1225 Form 8915-F (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8915f.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Form

(Rev. December 2025)

Department of the Treasury Internal Revenue Service

Attach to Form 1040, 1040-SR, or 1040-NR. Go to www.irs.gov/Form8915F for instructions and the latest information.

OMB No. 1545-0074

Attachment Sequence No. 915

Name. If married, file a separate form for each spouse required to file Form 8915-F. See instructions. Your social security number

Before you begin (see instructions for details):

• Use Form 8915-F for 2021 and later disasters. Also, use it after 2020 for coronavirus-related and other 2020 disasters instead of Form 8915-E.

• Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the only qualified disasters and their FEMA numbers for item C.

• “This year” (as used on this form) is the year of the form you check in item A next. For example, if you check 2022, “this year” is 2022.

Complete items A and B below. Complete item C and check the box in item D for the coronavirus, as applicable.

A Tax year for which you are filing form (check only one box):

2021 2022 2023 2024 2025 2026 2027 2028 Other

B Calendar year in which qualified disaster(s) began (check only one box):

2020 2021 2022 2023 2024 2025 2026 2027 Other

C FEMA number for each of your qualified disasters for the year checked in item B above. Use item D, not item C, for the coronavirus.

(1) (2) (3) (4) (5) (6)

D If your only disaster, or one of your disasters, is the coronavirus, check this box Don’t list the coronavirus in item C.

Which lines on this form should I use? See CHARTS 1 and 2 below.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 75585Y Form 8915-F (Rev. 12-2025) Created 5/23/25

Form 8915-F (Rev. 12-2025) Page 2 Part I Total Distributions From All Retirement Plans (Including IRAs) (see instructions) Caution: Complete Part I if, this year, you have qualified disaster distributions (see instructions) for disasters listed in item C earlier. Part I Disaster Table. Provide the information requested below for the disaster(s) in item C earlier for which you are reporting qualified disaster distributions in this part.

Disaster FEMA number* Disaster declaration date* Disaster beginning date*

• Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the FEMA number, Disaster declaration date, and Disaster beginning date for the disaster(s) listed in the Part I Disaster Table. If more than two disasters, see instructions and check this box . . . .

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
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1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
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1b
c
Subtract line 1b from line 1a .
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1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
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1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
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1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
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3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
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4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
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5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
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5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
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6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
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7|1a||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
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1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
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1b
c
Subtract line 1b from line 1a .
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1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
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1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
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1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
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3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
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4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
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5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
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5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
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6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
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7|1b||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
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1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
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1b
c
Subtract line 1b from line 1a .
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1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
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1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
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1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
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3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
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4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
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5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
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5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
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6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
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7|1c||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
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1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
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1b
c
Subtract line 1b from line 1a .
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1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
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1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
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1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
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3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
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4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
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5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
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5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
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6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
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7|1d||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
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1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7|1e||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7|2||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7|3||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7|4||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7|5a||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
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.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
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.
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.
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.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
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.
7|5b||||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
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.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
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.
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.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
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.
7|5b||6||

|Date(s) of distribution(s) made this year
If you completed Part I of two or more Forms 8915-F on which you checked the same year in item A but
different years in item B, seePart I in the instructions to figure the amount for lines 2, 3, and 4 in column (a).
(a)
Available
distributions
for this year
(see instructions)
1
See line 1a below to determine whether you need to complete lines 1a through 1e. You
must use Worksheet 1B in the instructions if you are directed to do so in line 1a.
a
(i) If you checked 2021 in item A and 2020 in item B, do one of the following.
• If either you didn’t file 2020 Form 8915-E or, on 2020 Form 8915-E, you only
reported disasters other than those listed in the Part I Disaster Table earlier, skip
lines 1a through 1d, and on line 1e enter $100,000 times the number of disasters
you entered in the Part I Disaster Table.
• Otherwise, complete lines 1a through 1e, entering on line 1a $100,000 times the
number of disasters you entered in the Part I Disaster Table that were also reported
on 2020 Form 8915-E, but do not include the coronavirus.
(ii) If you checked 2021 or later in both item A and item B, do one of the following.
(For 2021 and later disasters, the limit is $22,000, not $100,000, per disaster.)
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F doesn’t list that disaster in item C, skip to line 1e and enter $22,000 there.
• If you listed only one disaster in the Part I Disaster Table and a prior year’s Form
8915-F lists that disaster in item C, complete lines 1a through 1e, entering $22,000
on line 1a.
• Otherwise, for lines 1a through 5, see the instructions to determine whether you
must use Worksheet 1B in the instructions .
.
.
.
.
.
.
.
.
.
.
.
.
1a
**b **Enter the total qualified disaster distributions made to you in prior year(s) for all disasters
in the Part I Disaster Table. See_Part I_ in the instructions
.
.
.
.
.
.
.
.
.
.
1b
c
Subtract line 1b from line 1a .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
**d **

Enter $22,000 ($100,000 if you checked 2020 in item B) times the number of qualified
disasters that you entered in the Part I Disaster Table but didn’t enter in item C on a prior
year’s Form 8915-F, or in Part I of 2020 Form 8915-E if you checked 2020 in item B .
.
1d
e


Total available qualified disaster distribution amount for this year. Enter the sum of
lines 1c and 1d.If the amount on line 1e is zero, complete lines 2 through 4 in column
(a), skip line 5, enter -0- on line 6, and do NOT include, in Part II or III later, amounts for
disasters listed in the Part I Disaster Table .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2
Enter, in column (a), distributions from retirement plans (other than IRAs) made this year
2
3
Enter, in column (a), distributions from traditional IRAs made this year. Traditional IRAs
include traditional SEP IRAs and traditional SIMPLE IRAs .
.
.
.
.
.
.
.
.
.
3
4
Enter, in column (a), distributions from Roth IRAs made this year. Roth IRAs include Roth SEP
IRAs and Roth SIMPLE IRAs
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
5aEnter, on line 5a, column (a), the total distributions from lines 2 through 4 in column (a)
that aren’t qualified disaster distributions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
b
Do (1) through (3) below in the order indicated.
(1) Enter on line 5b, column (a), the sum of lines 2 through 4 in column (a) reduced by the
amount on line 5a.
(2) Enter on line 5b, column (b), the smaller of the amount on line 5b, column (a), or line 1e.
(3) Enter on lines 2 through 4 in column (b) the amounts from lines 2 through 4, respectively,
in column (a)allocated, if needed, by any reasonable method so that the sum of lines 2
through 4 in column (b) equals the amount on line 5b, column (b)
.
.
.
.
.
.
.
5b
**6 **

Total qualified disaster distributions. Enter the amount from line 5b, column (b). The additional tax for
early withdrawals is waived for this amount (see instructions). See Parts II and III, later, for the tax on this
amount .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
**7 **


Taxable amount. Enter the excess of the sum of lines 2 through 4 in column (a) over the amount on line 6.
Report this excess as IRA and/or pension and annuity distributions, as applicable, in accordance with the
instructions for your tax return. All or part of the amount on line 7 may be eligible for the tax benefits in Part
IV. See instructions .
.
.
.
.
.
.
.
.
.
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.
.
.
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.
7|5b||7||

Form 8915-F (Rev. 12-2025)

Form 8915-F (Rev. 12-2025) Page 3 Part II Qualified Disaster Distributions From Retirement Plans (Other Than IRAs) for the Coronavirus and Disaster(s) Listed in Item C

Form 8915-F (Rev. 12-2025)

Form 8915-F (Rev. 12-2025) Page 4 Part IV Qualified Distributions for the Purchase or Construction of a Main Home in the Area of Disaster(s) Listed in Item C

Before you begin: Complete this year’s Form 8606, Nondeductible IRAs, if required.

Caution: Complete Part IV if, this year, you received a qualified distribution (as defined in the instructions) for the purchase or construction of a main home in the area of a disaster listed in item C earlier. You can only repay the distribution during the disaster’s qualified distribution repayment period (see Qualified distribution repayment period in the instructions). If you are allowed to repay the distribution, in whole or in part, after this year, see the instructions. For the applicability of Part IV to other years for disasters listed in item C, see the instructions.

Part IV Disaster Table. Provide the information requested below for the disaster(s) in item C earlier for which you are reporting qualified distributions in this part.

Disaster FEMA number* Disaster declaration date* Disaster beginning date* Disaster ending date*

• Major Disaster Declarations at www.FEMA.gov/disaster/declarations provides the FEMA number, Disaster declaration date, Disaster beginning date, and Disaster ending date for the disaster(s) listed in the Part IV Disaster Table.

Date(s) of qualified distribution(s) received this year

Form 8915-F (Rev. 12-2025)