Instructions:

[L2] Include on line 2 only those amounts you, or others on your
behalf, contributed to your HSA for 2024. Also, include
amounts contributed for 2024 made in 2025 by the
unextended deadline for filing your 2024 federal income tax
return, April 15, 2025. If you were serving in, or in support of,
the U.S. Armed Forces in a designated combat zone or
contingency operation, you may be able to file later. See Pub.
3 for details. Thus, you may contribute to your 2024 HSA
through April 15, 2025, or a later date if you served in a
designated combat zone or contingency operation.

[L3] If you were, or were considered, an eligible individual
for the entire year and you did not change your type of
coverage, enter $4,150 for a self-only HDHP or $8,300 for a
family HDHP on line 3. (See Instructions if not an eligible individual)

[L4] Enter the amount you and your employer contributed to your Archer MSAs for 2020 from Form 8853,
lines 1 and 2. If you or your spouse had family coverage under an HDHP at any time during 2020, also
include any amount contributed to your spouse's Archer MSAs.

[l5] If you were not an eligible individual on the first day of
the last month of your tax year, use the Line 3 Limitation
Chart and Worksheet (in these instructions) to determine the
amount to enter on line 3. (See (6) in this list.)

[L6] If, at the end of 2024, you were age 55 or older and
unmarried or married with self-only HDHP coverage for the
entire year, you can increase the amount determined in (3) or
(4) by $1,000 (the additional contribution amount). The
$1,000 additional contribution amount is not allocable among
spouses, unlike the $8,300 family contribution discussed
below. For the Line 3 Limitation Chart and Worksheet, the
additional contribution amount is included for each month
you are an eligible individual.

[L7] If, at the end of 2024, you were age 55 or older and married,
use the Additional Contribution Amount Worksheet ((See Instructions for Worksheet)) if both of the following apply.
1. You or your spouse had family coverage under an
HDHP and were, or were considered to be, an eligible
individual on the first day of the month.
2. You were not enrolled in Medicare for the month. 

[L14b] Include on line 14b any distributions you received in 2024
that qualified as a rollover contribution to another HSA. See
Rollovers, earlier. Also include any excess contributions (and
the earnings on those excess contributions) included on
line 14a that were withdrawn by the due date, including
extensions, of your return. See the instructions for line 13,
earlier.
