2020
disasters).
You received qualified Complete Part IV.
distributions for the Alaska
(4585-DR-AK) disaster on
Qualified 2020 disaster distributions were not January 1, 2021
made to you in 2021 AND you did not file a 2020 You did NOT receive STOP. You can’t use 2021 Form 8915-F.
Form 8915-E qualified distributions on
January 1, 2021, for
4585-DR-AK

Instructions for Form 8915-F (Rev. 1-2023) -23-

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2022 Form 8915-F (2020 Disasters)
IF . . .                                             AND . . .                   THEN . . .
                                                     You didn’t check the box on  Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022 
                                                     line 11 or 22 on the 2021   Form 8915-F (2020 disasters). 
                                                     Form 8915-F (2020 
                                                     disasters) AND/OR on 
You claimed qualified 2020 disaster distributions    line 9 or 17 on the 2020 
on a 2021 Form 8915-F (2020 disasters) AND you       Form 8915-E
claimed coronavirus-related distributions or other 
qualified 2020 disaster distributions on a 2020      You checked the box on      If you are repaying those distributions, complete lines 14 and 25, as applicable, of your 
Form 8915-E                                          line 11 or 22 on the 2021   2022 Form 8915-F.
                                                     Form 8915-F (2020           If you aren’t repaying those distributions, you can’t use 2022 Form 8915-F (2020 
                                                     disasters) AND on line 9 or disasters).
                                                     17 on the 2020 Form 
                                                     8915-E
You claimed qualified 2020 disaster distributions    You didn’t check the box on Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022 
on a 2021 Form 8915-F (2020 disasters) but you       line 11 or 22 on the 2021   Form 8915-F (2020 disasters). 
did not claim coronavirus-related distributions or   Form 8915-F (2020 
other qualified 2020 disaster distributions on a     disasters)
2020 Form 8915-E
                                                     You didn’t checked the box  Complete lines 12 through 15 and lines 23 through 26, as applicable, of your 2022 
                                                     on line 9 or 17 on the 2020 Form 8915-F (2020 disasters).
You claimed coronavirus-related distributions or     Form 8915-E
other qualified 2020 disaster distributions on a                                 If you are repaying those distributions, complete lines 14 and 25, as applicable, of your 
2020 Form 8915-E but not on a 2021 Form 8915-F       You checked the box on      2023 Form 8915-F (2020 disasters).
(2020 disasters)                                     line 9 or 17 on the 2020 
                                                     Form 8915-E                 If you aren’t repaying those distributions, STOP. You can’t use 2023 Form 
                                                                                 8915-F.
You did NOT claim qualified 2020 disaster                                        STOP. You can’t use 2023 Form 8915-F (2020 disasters).
distributions on a 2021 Form 8915-F (2020 
disasters) AND you did not claim                                   —
coronavirus-related distributions or other qualified 
2020 disaster distributions on a 2020 Form 8915-E

2023 Form 8915-F (2020 Disasters)
IF . . .                                                              AND . . .                            THEN . . .
                                                                      You did not check the box on line 11 Complete lines 12 through 15 and lines 23 through 26, as 
                                                                      or 22 on that form                   applicable, of your 2023 Form 8915-F (2020 disasters). 
                                                                                                           If you are repaying qualified 2020 disaster distributions 
You claimed qualified 2020 disaster distributions on a 2021 Form                                           made in 2020 or in 2021, complete lines 14 and 25, as 
8915-F (2020 disasters)                                               You checked the box on line 11 or    applicable, of your 2023 Form 8915-F (2020 disasters). .
                                                                      22 on that form                      If you aren’t repaying qualified 2020 disaster distributions 
                                                                                                           made in 2020 or in 2021, you can’t use 2023 Form 
                                                                                                           8915-F (2020 disasters). 
                                                                                                           If you are repaying coronavirus-related distributions or 
                                                                                                           other qualified 2020 disaster distributions, complete lines 
You claimed coronavirus-related distributions or other qualified 2020                                      14 and 25, as applicable, of your 2023 Form 8915-F (2020 
                                                                                                           disasters).
disaster distributions on a 2020 Form 8915-E and you did NOT claim                    —
qualified 2020 disaster distributions on a 2021 Form 8915-F (2020                                          If you aren’t repaying coronavirus-related 
disasters)                                                                                                 distributions or other qualified 2020 disaster 
                                                                                                           distributions, STOP. You can’t use 2023 Form 8915-F 
                                                                                                           (2020 disasters).
You did NOT claim qualified 2020 disaster distributions on a 2021                                          STOP. You can’t use 2023 Form 8915-F (2020 
Form 8915-F (2020 disasters) AND you did not claim                                    —                    disasters).
coronavirus-related distributions or other qualified 2020 disaster 
distributions on a 2020 Form 8915-E
Note. This is the last year in which a coronavirus-related distribution can be repaid. You cannot repay a coronavirus-related distribution later than 3 years and one day after the 
coronavirus-related distribution was received.

                                                                                 -24-                      Instructions for Form 8915-F (Rev. 1-2023)

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2024 Form 8915-F (2020 Disasters)
IF . . .                                                             AND . . .       THEN . . .
You claimed qualified 2020 disaster distributions other than                         If you are repaying qualified 2020 disaster distributions 
coronavirus-related distributions on a 2020 Form 8915-E and you did                  other than coronavirus-related distributions, complete 
NOT claim qualified 2020 disaster distributions on a 2021 Form                       lines 14 and 25, as applicable, of your 2024 Form 8915-F 
8915-F (2020 disasters)                                                              (2020 disasters).
                                                                                   —
                                                                                     If you aren’t repaying qualified 2020 disaster 
                                                                                     distributions other than coronavirus-related 
                                                                                     distributions, STOP. You can’t use 2024 Form 8915-F 
                                                                                     (2020 disasters).
You did NOT claim qualified 2020 disaster distributions on a 2021                    STOP. You can’t use 2024 Form 8915-F (2020 
Form 8915-F (2020 disasters) AND you did not claim                                 — disasters).
coronavirus-related distributions or other qualified 2020 disaster 
distributions on a 2020 Form 8915-E
Note: Coronavirus-related distributions can NOT be repaid after 2023.

Instructions for Form 8915-F (Rev. 1-2023)                                     -25-

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Form 8915-F (2021 and Later Disasters): Lines • You received no qualified distributions this year.
To Use 4. Complete line 14 and/or 25, as applicable, you if
For qualified 2021 and later disasters, follow the are only making repayments this year.
instructions in the numerical bullet below that best • This can occur no qualified disaster distributions were if
describe your situation. made to you this year; on, an earlier Form 8915-F, you
checked the box on line 11 and/or 22 (thus not spreading
1. Complete Part I and, as applicable, Parts II, III, and
the income over 3 years); the repayment period for the
IV qualified disaster distributions were made to you this if
disaster has not ended; and you received no qualified
year for a disaster listed in item C of this year’s Form
distributions this year.
8915-F.
• It can also occur no qualified disaster distributions if
2. Complete lines 12 through 15 :if were made to you this year; on, an earlier Form 8915-F,
• No qualified disaster distributions were made to you this you did not check the box on line 11 and/or 22 (thus
year. spreading the income over 3 years); the 3 years for
• On an earlier Form 8915-F, you did not check the box reporting income on your distributions has passed; the
on line 11 (thus spreading the income over 3 years) and, repayment period for the qualified disaster distributions
on line 12 of this year’s Form 8915-F, you must report has not ended; and you received no qualified distributions
income from those distributions. this year.
• You received no qualified distributions this year.
5. Complete Part IV also in any of the scenarios above
3. Complete lines 23 through 26 :if if you received qualified distributions this year.
• No qualified disaster distributions were made to you this
6. Complete Part IV if you received qualified
year.
distributions this year and if you are not completing Part I,
• On an earlier Form 8915-F, you did not check the box
and are not required to complete any lines in Part II or III,
on line 22 (thus spreading the income over 3 years) and,
on this year’s Form 8915-F.
on line 23 of this year’s Form 8915-F, you must report
income from those distributions.

-26- Instructions for Form 8915-F (Rev. 1-2023)

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Appendix B, Worksheets                                     14, 23, and 25, of this year’s Form 8915-F, attach the 
                                                           page(s) with the completed worksheet(s) to this year’s 
Blank Worksheets 1A-1, 1A-2,1B, 2, 3, 4, and 5 are in this Form 8915-F.
appendix. If you complete any of these worksheets in 
determining amounts to enter on lines 1a through 5, 12, 

Instructions for Form 8915-F (Rev. 1-2023)                 -27-

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Worksheet 1A-1.                                                                                                Keep for Your Records
Name                                                                          Social Security No.
                                                                 (a)          (b)                                  (c)
       First Form 8915-F                          Total distributions in this Qualified disaster distributions Allocation of column (b)
                                                                 year 
2 Distributions from retirement plans (other than 
  IRAs) made this year
3 Distributions from traditional, SEP, and SIMPLE 
  IRAs made this year
4 Distributions from Roth IRAs made this year

                                                                                                 (a)
                   Second Form 8915-F 
                                                                              Available distributions for this year
2 Enter, in column (a), distributions from retirement plans 
  (other than IRAs) made this year.
3 Enter, in column (a), distributions from traditional, SEP, and 
  SIMPLE IRAs made this year. 
4 Enter, in column (a), distributions from Roth IRAs made this 
  year.

Worksheet 1A-2.                                                                                                Keep for Your Records
Name                                                                          Social Security No.
                                                                 (a)          (b)                                  (c)
       Form 8915-D                                                            Qualified 2019 disaster          Allocation of column (b)
                                                  Total distributions in 2021 distributions 
2 Distributions from retirement plans (other than 
  IRAs) made in 2021
3 Distributions from traditional, SEP, and SIMPLE 
  IRAs made in 2021
4 Distributions from Roth IRAs made in 2021

                                                                                                 (a)
       Form 8915-F (2020 disasters) 
                                                                              Available distributions for this year
2 Enter, in column (a), distributions from retirement plans 
  (other than IRAs) made this year.
3 Enter, in column (a), distributions from traditional, SEP, and 
  SIMPLE IRAs made this year. 
4 Enter, in column (a), distributions from Roth IRAs made this 
  year.

                                                                      -28-    Instructions for Form 8915-F (Rev. 1-2023)

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Worksheet 1B: Use if you are directed on line 1a of your Form 8915-F 
to use Worksheet 1B.                                                                                                                                                                                                                                                      Keep for Your Records
Name                                                                                                                                                                                                                                                   Social Security No.
Worksheet 1B for Form 8915-F                                                                                                                                                                                                     (a)                           (X)                                  (b)
                                                                                                                                                                                                                                 Total      Qualified _____ disaster distributions made in _____2 1 Qualified 2
                                                                                                                                                                                                                                 available                                                          _____ disaster 
                                                                                                                                                                                                                                                                                                    distributions  1
                                                                                                                                                                                                                                 distributi                                                         made in _____
                                                                                                                                                                                                                                 ons in 1   Disaster 1 Disaster 2 Disaster 3 Disaster 4             (Total for all 
                                                                                                                                                                                                                                 _____                                                              disasters)
                                                                                                                                                                                                                                            ________3  ________3  ________3  ________3
                                                                                                                                                                                                                                            ________4  ________4  ________4  ________4
                                                                                                                                                                                                                                            ________5  ________5  ________5  ________5
     1 You do not need to use Worksheet 1B if you checked 
     2020 in item B of this year's Form 8915-F.
     • If you checked the same year in both item A and 
     item B on this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you did not enter in item C of a prior year's Form 
     8915-F any of the disasters listed in the table at the top 
     of Part I of this year's Form 8915-F, enter -0- for each 
     listed Disaster in column X.
     • If you only entered one disaster in the table at the 
     top of Part I of this year's Form 8915-F and that was 
     the only disaster you listed in item C of the prior year's 
     Form 8915-F, enter the amount from line 6 of the prior 
     year's Form 8915-F.
     • For each Disaster listed in the table at the top of 
     Part I of this year's Form 8915-F that was not listed in 
     item C on a Form 8915-F for a prior year, enter -0- in 
     column (X).
     • If you listed two or more disasters in the table at the 
     top of Part I of this year's Form 8915-F and you filed a 
     Form 8915-F for a prior year on which you listed in 
     item C some or all of those disasters, enter in column 
     (X) the amounts from line 5 in column (X) of the prior 
     year's Worksheet 1B. If you did not use Worksheet 1B 
     in that prior year, allocate the amount from line 6 of 
     that prior year's Form 8915-F among the Disasters on 
     line 1 of this worksheet using any reasonable method, 
     except if all of the disasters listed on the prior year's 
     Form 8915-F are not listed on this year’s table at the 
     top of Part I. In the latter case, allocate the amount on 
     line 6 of that prior year's Form 8915-F first to the 
     disasters not listed in the table at the top of Part I of 
     this year's Form 8915-F, and allocate any remaining 
     amount among the Disasters on line 1 of this 
     Worksheet 1B using any reasonable method. 
      
     Note. If the amount on line 1 of this worksheet is 
     $22,000 or more for a disaster, you cannot have 
     qualified disaster distributions in this year for that 
     disaster. Remove that disaster from the list at the 
     top of Part I on page 1 of this year's Form 8915-F 
     and exclude it from your calculations for Part I of 
     this year's Form 8915-F. 
2    Distributions from retirement plans (other than IRAs) 
3    Distributions from traditional, SEP, and SIMPLE IRAs
4    Distributions from Roth IRAs
5    Totals. Add lines 2 through 4.

34521 Enter the date the distribution period for the disaster begins. Enter the disaster's FEMA number. Enter year checked in item B. Enter the date the distribution period for the disaster ends. Enter year checked in item A.

Instructions for Form 8915-F (Rev. 1-2023)                                                                                                                                                                                                -29-

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Worksheet 2 for Line 12. Total Income From 
Other- Than-IRA Distributions Made in Prior 
Years
Keep for Your Records
Name                                                          SSN
Before you begin.
From this year's form:
• Enter the disaster year you checked in item B _________
• Enter the tax return year you checked in item A _________
1. Enter the amount from column (c) of 
  Worksheet 2: Supplemental 
  Information . . . . . . . . . . . . . . . . . . . . . . .   1.  
2. Enter the amount from column (d) of 
  Worksheet 2: Supplemental 
  Information . . . . . . . . . . . . . . . . . . . . . . . . 2.  
3. Enter the total of lines 1 and 2 here and on 
  line 12 of this year’s Form 8915-F  . . . . . . . .         3.

                                                                  -30- Instructions for Form 8915-F (Rev. 1-2023)

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Worksheet 2: Supplemental Information
This section provides the information you will need to complete lines 1 and 2 of Worksheet 2.
   (a)                           (b)                                      (c)                                                   (d)
Disaster Year (item Tax Return year                  Worksheet 2, line 1: Enter amount, if any, from your: Worksheet 2, line 2: Enter amount, if any, from your:
B)                  (item A)
                                 2021                2020 Form 8915-E, line 9 (if you checked the box on                        0
                                                     that line, enter -0-)
                                 2022                2021 Form 8915-F (2020 disasters), line 11 (if you    2020 Form 8915-E, line 9 (if you checked the box on 
   2020                                              checked the box on that line, enter -0-)              that line, enter -0-)
                                 2023                                     0                                2021 Form 8915-F (2020 disasters), line 11 (if you 
                                                                                                           checked the box on that line, enter -0-)
                                 2024                                     0                                                     0

                                                     Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (2021 disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                  (item A)                         Worksheet 2, line 1                                   Worksheet 2, line 2
                                 2021                                     0                                                     0
                                 2022                                     2021                                                  0
                                 2023                                     2022                                                  2021
   2021
                                 2024                                     2023                                                  2022
                                 2025                                     0                                                     2023
                                 2026                                     0                                                     0

                                                     Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (2022 disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                               (item A)            Worksheet 2, line 1                                   Worksheet 2, line 2
                                 2022                                     0                                                     0
                                 2023                                     2022                                                  0
                                 2024                                     2023                                                  2022
   2022
                                 2025                                     2024                                                  2023
                                 2026                                     0                                                     2024
                                 2027                                     0                                                     0

For Disasters that begin after 2023                  Insert on the applicable line of your Worksheet 2 the amount from Form 8915-F (______ * disasters), 
                                                     line 11, for the tax year shown. If you checked the box on that line, enter -0-.

Disaster Year (item Tax Return year 
   B)                            (item A)            Worksheet 2, line 1                                   Worksheet 2, line 2
                                 ______*                                  0                                                     0
                                 ______**                                 ______*                                               0
                                 ______***                                ______**                                              _____*
   ______*
                                 ______****                               ______***                                             ______**
                                 ______*****                              0                                                     ______***
                    ______******                                          0                                                     0
* The year you checked in item B.
** Add 1 year to the year you checked in item B.
*** Add 2 years to the year you checked in item B.
**** Add 3 years to the year you checked in item B.
***** Add 4 years to the year you checked in item B.
****** Add 5 years to the year you checked in item B.

Instructions for Form 8915-F (Rev. 1-2023)                                -31-

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Worksheet 3
Keep for Your Records
Name                                                         SSN
1. Enter the amount, if any, from last year's 
Form 8915-F, line 14, except as follows.
 
If you are completing 2021 Form 8915-F 
(2020 disasters), enter the amount, if any, 
from your 2020 Form 8915-E, line 10.
 
If you are completing 2023 Form 8915-F 
(2021 disasters), enter the amount, if any, 
from your 2022 Form 8915-F (2021 
disasters), line 14, if you completed that 
form. If you didn't complete that form, enter 
the amount, if any, from your 2021 Form 
8915-F (2021 disasters), line 14 . . . . . . . .             1.   
2. Enter the amount, if any, from last year's 
Form 8915-F, line 13, except as follows.
 
 If you are completing 2021 Form 8915-F 
(2020 disasters), enter the amount, if any, 
from your 2020 Form 8915-E, line 9. 
 
If you are completing 2023 Form 8915-F 
(2021 disasters), enter the amount, if any, 
from your 2022 Form 8915-F (2021 
disasters), line 13, if you completed that 
form. If you didn't complete that form, enter 
the amount, if any, from your 2021 Form 
8915-F (2021 disasters), line 13 . . . . . . . .             2.   
3a.Subtract line 2 from line 1. If zero or less, 
enter -0- . . . . . . . . . . . . . . . . . . . . . . . . .  3a.  
 b.Enter the amount from line 3a that you have 
already carried back to a prior year . . . . . .             b.   
 c.Subtract line 3b from line 3a . . . . . . . . . .         c.   
4. Enter the total amount of any repayments 
you made, with respect to this year’s Form 
8915-F, before filing this year's tax 
return . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.   
5. Enter the total of lines 3c and 4 here and on 
line 14 of this year's Form 8915-F . . . . . . .             5.

                                                                  -32- Instructions for Form 8915-F (Rev. 1-2023)

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Worksheet 4 for Line 23. Total Income From 
IRA Distributions Made in Prior Years
Keep for Your Records
Name                                                         SSN
Before you begin.
From this year's form:
• Enter the disaster year you checked in item B _________
• Enter the tax return year you checked in item A _________
1. Enter the amount from column (c) of 
  Worksheet 4: Supplemental 
  Information  . . . . . . . . . . . . . . . . . . . . . . . 1.  
2. Enter the amount from column (d) of 
  Worksheet 4: Supplemental 
  Information . . . . . . . . . . . . . . . . . . . . . . .  2.  
3. Enter the total of lines 1 and 2 here and on 
  line 23 of this year’s Form 8915-F  . . . . . .            3.

Instructions for Form 8915-F (Rev. 1-2023)                       -33-

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Worksheet 4: Supplemental Information
This section provides the information you will need to complete lines 1 and 2 of Worksheet 4.
   (a)                            (b)                                     (c)                                                   (d)
Disaster Year (item Tax Return year                  Worksheet 4, line 1: Enter amount, if any, from your: Worksheet 4, line 2: Enter amount, if any, from your:
B)                  (item A)
                                  2021               2020 Form 8915-E, line 17 (if you checked the box on                       0
                                                     that line, enter -0-)
                                  2022               2021 Form 8915-F (2020 disasters), line 22 (if you    2020 Form 8915-E, line 17 (if you checked the box on 
   2020                                              checked the box on that line, enter -0-)              that line, enter -0-)
                                  2023                                    0                                2021 Form 8915-F (2020 disasters), line 22 (if you 
                                                                                                           checked the box on that line, enter -0-) 
                                  2024                                    0                                                     0

                                                     Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (2021 disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                  (item A)                         Worksheet 4, line 1                                   Worksheet 4, line 2
                                  2021                                    0                                                     0
                                  2022                                    2021                                                  0
                                  2023                                    2022                                                  2021
   2021
                                  2024                                    2023                                                  2022
                                  2025                                    0                                                     2023
                                  2026                                    0                                                     0

                                                     Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (2022 disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.
Disaster Year (item Tax Return year 
B)                                (item A)           Worksheet 4, line 1                                   Worksheet 4, line 2
                                  2022                                    0                                                     0
                                  2023                                    2022                                                  0
                                  2024                                    2023                                                  2022
   2022
                                  2025                                    2024                                                  2023
                                  2026                                    0                                                     2024
                                  2027                                    0                                                     0

For Disasters that begin after 2023                  Insert on the applicable line of your Worksheet 4 the amount from Form 8915-F (______* disasters), 
                                                     line 22, for the tax year shown. If you checked the box on that line, enter -0-.

Disaster Year (item Tax Return year 
   B)                             (item A)           Worksheet 4, line 1                                   Worksheet 4, line 2
                                  ______*                                 0                                                     0
                                  ______**                                ______*                                               0
                                  ______***                               ______**                                              ______*
   ______*
                                  ______****                              ______***                                             ______**
                    ______*****                                           0                                                     ______***
                    ______******                                          0                                                     0
* The year you checked in item B. 
** Add 1 year to the year you checked in item B. 
*** Add 2 years to the year you checked in item B.
**** Add 3 years to the year you checked in item B.
***** Add 4 years to the year you checked in item B.
****** Add 5 years to the year you checked in item B.

                                                                          -34-                             Instructions for Form 8915-F (Rev. 1-2023)

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Worksheet 5
Keep for Your Records
Name                                                          SSN
1. Enter the amount, if any, from last year's Form 
8915-F, line 25, except as follows.
 
If you are completing 2021 Form 8915-F (2020 
disasters), enter the amount, if any, from your 
2020 Form 8915-E, line 18.
 
If you are completing 2023 Form 8915-F (2021 
disasters), enter the amount, if any, from your 
2022 Form 8915-F (2021 disasters), line 25, if 
you completed that form. If you didn't complete 
that form, enter the amount, if any, from your 
2021 Form 8915-F (2021 disasters), 
line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.   
2. Enter the amount, if any, from last year's Form 
8915-F, line 24, except as follows.
 
 If you are completing 2021 Form 8915-F (2020 
disasters), enter the amount, if any, from your 
2020 Form 8915-E, line 17. 
 
If you are completing 2023 Form 8915-F (2021 
disasters), enter the amount, if any, from your 
2022 Form 8915-F (2021 disasters), line 24, if 
you completed that form. If you didn't complete 
that form, enter the amount, if any, from your 
2021 Form 8915-F (2021 disasters), 
line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.   
3a. Subtract line 2 from line 1. If zero or less, 
enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . 3a.  
 b. Enter the amount from line 3a that you have 
already carried back to a prior year . . . . . . .            b.   
 c. Subtract line 3b from line 3a  . . . . . . . . . . . .    c.   
4. Enter the total amount of any repayments you 
made, with respect to this year's Form 8915-F, 
before filing this year's tax return . . . . . . . . .        4.   
5. Enter the total of lines 3c and 4 here and on 
line 25 of this year's Form 8915-F. . . . . . . . .           5.

Instructions for Form 8915-F (Rev. 1-2023)                         -35-

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