Do I file Form 8853 with Form 1040?

Yes. Form 8853 is attached to your Form 1040 for the year in which MSA distributions or long-term care contract amounts apply. File the worksheet with the return or the return extension when appropriate.

Can Form 8853 be signed electronically?

Yes. Electronic signatures that meet ESIGN (15 U.S.C. ch. 96) and applicable state UETA/ESRA requirements are generally valid for tax return attachments. Ensure the platform captures intent, attribution, and retention per legal standards.

Is a notary required for Form 8853?

No. The IRS does not require notarization for Form 8853 when submitted with Form 1040. Notarization may be needed only if a separate state or third-party process demands it.

What records should I keep?

Keep MSA trustee statements, receipts for qualified medical expenses, insurer schedules, and a copy of the filed Form 8853 for at least three years; retain longer if the IRS audit window or state rules require it.

What if amounts disagree with trustee statements?

Reconcile differences promptly with the trustee and amend the return if necessary. Retain correspondence and corrected statements to support any later adjustments.

Who must sign the form?

The taxpayer must sign the return. If a paid preparer completes Form 8853, the preparer must sign where required on the return and include preparer information as instructed by the IRS.

Electronic Signature
Templates
Insurance
Form 8853 Archer MSAs and Long Term Care Insurance Contracts

Form 8853 Archer MSAs and Long Term Care Insurance Contracts

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What Form 8853 Is and when it applies

Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, is an IRS information and reporting worksheet used to report Archer Medical Savings Account (MSA) contributions and distributions and certain long-term care insurance contract amounts. Taxpayers who established Archer MSAs, received distributions from an MSA, or who may have to include long-term care contract amounts must complete Form 8853 and attach it to their individual tax return (Form 1040). The form documents taxable distributions, qualified medical expenses paid from an MSA, and tax consequences for nonqualified distributions or excess contributions.

Why completing Form 8853 correctly matters

Accurate completion determines taxable income and potential additional tax on nonqualified Archer MSA distributions and documents long-term care insurance amounts relevant to exclusions or limits. Proper reporting avoids IRS adjustments and helps tax professionals reconcile MSA activity with Form 1040 entries.

Who typically completes Form 8853

Form 8853 is completed by individual taxpayers and their tax preparers when Archer MSA or qualifying long-term care insurance activity occurred during the tax year.

Self-filed taxpayers with Archer MSAs who report distributions or excess contributions.
CPAs and enrolled agents preparing individual returns involving MSA or LTC items.
Employers or benefits administrators when reconciling Archer MSA plan reporting for staff guidance.

Preparers should confirm payer records and MSA trustee statements before entering amounts to ensure consistency with IRS reporting and elimination of duplicate entries.

Step-by-step: fill and review Form 8853

Follow these sequential steps to complete Form 8853 accurately and attach it to the appropriate return.

01

Gather documents: Collect MSA trustee statements and long-term care policy statements.
02

Fill identification: Enter name, SSN, and tax year exactly as on Form 1040.
03

Calculate amounts: Compute distributions, qualified expenses, and taxable portions.
04

Attach and file: Attach Form 8853 to Form 1040 before submitting the return.

Where Form 8853 fits in your filing workflow

Form 8853 is an attachment to the individual income tax return; include it in the same filing package whether filing electronically or on paper.

Prepare Form 1040: Complete Form 1040 primary sections before adding Form 8853.
Complete Form 8853: Enter MSA and LTC items and compute taxable amounts.
Attach to return: Include Form 8853 with Form 1040 electronic file or paper submission.
Retain records: Keep MSA trustee statements and receipts for substantiation.

Set up a digital workflow for Form 8853

Configure fields and signature order in your eSignature platform before sharing the form with the taxpayer and preparer.

Field	Configuration
Identification fields	Require exact-name validation; single-line text
Numeric fields	Use currency format with two decimals
Attachments	Allow PDF upload for MSA trustee statements
Signature	Place signer blocks in taxpayer then preparer order

Digital signing and submission considerations

Use a platform that supports audit trails, secure storage, and flexible signer authentication for Form 8853 workflows.

Document formats: PDF and DOCX accepted
Authentication: Email + SMS code recommended
Audit trail: Timestamp, IP, and action log

Ensure the chosen provider supports ESIGN/UETA compliance and, where applicable for healthcare-adjacent data, HIPAA-ready configurations via a BAA.

Key filing dates for Form 8853 and related returns

Form 8853 is filed with the taxpayer's individual income tax return; observe the same deadlines and extension rules that apply to Form 1040.

Form 1040 due date:

April 15 for most taxpayers

Extension deadline:

October 15 with timely Form 4868 extension

Attach at filing:

File Form 8853 with the original return or extension

Late filing:

Penalties and interest may apply

Recordkeeping:

Retain supporting receipts for substantiation

Common mistakes to avoid when preparing Form 8853

Mixing Archer MSA and HSA amounts, causing misreporting of contributions or distributions.
Failing to attach supporting trustee statements, making it difficult to substantiate distributions or qualified expenses.
Rounding or truncating dollar amounts incorrectly, which can lead to mismatches with payer records.
Using incorrect taxpayer identification, which can delay processing or trigger IRS notices.

Potential penalties and tax risks

Incorrect reporting: Additional tax assessed

Late filing: Late-filing penalty

Unsubstantiated expenses: Disallowed deductions

Excess contributions: Penalty tax on excess

Identity mismatch: Processing delays

Intentional disregard: Higher penalties

Required information and essential fields at a glance

Taxpayer name: Primary filer name

Social Security number: 9-digit SSN

Tax year: Calendar year

MSA distributions: Total distributions

MSA contributions: Contributions reported

LTC contract amounts: Reported premiums/amounts

Core sections and attachments expected on Form 8853

Form 8853 contains dedicated parts for reporting Archer MSA contributions and distributions and for reporting long-term care insurance contract amounts; attachments and instructions clarify calculation details.

Part I — Archer MSA

Reports Archer MSA distributions and identifies amounts used for qualified medical expenses, which determine taxable and nontaxable portions reported to Form 1040.

Part II — Distributions

Breaks out distributions from Archer MSA accounts and calculates additional tax on nonqualified distributions when applicable.

Part III — LTC contracts

Reports qualifying long-term care insurance contract amounts and any exclusions or limits that affect taxable income.

Instructions

IRS instructions explain definitions, computation examples, and where to enter amounts on Form 1040.

Supporting statements

Attach trustee statements, receipts, or insurer schedules that substantiate distributions or premiums claimed.

Filing linkage

Amounts from Form 8853 flow to specific lines on Form 1040 and must reconcile with return totals.

Sample eSignature pricing and capability comparison for Form 8853 workflows

This comparison highlights starting prices and key capabilities for common eSignature vendors used to collect taxpayer signatures and supporting documentation.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes (Business Premium)	Varies	Varies	Varies	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently asked questions about Form 8853 and e-signing

Answers address common procedural and electronic signature concerns for taxpayers completing Form 8853.

Need help? Contact support

Do I file Form 8853 with Form 1040?
Yes. Form 8853 is attached to your Form 1040 for the year in which MSA distributions or long-term care contract amounts apply. File the worksheet with the return or the return extension when appropriate.
Can Form 8853 be signed electronically?
Yes. Electronic signatures that meet ESIGN (15 U.S.C. ch. 96) and applicable state UETA/ESRA requirements are generally valid for tax return attachments. Ensure the platform captures intent, attribution, and retention per legal standards.
Is a notary required for Form 8853?
No. The IRS does not require notarization for Form 8853 when submitted with Form 1040. Notarization may be needed only if a separate state or third-party process demands it.
What records should I keep?
Keep MSA trustee statements, receipts for qualified medical expenses, insurer schedules, and a copy of the filed Form 8853 for at least three years; retain longer if the IRS audit window or state rules require it.
What if amounts disagree with trustee statements?
Reconcile differences promptly with the trustee and amend the return if necessary. Retain correspondence and corrected statements to support any later adjustments.
Who must sign the form?
The taxpayer must sign the return. If a paid preparer completes Form 8853, the preparer must sign where required on the return and include preparer information as instructed by the IRS.

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