I received a 1099-qa for taking less then $300 out of a Pennsylvania ABLE account. I receive disability but not taxable disability. Do I need to file a tax return?

It is only taxable if you used the money for something other than the support of a disable person.   If you used the money for the support of a disabled person, it is not taxable and you don't report it.   If you used it for something else, you can search for 1099-qa and use the jump to link to report it.