Specific Instructions

Name and social security number (SSN).   If you file a joint return, enter only the name and SSN of the spouse whose information is being reported on Form 8930. If both you and your spouse are required to file Form 8930, file a separate Form 8930 for each of you.

Part I—Qualified Disaster Recovery Assistance Distributions From Retirement Plans (other than IRAs)

Complete Part I if you made a repayment of a qualified disaster recovery assistance distribution.

Line 4

At any time during the 3-year period after the date you received a qualified disaster recovery assistance distribution, you can repay any portion of the distribution to an eligible retirement plan that is permitted to accept rollover contributions. You cannot, however, repay more than the amount of the original distribution. See Repayment of a Qualified Disaster Recovery Assistance Distribution, earlier, for details.

Enter on line 4 the amount of any repayments you made during 2012. Do not include any repayments you included on your 2011 Form 8930.

Example.

You received a $90,000 qualified disaster recovery assistance distribution on June 9, 2009, from your 401(k) plan because of the severe storms in the Midwestern disaster areas. On April 1, 2012, you repay $30,000 to an IRA. You would enter the $30,000 repayment on line 4.

Line 5

If you have an amount on line 5, you may be able to carry this amount back to your 2009, 2010, or 2011 return and reduce the amount of tax. For more information, see Amending Form 8930, earlier.

Part II—Qualified Disaster Recovery Assistance Distributions From Traditional, SEP, SIMPLE, and Roth IRAs

Complete Part II if you made a repayment of a qualified disaster recovery assistance distribution.

Line 9

At any time during the 3-year period after the date you received a qualified disaster recovery assistance distribution, you can repay any portion of the distribution to an eligible retirement plan that is permitted to accept rollover contributions. You cannot, however, repay more than the amount of the original distribution. See Repayment of a Qualified Disaster Recovery Assistance Distribution, earlier, for details.

Enter on line 9 the amount of any repayments you made during 2012. Do not include any repayments you included on your 2011 Form 8930.

Example.

You received a $90,000 qualified disaster recovery assistance distribution on October 1, 2009, from your Roth IRA because of the severe storms in the Midwestern disaster areas. On April 1, 2012, you repay $30,000 to your Roth IRA. You would enter the $30,000 repayment on line 9.

Line 10

If you have an amount on line 10, you may be able to carry this amount back to your 2009, 2010, or 2011 return and reduce the amount of tax. For more information, see Amending Form 8930, earlier.


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