Health Savings Account (HSAs) HSA Forms HSA Application #3500 Beneficiary Designation Form #3301 Eligibility Form #3109 Transfer Request #3302 Rollover Certification #3103 Withdrawal Statement #3314 Contribution/Investment Form #3107 On-Line Banking & Debit Card Application#3000  Qualified Funding Distribution #3322     Links to More Information Health Savings Account, Qualified Expenses Health Savings Account and Other Tax-Favored Health Plans Employer Comparable Contributions to Health Savings Accounts under Section 4980G