Chapter 19 - Health Savings Account HSA Reporting Penalties VIOLATION Failure to provide a copy of the plan agreement (e.g., Form 5305-B or 5305-C) Failure to timely file Form 5498-SA with the IRS Failure to timely file Form 1099-SA with the IRS Failure to provide Form 1099-SA to the HSA owner or beneficiary Failure to provide an account statement (generally copy B of Form 5498-SA) to the HSA owner PENALTY $50 for each failure [IRC §6693(a)] $50 for each failure, no maximum [IRC §6693(a); §223(h)(1)] $50 for each failure, no maximum [IRC §6693(a); §223(h)(1)] $50 for each failure, no maximum [IRC §6693(a); §223(h)(1)] $50 for each failure, no maximum [IRC §6693(a); §223(h)(1)] IRA Digital Reference Manual © PMC