Important Message
Important Message

Health Savings Accounts Forms

HSA Beneficiary Designation Form

Identify who should receive your HSA assets in the event of your death.

HSA Contribution Form

Make a normal, mistaken distribution, or rollover contribution to your HSA.

HSA Death Distribution Request Form

Use to authorize a distribution of assets from a decedent’s HSA.

HSA Decedent Claim Direct Deposit Form

Request a onetime disbursement of funds from an Associated Bank HSA to another deposit account via electronic ACH transfer relating to a decedent claim.

HSA Distribution Request Form

Request a distribution from your HSA.

HSA Individual Transfer Form

Use to initiate a direct transfer of funds from your current HSA.

HSA Legal Name Change Form

Use to make a legal name change on your HSA.

HSA Plus Custodial Agreement

HSA Plus Online Portal Terms and Conditions

Patriot Act Notice

eSign Notice

Taxpayer Identification Number Certification




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