Revenue

Procedure

2022-25

Reprinted from IR Bulletin 2022-27 Dated July 05, 2022

Publication 1179

General Rules and Specifications for Substitute Forms 1096, 1098, 1099, 5498, and Certain Other Information Returns

IRS

Department of the Treasury

Internal Revenue Service

Publication 1179 (Rev. 07-2022)

Catalog Number 47022Q

www.irs.gov

NOTE. This revenue procedure will be reproduced as the next revision of IRS Publication 1179, General Rules and Specifications for Substitute Forms 1096, 1098, 1099, 5498, and Certain Other Information Returns.

Forms and instructions. (Also, Part 1, Sections 101, 162(f), 170, 199A, 220, 223,

401(a), 403(a), 403(b), 408, 408A, 457(b), 529, 529A, 530, 853A, 892, 1400Z-1,

1400Z–2, 1441, 6041, 6041A, 6042, 6043, 6044, 6045, 6047, 6049, 6050A, 6050B,

6050D, 6050E, 6050H, 6050J, 6050N, 6050P, 6050Q, 6050R, 6050S, 6050U, 6050W,

6050X, 6050Y, 6071, 1.402A-2, 1.408-5, 1.408-7, 1.408-8, 1.408A-7, 1.1441-1 through

1.1441-5, 1.1471-4, 1.6041-1, 1.6042-2, 1.6042-4, 1.6043-4, 1.6044-2, 1.6044-5,

1.6045-1, 1.6045-2, 1.6045-4, 1.6047-1, 1.6047-2, 1.6049-4, 1.6049-6, 1.6049-7,

1.6050A-1, 1.6050B-1, 1.6050D-1, 1.6050E-1, 1.6050H-1, 1.6050H-2, 1.6050J-1T,

1.6050N-1, 1.6050P-1, 1. 6050S-1, 1.6050S-3, 1.6050W-1, 1.6050W-2, 1.6050X-1,

1.6050Y-1, 1.6050Y-2, 1.6050Y-3.)

Rev. Proc. 2022-25

TABLE OF CONTENTS

Part 1 – GENERAL INFORMATION

Section 1.1 – Overview of Revenue Procedure 2022-25 /What's New. . . . . . . . . . . . . . 1

Section 1.2 – Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Section 1.3 – General Requirements for Acceptable Substitute Forms 1096, 1097-

BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S. . . . . . . . . . . . . 6

Part 2 – SPECIFICATIONS FOR SUBSTITUTE FORMS 1096 AND COPIES A OF FORMS 1098, 1099, 3921, 3922, AND 5498 (ALL FILED WITH THE IRS)

Section 2.1 – Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Section 2.2 – Instructions for Preparing Paper Forms That Will Be Filed With the

IRS ............................................... 14

Part 3 – SPECIFICATIONS FOR SUBSTITUTE FORM W-2G (FILED WITH THE IRS)

Section 3.1 – General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Section 3.2 – Specifications for Copy A of Form W-2G . . . . . . . . . . . . . . . . . . . . . . 17

Part 4 – SUBSTITUTE STATEMENTS TO FORM RECIPIENTS AND FORM RECIPIENT COPIES

Section 4.1 – Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Section 4.2 – Composite Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Section 4.3 – Additional Information for Substitute and Composite Forms 1099-B. . . .24

Section 4.4 – Required Legends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Section 4.5 – Miscellaneous Instructions for Copies B, C, D, E, 1, and 2 . . . . . . . . . . . 27

Section 4.6 – Electronic Delivery of Recipient Statements. . . . . . . . . . . . . . . . . . . .29

Part 5 – ADDITIONAL INSTRUCTIONS FOR SUBSTITUTE FORMS 1097-BTC, 1098, 1099, 5498, W-2G, AND 1042-S

Section 5.1 – Paper Substitutes for Form 1042-S. . . . . . . . . . . . . . . . . . . . . . . . . .31

Section 5.2 – OMB Requirements for All Forms in This Revenue Procedure. . . . . . . .33

Section 5.3 – Ordering Forms and Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Section 5.4 – Effect on Other Revenue Procedures. . . . . . . . . . . . . . . . . . . . . . . . .34

Part 6 – EXHIBITS

Section 6.1 – Exhibits of Forms in This Revenue Procedure. . . . . . . . . . . . . . . . . . .34

Part 1

General Information

Section 1.1 – Overview of Revenue Procedure 2022-25 /What's New

1.1.1

Purpose

1.1.2

Which Forms Are Covered?

The purpose of this revenue procedure is to set forth the 2022 requirements for:

Using official Internal Revenue Service (IRS) forms to file information returns with the IRS,

Preparing acceptable substitutes of the official IRS forms to file information returns with the IRS, and

Using official or acceptable substitute forms to furnish information to recipients.

This revenue procedure contains specifications for these information returns:

Form	Title
1096	Annual Summary and Transmittal of U.S. Information Returns
1097-BTC	Bond Tax Credit
1098	Mortgage Interest Statement
1098-C	Contributions of Motor Vehicles, Boats, and Airplanes
1098-E	Student Loan Interest Statement
1098-F	Fines, Penalties, and Other Amounts
1098-MA	Mortgage Assistance Payments
1098-Q	Qualifying Longevity Annuity Contract Information
1098-T	Tuition Statement
1099-A	Acquisition or Abandonment of Secured Property
1099-B	Proceeds From Broker and Barter Exchange Transactions
1099-C	Cancellation of Debt
1099-CAP	Changes in Corporate Control and Capital Structure
1099-DIV	Dividends and Distributions
1099-G	Certain Government Payments
1099-H	Health Coverage Tax Credit (HCTC) Advance Payments
1099-INT	Interest Income
1099-K	Payment Card and Third Party Network Transactions
1099-LS	Reportable Life Insurance Sale
1099-LTC	Long-Term Care and Accelerated Death Benefits
1099-MISC	Miscellaneous Information
1099-NEC	Nonemployee Compensation
1099-OID	Original Issue Discount
1099-PATR	Taxable Distributions Received From Cooperatives
1099-Q	Payments From Qualified Education Programs (Under Sections 529 and 530)

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1.1.3

Scope

Form	Title
1099-QA	Distributions From ABLE Accounts
1099-R	Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans,
	IRAs, Insurance Contracts, etc.

1099-S	Proceeds From Real Estate Transactions
1099-SA	Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
1099-SB	Seller's Investment in Life Insurance Contract
3921	Exercise of an Incentive Stock Option Under Section 422(b)
3922	Transfer of Stock Acquired Through An Employee Stock Purchase Plan
	Under Section 423(c)

5498	IRA Contribution Information
5498-ESA	Coverdell ESA Contribution Information
5498-QA	ABLE Account Contribution Information
5498-SA	HSA, Archer MSA, or Medicare Advantage MSA Information
W-2G	Certain Gambling Winnings
1042-S	Foreign Person’s U.S. Source Income Subject to Withholding

For purposes of this revenue procedure, a substitute form or statement is one that is not published by the IRS. For a substitute form or statement to be acceptable to the IRS, it must conform to the official form or the specifications outlined in this revenue procedure. Do not submit any substitute forms or statements listed above to the IRS for approval. Privately published forms may not state, “This is an IRS approved form.”

Filers making payments to certain recipients during a calendar year are required by the Internal Revenue Code (the Code) to file information returns with the IRS for these payments. These filers must also provide this information to their recipients. In some cases, this also applies to payments received. See Part 4 for specifications that apply to recipient statements (generally Copy B).

In general, section 6011 of the Code authorizes the Secretary of Treasury to publish regulations that require filers to file information returns according to those regulations and the corresponding forms and instructions. A filer who is required to file 250 or more information returns of any one type during a calendar year must file those returns electronically.

Caution. Financial institutions that are required to report payments made under chapter 3 or 4 must file Forms 1042-S electronically, regardless of the number of returns required to be filed.

Note. If you file electronically, do not file the same returns on paper.

Filers required to file fewer than 250 returns of any one type during a calendar year are encouraged to file the information returns electronically. See the requirements for filing information returns (and providing a copy to a payee) in the 2022 General Instructions for Certain Information Returns and the 2022 Instructions for Form 1042-S. In addition, see the current revision of Publication 1220, Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G, for electronic filing through the IRS FIRE system.

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1.1.4

For More Information

1.1.5

What’s New

The IRS prints and provides the forms on which various payments must be reported. See Section 5.3, later, for ordering forms and instructions. Alternately, filers may prepare substitute copies of these IRS forms and use such forms to report payments to the IRS.

The Internal Revenue Service/Information Returns Branch (IRS/IRB) maintains a centralized customer service call site to answer questions related to information returns (Forms W-2, W-3, W-2c, W-3c, 1099

series, 1096, etc.). You can reach the call site at 866-455-7438 (toll-free) or outside the United States 304-263-8700 (not a toll-free number). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not a toll-free number).

You may also send questions to the call site via the Internet at mccirp@irs.gov.

IRS/IRB does not process information returns which are filed on paper

forms. See Publication 1220 for information on waivers and extensions

of time.^CAUTION

For other tax information related to business returns or accounts, call 800-829-4933. Persons with hearing or speech disabilities with access to TTY/TDD equipment can call 800-829-4059 to ask tax account

questions or to order forms and publications.

Further information impacting Publication 1179, such as issues TIP arising after its final release, will be posted on IRS.gov at IRS.gov/

pub1179.

The following changes have been made to this year’s revenue procedure. For further information about each form listed below, see the separate reporting instructions.

Electronic filing of returns. The Taxpayer First Act of 2019, enacted July 1, 2019, authorized the Department of the Treasury and the IRS to issue regulations that reduce the 250-return requirement for 2022 tax returns. If final regulations are issued and effective for 2022 tax returns required to be filed in 2023, we will post an article at IRS.gov explaining the change. Until final regulations are issued, however, the number remains at 250, as reflected in these instructions.

Electronic filing of Forms 1099. Under Section 2102 of the Taxpayer First Act, the IRS is developing an Internet portal that will allow taxpayers to electronically file Forms 1099 after December 31, 2022 , as an alternative to using the Filing Information Returns Electronically (FIRE) system. See Part F in the General Instructions for Certain Information Returns for 2022 or go to IRS.gov for additional information and updates.

Form 1099-H. The Health Coverage Tax Credit expired on December 31, 2021. The form is listed for reference purposes only.

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New Form 1098-F filing requirement. File Form 1098-F, Fines, Penalties and Other Amounts, to report payments made under suits and agreements which are binding on or after January 1, 2022. See T.D. 9946, available at IRS.gov/ TD9946. For the latest filing information, see IRS.gov/Form1098F.

Continuous use conversion. Forms 1098, 1099-A, 1099-C, 1099-DIV, 1099-G, 1099-INT, 1099-K, 1099-MISC, 1099-NEC, and 1099-S and their instructions have been converted from annual updates to continuous use. The form and its instructions will be updated as needed.

Form 1099-DIV new box 11. The “FATCA filing requirement” checkbox has been assigned box number 11. Subsequently, box numbers 11 through 15 have been renumbered 12 through 16, respectively.

Form 1099-MISC new box 13. The “FATCA filing requirement” checkbox has been assigned box number 13. Subsequently, box numbers 13 through 17 have been renumbered 14 through 18, respectively.

Exhibits. All of the exhibits in this publication were updated to include all of the 2022 revisions of those forms that have been revised.

Editorial changes. We made editorial changes throughout, including updated references. Redundancies were eliminated as much as possible.

Available Instructions

In addition to the general instructions, which contain general information concerning Forms 1096, 1097, 1098, 1099, 3921, 3922, 5498, and W-2G, specific form instructions are provided separately. Use the instructions to prepare acceptable substitutes of the official IRS forms to file information returns with the IRS.

Instructions for Form 1097-BTC.

Instructions for Form 1098.

Instructions for Form 1098-C.

Instructions for Forms 1098-E and 1098-T.

Instructions for Form 1098-F.

Instructions for Form 1098-Q.

Instructions for Forms 1099-A and 1099-C.

Instructions for Form 1099-B.

Instructions for Form 1099-CAP.

Instructions for Form 1099-DIV.

Instructions for Form 1099-G.

Instructions for Form 1099-H.

Instructions for Forms 1099-INT and 1099-OID.

Instructions for Form 1099-K.

4

Instructions for Form 1099-LS.

Instructions for Form 1099-LTC.

Instructions for Forms 1099-MISC and 1099-NEC.

Instructions for Form 1099-PATR.

Instructions for Form 1099-Q.

Instructions for Forms 1099-QA and 5498-QA.

Instructions for Forms 1099-R and 5498.

Instructions for Form 1099-S.

Instructions for Form 1099-SB.

Instructions for Forms 3921 and 3922.

Instructions for Form 5498-ESA.

Instructions for Forms W-2G and 5754.

You can also obtain the latest developments for each of the forms and instructions listed here by visiting their information pages at IRS.gov. See the separate instructions for each form on the webpage via the link.

Section 1.2 – Definitions

1.2.1

Form Recipient

1.2.2

Filer

1.2.3

Substitute Form

Form recipient means the person to whom you are required by law to furnish a copy of the official form or information statement. The form recipient may be referred to by different names on various Forms 1099 and related forms (beneficiary, borrower, debtor, donor, employee, filer, homeowner, insured, participant, payee, payer, payer/borrower, payment recipient, policyholder, seller, shareholder, student, transferor, or, in the case of Form W-2G, the winner). See Section 1.3.4.

Filer means the person or organization required by law to file with the IRS a form listed in Section 1.1.2 with the IRS. A filer may be a payer, creditor, payment settlement entity, recipient of mortgage or student loan interest payments, educational institution, broker, barter exchange, person reporting real estate transactions; a trustee or issuer of any educational or ABLE Act savings account, individual retirement arrangement, or medical savings account; a lender who acquires an interest in secured property or who has reason to know that the property has been abandoned; a corporation reporting a change in control and capital structure or transfer of stock to an employee; certain donees of motor vehicles, boats, and airplanes; or an acquirer or issuer of a life insurance contract.

Substitute form means a paper substitute of Copy A of an official form listed in Section 1.1.2 that completely conforms to the provisions in this revenue procedure.

5

1.2.4

Substitute Form Recipient Statement (recipient statement)

1.2.5

Composite

Substitute

Statement

Substitute form recipient statement means a paper or electronic statement of the information reported on a form listed in Section 1.1.2. For the remainder of this revenue procedure, we will refer to this as a recipient statement. This statement must be furnished to a person (form recipient), as defined under the applicable provisions of the Code and the applicable regulations.

Composite substitute statement means one in which two or more required statements (for example, Forms 1099-INT and 1099-DIV) are furnished to the recipient on one document. However, each statement must be designated separately and must contain all the requisite Form 1099 information except as provided under Section 4.2. A composite statement may not be filed with the IRS.

Section 1.3 – General Requirements for Acceptable Substitute Forms 1096, 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S

1.3.1

Introduction

Paper substitutes for Form 1096 and Copy A of Forms 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S that completely conform to the specifications listed in this revenue procedure may be privately printed and filed as returns with the IRS. The reference to the Department of the Treasury– Internal Revenue Service should be included on all such forms.

If you are uncertain of any specification and want it clarified, you may submit a letter citing the specification, stating your understanding and interpretation of the specification, and enclosing an example of the form (if appropriate) to:

1.3.2

Logos, Slogans,

and

Advertisements

Internal Revenue Service

Attn: Substitute Forms Program

SE:W:CAR:MP:P:TP

1111 Constitution Ave. NW

Room 6554

Washington, DC 20224

Note. Allow at least 30 days for the IRS to respond.

You may also contact the Substitute Forms Program via email at substituteforms@irs.gov. Please enter “Substitute Forms” on the Subject Line.

Forms 1096, 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S are subject to annual review and possible change. Therefore, filers are cautioned against overstocking supplies of privately printed substitutes.

Some Forms 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S that include logos, slogans, and advertisements may not be recognized as important tax documents. A payee may not recognize the importance of the payee copy for tax reporting purposes due to the use of logos, slogans, and advertisements. Accordingly, the IRS has determined that logos, slogans, and advertising are not

6

1.3.3

Copy A

Specifications

allowed on the payee copies of the above forms, on Copy A filed with the IRS, or on Form 1096, with the following exceptions:

The exact name of the payer, broker, or agent, primary trade name, trademark, service mark, or symbol of the payer, broker, or agent, an embossment or watermark on the information return and payee copies that is a representation of the name, a primary trade name, trademark, service mark, or symbol of the payer, broker, or agent, that is;

Presented in any typeface, font, stylized fashion, or print color normally used by the payer, broker, or agent, and used in a non-intrusive manner; and

As long as these items do not materially interfere with the ability of the recipient to recognize, understand, and use the tax information on the payee copies.

The IRS e-file logo on the IRS official payee copies may be included, but it is not required, on any of the substitute form copies.

The information return and payee copies must clearly identify the payer’s name associated with its employer identification number.

Logos and slogans may be used on permissible enclosures, such as a check or account statement, other than information returns and payee copies.

If you have comments about the restrictions on including logos, slogans, and advertising on information returns and payee copies, send your comments to:

Internal Revenue Service

Attn: Substitute Forms Program

SE:W:CAR:MP:P:TP

1111 Constitution Ave. NW

Room 6554

Washington, DC 20224

or email them to substituteforms@irs.gov.

Proposed substitutes of Copy A must be exact replicas of the official IRS form with respect to layout and content. Proposed substitutes for Copy A that do not conform to the specifications in this revenue procedure are not acceptable.

Further, if you file such forms with the IRS, you may be subject to a penalty for failure to file a correct information return under section 6721 of the Code. The amount of the penalty is based on when you file the correct information return.

Penalties The amounts of the penalty for returns required to be filed in 2023 is shown in Part O, Penalties in the 2022 General Instructions for Certain Information Returns.

7

1.3.4

Copy B and Copy C Specifications

Copy B and Copy C of the following forms must contain the information in Part 4 to be considered a “statement” or “official form” under the applicable provisions of the Code. The format of this information is at the discretion of the filer with the exception of the location of the tax year, form number, form name, and the information for composite Form 1099 statements as outlined under Section 4.2.

Copy B, of the forms below, is for the following recipients.

Form	Recipient
1098	For Payer/Borrower
1098-C	For Donor
1098-E; 1099-A	For Borrower
1098-F	For Payer
1098-MA	For Homeowner
1098-Q	For Participant
1098-T	For Student
1099-C	For Debtor
1099-CAP	For Shareholder
1099-K	For Payee
1099-LS	For Payment Recipient
1099-LTC	For Policyholder
1099-R; W-2G	Copy B may be required to be attached to the filer's federal
	income tax return.

1099-S	For Transferor
1099-SB	For Seller
All remaining Forms 1099;	For Recipient
1097-BTC;1042-S

3921; 3922	For Employee
5498; 5498-SA	For Participant
5498-QA; 5498-ESA	For Beneficiary

Copy C of the following forms is for the following recipients.

Form	Recipient
1097-BTC	For Payer
1098	For Recipient/Lender
1098-C	For Donor’s Records
1042-S; 1098-E	For Recipient
1098-F; 1098-MA; 1098-T;	For Filer
1099-K

1098-Q	For Issuer
1099-CAP; 3921; 3922	For Corporation
1099-LTC	For Insured

8

Form	Recipient
1099-QA	For Payer
1099-R	For Recipient’s Records
All other Forms 1099	See Section 4.5.2
5498	For Trustee or Issuer
5498-ESA; 5498-SA	For Trustee
5498-QA	For Issuer
W-2G	For Winner’s Records

Note. On Copy C, Form 1099-LTC, you may reverse the locations of the policyholder’s and the insured’s name, street address, city, state, and ZIP code for easier mailing.

Part 2

Specifications for Substitute Forms 1096 and Copies A of Forms 1098, 1099, 3921, 3922, and 5498 (All Filed With the IRS)

Section 2.1 – Specifications

2.1.1

Online Fillable Forms

Due to the very low volume of paper Forms 1097-BTC, 1098-C, 1098–F, 1098-MA, 1099-A, 1099-CAP, 1099-LTC, 1099-Q, 1099-QA, 1099-SA, 3922, 5498-ESA, 5498-QA, and 5498-SA received and processed by the IRS each year, these forms have been converted to fillable online PDFs.

Note. The instructions for substitute Forms 1042-S, also a fillable online format, are found separately in Part 5.

These forms in their fillable format can be found at IRS.gov/formspubs.

All the instructions regarding the substitute forms found in Part 1, and Sections 2.1.2, 2.1.7, 2.1.9, and 2.1.10, and the remainder of this publication, unless specified differently immediately below, remain in effect if you are going to produce the online fillable forms as paper or online substitute forms.

Copy A of privately printed substitutes of the forms listed above must be exact replicas of the official forms with respect to layout and content. Use the official form, found on IRS.gov, printed actual size on an 8½ inches by 11 inches sheet of paper. The forms will print one to a page.

All printing must be in high quality nongloss black ink.

Paper for Copy A must be white chemical wood bond, or equivalent, 20 pounds (basis 17 x 22-500), plus or minus 5% (0.05); or offset book paper, 50 pounds (basis 25 x 38-500). No optical brighteners may be added to the pulp or paper during manufacture. The paper must consist

9

2.1.2

General

Requirements

2.1.3

Color and Paper Quality

of principally bleached chemical wood pulp or recycled printed paper.

It must also be suitably sized to accept ink without feathering.

Note. If you want to print the forms as they formerly appeared to save paper, with the exception of Forms 1097-BTC (printed 2-to-a-page) and 1098-C (single form page), they are all printed 3-to-a-page. Follow the 3-to-a-page measurements in Section 6. Form 1098-C can be found at IRS.gov/Form1098C. Print the form to actual size, no scaling.

Form identifying numbers (for example, 9191 for Form 1099-DIV) must be printed in nonreflective black carbon-based ink in print positions 15 through 19 using an optical character recognition (OCR) A font. The checkboxes to the right of the form identifying numbers must be 10-point boxes. The “VOID” checkbox is in print position 25 (1.9 inches from left vertical line of the form). The “CORRECTED” checkbox is in print position 33 (2.7 inches from left vertical line of the form). Measurements are generally from the left edge of the paper, not including the perforated strip.

The substitute form Copy A must be an exact replica of the official IRS form with respect to layout and content. To determine the correct form measurements, see Exhibits A through CC at the end of this publication.

Hot wax and cold carbon spots are not permitted on any of the internal form plies. These spots are permitted on the back of a mailer top envelope ply.

Use of chemical transfer paper for Copy A is acceptable.

The Government Printing Office (GPO) symbol must be deleted.

Color and paper quality for Copy A (cut sheets and continuous pinfeed forms) as specified by JCP Code 0-25, dated November 29, 1978, must be white 100% bleached chemical wood, OCR bond produced in accordance with the following specifications.

Note. Reclaimed fiber in any percentage is permitted provided the requirements of this standard are met.

Acidity: Ph value, average, not less than	4.5
Basis Weight: 17 x 22-500 cut sheets	18-20
Metric equivalent–g/m²	75
A tolerance of ±5 pct. is allowed.
Stiffness: Average, each direction, not less than-milligrams	50
Tearing strength: Average, each direction, not less than-grams	40
Opacity: Average, not less than-percent	82
Thickness: Average-inch	0.0038
Metric equivalent-mm	0.097
A tolerance of +0.0005 inch (0.0127 mm) is allowed. Paper cannot vary more than
0.0004 inch (0.0102 mm) from one edge to the other.
Porosity: Average, not less than-seconds	10
Finish (smoothness): Average, each side-seconds	20-55

10

2.1.4

Chemical

Transfer Paper

2.1.5

Printing

2.1.6

OCR

Specifications

For information only, the Sheffield equivalent-units	170-100
Dirt: Average, each side, not to exceed-parts per million	8

Chemical transfer paper is permitted for Copy A only if the following standards are met.

Only chemically backed paper is acceptable for Copy A. Front and back chemically treated paper cannot be processed properly by machine.

Carbon-coated forms are not permitted.

Chemically transferred images must be black.

All copies must be clearly legible. Fading must be minimized to assure legibility.

All print on Copy A of Forms 1097-BTC, 1098, 1098-C, 1098-E, 1098-F, 1098-MA, 1098-Q, 1098-T, 1099-A, 1099-B, 1099-C, 1099-DIV, 1099-G,

1099-INT, 1099-K, 1099-LS, 1099-MISC, 1099-NEC, 1099-OID, 1099-PATR, 1099-Q, 1099-R, 1099-S, 1099-SB, 3921, 3922, 5498, and the print on Form 1096 above the statement, “Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.” must be in Flint J-6983 red OCR dropout ink or an exact match. However, the 4-digit form identifying number must be in nonreflective carbon-based black ink in OCR A font.

The shaded areas of any substitute form should generally correspond to the format of the official form.

The printing for the Form 1096 jurat statement and the text that follows may be in any shade or tone of black ink. Black ink should only appear on the lower part of the reverse side of Form 1096, where it will not bleed through and interfere with scanning.

Note. The instructions on the front and back of Form 1096, which include filing addresses, must be printed.

Separation between fields must be 0.1 inch.

Other printing requirements are discussed in Sections 2.1.5 through 2.1.9.

You must initiate, or have, a quality control program to assure OCR ink density. Readings will be made when printed on approved 20 lb. white OCR bond with a reflectance of not less than 80% (0.80). Black ink must not have a reflectance greater than 15% (0.15). These readings are based on requirements of the “BancTec IntelliScan XDS” Optical Scanner using Flint J-6983 red OCR dropout ink or an exact match.

The following testers and ranges are acceptable:

Important information: The forms produced under these specifications must be guaranteed to function properly when processed through High Speed Scan-Optics 9000 mm scanners. Forms require precision spacing, printing, and trimming.

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2.1.7

Typography

2.1.8

Dimensions

Density readings on the solid J-6983 (red) must be between the ranges of 0.95 to 0.90. The optimal scanning range is 0.93. Density readings on the solid black must be between the ranges of 112 to 108. The optimal scanning range is 110.

Note. The readings are taken using an Ex-Rite 500 series densitometer, in Status T with Absolute or – paper setting under an Illuminate 5000 Kelvin Watt Light. You must maintain print contrast specification of ink and densitometer reflectivity reading throughout the entire production run.

MacBeth PCM-II. The tested Print Contrast Signal (PCS) values when using the MacBeth PCM-II tester on the “C” scale must range from .01 minimum to .06 maximum.

Kidder 082A. The tested PCS values when using the Kidder 082A tester on the Infra Red (IR) scale must range from .12 minimum to .21 maximum. White calibration disc must be 100%. Sensitivity must be set at one (1).

Alternative testers must be approved by the IRS to establish tested PCS values. You may obtain approval by writing to the following address:

Commissioner of Internal Revenue

Attn: SE:W:CAR:MP:P:TP

Business Publishing – Tax Products

1111 Constitution Ave. NW

Room 6554

Washington, DC 20224

Type must be substantially identical in size and shape to the official form. All rules are either 1/2-point or 3/4-point. Rules must be identical to those on the official IRS form.

Note. The form identifying number must be nonreflective carbon-based black ink in OCR A font.

Generally, three Copies A of Forms 1098, 1099, 3921, and 3922 are contained on a single page (3-to-a-page), 8 inches wide (without any snap-stubs and/or pinfeed holes) by 11 inches deep.

Exceptions. Forms 1097-BTC, 1098, 1098-Q, 1099-B, 1099-DIV, 1099-INT, 1099-K, 1099-MISC, 1099-OID, 1099-R, and 5498 contain two copies on a single page (2-to-a-page). Forms 1098-C and 1042-S are single-page documents.

There is a 0.33 inch top margin from the top of the corrected box, and a 0.2 to 0.25 inch right margin, with a +/- 1/20 (0.05) inch tolerance for the right margin. If the right and top margins are properly aligned, the left margin for all forms will be correct. All margins must be free of print. See Exhibits A through CC in Part 6 for correct form measurements.

These measurements are constant for certain Forms 1098, 1099, and 5498.

These measurements are shown only once in this publication, on Form

1097-BTC (Exhibit B) 2-to-a-page and on Form 1098-E (Exhibit E) 3-to-a-page.

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2.1.9

Perforation

2.1.10 Required Inclusions/ Exclusions

Exceptions to these measurements, and form-specific measurements are shown on the rest of the exhibits.

The depth of the individual trim size of each 3-to-a-page form must be 3 2/3 inches, the same depth as the official form, unless otherwise indicated.

The depth of the individual trim size of each 2-to-a-page form is 5 1/2 inches.

Copy A (3-to-a-page and 2-to-a-page) of privately printed continuous substitute forms must be perforated at each 11 inches page depth. No perforations are allowed between forms on the Copy A page.

Exception. Copy A of Form W-2G may be perforated.

The words “Do Not Cut or Separate Forms on This Page” must be printed using Flint J-6983 red OCR dropout ink or an exact match (see Section 2.1.5, earlier) between the 3-to-a-page or 2-to-a-page. This statement should not be included after the last form on the page.

Separations are required between all the other individual copies (Copies B and C, and Copies 1 and 2 of Forms 1099-B, 1099-DIV, 1099-G, 1099-INT,

1099-K, 1099-MISC, 1099-NEC, 1099-OID, 1099-R, and Copy D for Forms 1099–LS, 1099-LTC, 1099-R, and 1042-S) in the set. Any recipient copies printed on a single sheet of paper must be easily separated. The best method of separation is to provide perforations between the individual copies. Each copy should be easily distinguished, whatever method of separation is used.

Note. Perforation does not apply to printouts of copies that are furnished electronically to recipients (as described in Regulations section 31.6051-1(j)). However, these recipients should be cautioned to carefully separate any copies. See Section 4.6.1, later, for information on electronically furnishing statements to recipients.

You must include the OMB Number on Copies A and Form 1096 in the same location as on the official form.

The following Privacy Act and Paperwork Reduction Act Notice phrases must be printed on Copy A of the forms as follows. It must also be printed on the Copy C, D, or E of the form retained by the filer.

“For Privacy Act and Paperwork Reduction Act Notice, see the current version of the General Instructions for Certain Information Returns” on Forms 3921 and 3922.

“For more information and the Privacy Act and Paperwork Reduction Act Notice, see the 2022 General Instructions for Certain Information Returns” on Form 1096.

“For Privacy Act and Paperwork Reduction Act Notice, see instructions” on Form 1042-S.

“For Privacy Act and Paperwork Reduction Act Notice, see the 2022 General Instructions for Certain Information Returns” must be printed on all other forms listed in Section 1.1.2.

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A postal indicia may be used if it meets the following criteria.

It is printed in the OCR ink color prescribed for the form.

No part of the indicia is within one print position of the scannable area.

The printer’s symbol (GPO) must not be printed on substitute Copy A. Instead, the employer identification number (EIN) or the vendor code of the form's printer must be entered in place of the Catalog Number (Cat. No.). The 4-digit vendor code, preceded by four zeros and a slash, for example, 0000/9876, must appear in 12-point Arial font, or a close approximation, on Copy A only of Forms 1096, 1097-BTC, 1098, 1099, 3921, 3922, 5498, and W-2G. The vendor code is used to identify the forms producer. Vendor codes can be obtained free of charge from the National Association of Computerized Tax Processors (NACTP) via email at president@nactp.org. The use of a vendor code is recommended.

Note. Vendor codes from the NACTP are required by those companies producing the 1099 family of forms (Forms 1096, 1097-BTC, 1098, 1099, 3921, 3922, 5498, and W-2G) as part of a product for resale to be used by multiple issuers. Issuers developing 1099 family forms to be used only for their individual company do not require a vendor code.

The Cat. No. shown on the forms is used for IRS distribution purposes and should not be printed on any substitute forms.

The form must not contain the statement “IRS approved” or any similar statement.

Section 2.2 – Instructions for Preparing Paper Forms That Will Be Filed With the IRS

2.2.1

Recipient

Information

The form recipient's name, street address, city, state, ZIP code, and telephone number (if required) should be typed or machine printed in black ink in the same format as shown on the official IRS form. The city, state, and ZIP code must be on the same line.

The following rules apply to the form recipient's name(s).

The name of the appropriate form recipient must be shown on the first or second name line in the area provided for the form recipient's name.

No descriptive information or other name may precede the form recipient's name.

Only one form recipient's name may appear on the first name line of the form.

If multiple recipients’ names are required on the form, enter on the first name line the recipient name that corresponds to the recipient taxpayer identification number (TIN) shown on the form. Place the other form recipients’ names on the second name line (only 2 name lines are allowable).

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2.2.2

Account Number Box

2.2.3

Specifications

and Restrictions

Because certain states require that trust accounts be provided in a different format, filers should generally provide information returns reflecting payments to trust accounts with the:

Trust’s employer identification number (EIN) in the recipient's TIN area,

Trust’s name on the recipient's first name line, and

Name of the trustee on the recipient's second name line.

Although handwritten forms will be accepted, the IRS prefers that filers type or machine print data entries. Also, filers should insert data as directed by shading, or in the middle of blocks, well separated from other printing and guidelines, and take measures to guarantee clear, dark black, sharp images. Photocopies are not acceptable.

Truncating payee identification number on payee statements. Where permitted, filers may truncate a payee's identification number (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)) on the payee statement (including substitute and composite substitute statements) furnished to the payee in paper form or electronically. Generally, the payee statement is that copy of an information return designated "Copy B" on the form. To truncate where allowed, replace the first 5 digits of the 9-digit number with asterisks (*) or Xs (for example, an SSN xxx-xx-xxxx would appear on the paper payee statement as ***-**-xxxx or XXX-XX-xxxx). See Treasury Decision 9675, 2014-31 I.R.B. 242, available at IRS.gov/irb/ 2014-31_IRB#TD-9675.

Caution. Recipient TINs must not be truncated on Copy A filed with the IRS.

Use the account number box on all Forms 1098, 1099, 3921, 3922, 5498, and W-2G for an account number designation when required by the official IRS form. The account number is required if you have multiple accounts for a recipient for whom you are filing more than one information return of the same type. Additionally, the IRS encourages you to include the recipients’ account numbers on paper forms if your system of records uses the account number rather than the name or TIN for identification purposes. Also, the IRS will include the account number in future notices to you about backup withholding. If you are using window envelopes to mail statements to recipients and using reduced rate mail, be sure the account number does not appear in the window. The Postal Service may not accept these for reduced rate mail.

Exception. Form 1098-T can have third-party provider information.

Machine-printed forms should be printed using a 6 lines/inch option, and should be printed in 10 pitch pica (10 print positions per inch) or 12 pitch elite (12 print positions per inch). Proportional spaced fonts are unacceptable.

Substitute forms prepared in continuous or strip form must be burst and stripped to conform to the size specified for a single sheet before they

15

2.2.4

Where To File

are filed with the IRS. The size specified does not include pin feed holes. Pin feed holes must not be present on forms filed with the IRS.

Do not use a felt tip marker. The machine used to “read” paper forms generally cannot read this ink type.

Do not use dollar signs ($), ampersands (&), asterisks (*), commas (,), or other special characters in the numbered money boxes. Exception. Use decimal points to indicate dollars and cents (for example, 2000.00 is acceptable).

Do not use apostrophes (’), asterisks (*), or other special characters on the payee name line.

Do not fold Forms 1097-BTC, 1098, 1099, 3921, 3922, or 5498 mailed to the IRS. Mail these forms flat in an appropriately sized envelope or box. Folded documents cannot be readily moved through the machine used in IRS processing.

Do not staple Forms 1096 to the transmitted returns. Any staple holes near the return code number may impair the IRS’s ability to machine scan the type of documents.

Do not type other information on Copy A.

Do not cut or separate the individual forms on the sheet of forms of Copy A (except Forms W-2G).

Mail completed paper forms to the IRS service center shown in the Instructions for Form 1096 and in the 2022 General Instructions for Certain Information Returns. Specific information needed to complete the forms mentioned in this revenue procedure are given in the specific form instructions. A chart showing which form must be filed to report a particular payment is included in the 2022 General Instructions for Certain Information Returns.

Part 3

Specifications for Substitute Form W-2G (Filed

With the IRS)

Section 3.1 – General

3.1.1

Purpose

The following specifications give the format requirements for substitute Form W-2G (Copy A only), which is filed with the IRS.

A filer may use a substitute Form W-2G to file with the IRS (referred to as “substitute Copy A”). The substitute form must be an exact replica of the official form with respect to layout and content.

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Section 3.2 – Specifications for Copy A of Form W-2G
3.2.1
	You must follow these specifications when printing substitute Copy A of the
Substitute Form
	Form W-2G.
W-2G (Copy A)
	Caution. The payee's TIN (SSN, ITIN, ATIN, or EIN) must not be truncated on

	Copy A of Form W2-G.

	Item	Substitute Form W-2G (Copy A)
		Paper for Copy A must be white chemical wood bond, or equivalent, 20
	Paper Color and	pounds (basis 17 x 22-500), plus or minus 5% (0.05). The paper must
		consist substantially of bleached chemical wood pulp. It must be free
	Quality
		from unbleached or ground wood pulp or post-consumer recycled paper.

		It must also be suitably sized to accept ink without feathering.
	Ink Color and Quality	All printing must be in a high quality nongloss black ink.
		The type must be substantially identical in size and shape to the official
	Typography	form. All rules on the document are either 1/2 point (0.007 inch), 1 point
		(0.015 inch), or 3 point (0.045). Vertical rules must be parallel to the left

		edge of the document; horizontal rules to the top edge.
		The official form is 8 inches wide x 51/2 inches deep, exclusive of a snap
		stub. Any substitute Copy A can be between 8 inches and 81/2 inches
		wide by 5 inches deep. The snap feature is not required on substitutes.
	Dimensions	All margins must be free of print. There is a 0.33 inch top margin from
		the top of the corrected box, and a 1/2 inch left margin. If the top and left

		margins are properly aligned, the right margin for all forms will be
		correct. If the substitute forms are in continuous or strip form, they must
		be burst and stripped to conform to the size specified for a single form.
	Hot Wax and Cold	Hot wax and cold carbon spots are not permitted on any of the internal
	Carbon Spots	form plies. These spots are permitted on the back of a mailer top
		envelope ply.
		The Government Printing Office (GPO) symbol must not be printed on
		substitute Forms W-2G. Instead, the employer identification number
	Printer’s Symbol	(EIN) of the form’s printer must be printed in the bottom margin on the
		face of each individual Copy A on a sheet. The form must not contain
		the statement “IRS approved” or any similar statement.
	Catalog Number	The Catalog Number (Cat. No.) shown on Form W-2G is used for IRS
		distribution purposes and should not be printed on any substitute forms.

Part 4

Substitute Statements to Form Recipients and

Form Recipient Copies

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Section 4.1 – Specifications

4.1.1

Introduction

4.1.2

Substitute

Statements to

Recipients for

Certain Forms

1099-B, 1099-

DIV, 1099-INT,

1099-OID, and

1099-PATR

If you do not use the official IRS form to furnish statements to recipients, you must furnish an acceptable substitute statement. Information presented in substitute statements should be in a point size large enough to be easily read by recipients. To be acceptable, your substitute statement must comply with the rules in this Part. If you are furnishing a substitute form, see Regulations sections 1.6042-4, 1.6044-5, 1.6049-6, and 1.6050N-1 to determine how the following statements must be provided to recipients for most Forms 1099-DIV and 1099-INT, all Forms 1099-OID and 1099-PATR, and Form 1099-MISC, or 1099-S for royalties. Generally, information returns may be furnished electronically with the consent of the recipient. See Section 4.6.1.

Note. A trustee of a grantor-type trust may choose to file Forms 1099 and furnish a statement to the grantor under Regulations sections 1.671-4(b)(2)(iii) and (b)(3)(ii). The statement required by those regulations is not subject to the requirements outlined in this section.

The rules in this section apply to Form 1099-B, 1099-DIV (except for section 404(k) dividends), 1099-INT (except for interest reportable under section 6041), 1099-OID, and 1099-PATR only. You may furnish form recipients with Copy B of the official Form 1099 or a substitute Form 1099 (recipient statement) if it contains the same information as the official IRS form (such as aggregate amounts paid to the form recipient, any backup withholding, the name, address, and TIN of the person making the return, and any other information required by the official form). Information not required by the official form should not be included on the substitute form except for state income tax withholding information. But see Section 4.3 regarding additional information that may be included on substitute and composite Forms 1099-B, such as basis for noncovered securities.

Note. Many of the information returns now include boxes for providing state withholding information as part of the official form, with additional copies for convenience. Payers may, however, provide the state withholding information separately (such as on a separate page or section) in order to assist the payee with completing a state income tax return that requires the attachment of any information return that includes state withholding amounts and payer numbers.

Exception for supplementary information. The substitute form may include supplementary information that will assist the payee with completing his or her tax return. Such information could include expense and cost basis factors related to the reporting for widely held fixed investment trusts (WHFITs), as required under Regulations section 1.671-5. The substitute statement should disclose to the payee that such supplementary information is not furnished to the IRS. See Section 4.3 for additional requirements when providing supplemental information with the Form 1099-B that is not furnished to the IRS.

Form 1099-B. For transactions reportable on Form 8949, brokers that use substitute statements should segregate dispositions of noncovered securities from covered securities, and further segregate long-term and short-term dispositions of covered securities. They may also segregate long-term from short-term dispositions of noncovered securities, to the extent that date acquired

18

is known. For 2022 dispositions, the substitute Forms 1099-B may have up to five separate sections, each with a heading identifying which securities are included in the list, and each separately totaled. Each section, after totaling or within the heading for the section, should indicate how to report the transactions on Form 8949, as indicated.

1. Short-term transactions for which basis is reported to the IRS—Report on Form 8949, Part I, with Box A checked.

2. Short-term transactions for which basis is not reported to the IRS—Report on Form 8949, Part I, with Box B checked.

3. Long-term transactions for which basis is reported to the IRS—Report on Form 8949, Part II, with Box D checked.

4. Long-term transactions for which basis is not reported to the IRS—Report on Form 8949, Part II, with Box E checked.

5. Transactions for which basis is not reported to the IRS and for which short-term or long-term determination is unknown (to Broker). You must determine short-term or long-term based on your records and report on Form 8949, Part I, with Box B checked, or on Form 8949, Part II, with Box E checked, as appropriate.

For each section, each transaction may include information not reported to the IRS, such as basis, date acquired, and gain or loss. Therefore, for short-term dispositions where basis was not reported to the IRS, basis and date acquired may be shown just as it would be shown for short-term dispositions where basis was reported to the IRS.

For 2022 dispositions, each of the applicable sections must have Sales Price and Cost or Other Basis (if known) separately totaled. Net gain or loss, if included for any of the sections, may also be totaled.

Brokers may also use substitute Form 1099-B for transactions that are not directly reported on Form 8949. Examples include transactions involving regulated futures contracts, foreign currency contracts, and section 1256 option contracts. Any additional sections created for this purpose should be segregated from those transactions directly reportable on Form 8949.

The substitute form requirements in the following paragraphs also apply to Form 1099-B.

Form 1099-INT, 1099-DIV, 1099-OID, or 1099-PATR. A substitute recipient statement for Forms 1099-INT, 1099-DIV, 1099-OID, or 1099-PATR must comply with the following requirements.

Box captions and numbers that are applicable must be clearly identified, using the same wording and numbering as on the official form.

The recipient statement (Copy B) must contain all applicable recipient instructions as provided on the front and back of the official IRS form. You may provide those instructions on a separate sheet of paper.

19

The box caption “Federal income tax withheld” must be in boldface type or otherwise highlighted on the recipient statement.

The recipient statement must contain the Office of Management and Budget (OMB) number as shown on the official IRS form. See Section 5.2.

The recipient statement must contain the tax year (for example, 2022), form number (for example, Form 1099-INT), and form name (for example, Interest Income) of the official IRS Form 1099. This information must be displayed prominently together in one area of the statement. For example, the tax year, form number, and form name could be shown in the upper right part of the statement. Each copy must be appropriately labeled (such as Copy B, For Recipient). See Section 4.5.2 for applicable labels and arrangement of assembly of forms. Note. Do not include the words “Substitute for” or “In lieu of” on the recipient statement.

Layout and format of the statement is at the discretion of the filer. However, the IRS encourages the use of boxes so that the statement has the appearance of a form and can be easily distinguished from other nontax statements.

Each recipient statement of Form 1099-B, 1099-DIV, 1099-INT,

1099-OID, or 1099-PATR must include the direct access telephone number of an individual who can answer questions about the statement. Include that telephone number conspicuously anywhere on the recipient statement.

A mutual fund family may furnish one statement (for example, one piece of paper) on which it reports the dividend income earned by a recipient from multiple funds within the family of mutual funds, as required by Form

1099-DIV. However, each fund and its earnings must be stated separately. The statement must contain an instruction to the recipient that each fund’s dividends and name, not the name of the mutual fund family, must be reported on the recipient's tax return. The statement cannot contain an aggregate total of all funds. In addition, a mutual fund family may furnish a single statement (as a single filer) for Form 1099-INT, 1099-DIV, or 1099-OID information (see Section 4.2.1, later). Each fund and its earnings must be stated separately. The statement must contain an instruction to the recipient that each fund’s earnings and name, not the name of the mutual fund family, must be reported on the recipient's tax return. The statement cannot contain an aggregate total of all funds.

You may enter a total of the individual accounts listed on the statement only if they have been paid by the same payer. For example, if you are listing interest paid on several accounts by one financial institution on Form 1099-INT, you may also enter the total interest amount. You may also enter a date next to the corrected box if that box is checked.

20

4.1.3

Substitute

Statements to

Recipients for

Certain Forms

1098, 1099, 5498,

and W-2G

Statements to form recipients for Forms 1097-BTC, 1098, 1098-C, 1098-E, 1098-F, 1098-MA, 1098-Q, 1098-T, 1099-A, 1099-C, 1099-CAP, 1099-G, 1099-K, 1099-LS, 1099-LTC, 1099-MISC, 1099-NEC, 1099-Q, 1099-QA,

1099-R, 1099-S, 1099-SA, 1099-SB, 3921, 3922, 5498, 5498-ESA, 5498-QA, 5498-SA, W-2G, 1099-DIV (only for section 404(k) dividends reportable under section 6047), and 1099-INT (only for interest of $600 or more made in the course of a trade or business reportable under section 6041) can be copies of the official forms or an acceptable substitute.

Caution. The IRS does not require a donee to use Form 1098-C as the written acknowledgment for contributions of motor vehicles, boats, and airplanes. However, if you choose to use copies of Form 1098-C or an acceptable substitute as the written acknowledgment, then you must follow the requirements of this section.

To be acceptable, a substitute recipient statement must meet the following requirements.

The tax year, form number, and form name must be the same as the official form and must be displayed prominently together in one area on the statement. For example, they may be shown in the upper right part of the statement.

The statement must contain the same information as the official IRS form, such as aggregate amounts paid to the form recipient, any backup withholding, the name, address, and TIN of the filer and of the recipient, and any other information required by the official form.

Each substitute recipient statement for Forms W-2G, 1097-BTC, 1098, 1098-C, 1098-E, 1098-F, 1098-T, 1099-A, 1099-C, 1099-CAP,

1099-DIV, 1099-G (excluding state and local income tax refunds), 1099-K, 1099-INT, 1099-LS, 1099-LTC, 1099-MISC (excluding fishing boat proceeds), 1099-NEC, 1099-Q, 1099-R (for qualified long-term care insurance contracts under combined arrangements only), 1099-S, 1099-SA, 1099-SB, and 5498-SA must include the direct access telephone number of an individual who can answer questions about the statement.

Include the telephone number conspicuously anywhere on the recipient statement. Although not required, payers reporting on Forms 1099-QA, 1099-R (payments other than qualified long-term care insurance contracts under combined arrangements), 3921, 3922, 5498,

5498-ESA, and 5498-QA are encouraged to furnish telephone numbers at which recipients of the form(s) can reach a person familiar with the information reported.

All applicable money amounts and information, including box numbers required to be reported to the form recipient, must be titled on the recipient statement in substantially the same manner as those on the official IRS form. The box caption “Federal income tax withheld” must be in boldface type on the recipient statement.

21

Exception. If you are reporting a payment as “Other income” in box 3 of Form 1099-MISC, you may substitute appropriate language for the box title. For example, for payments of accrued wages and leave to a beneficiary of a deceased employee, you might change the title of box 3 to “Beneficiary payments” or something similar.

Note. You cannot make this change on Copy A.

If federal income tax is withheld and shown on Form 1099-R or W-2G, Copy B and Copy C must be furnished to the recipient. If federal income tax is not withheld, only Copy C of Forms 1099-R and W-2G must be furnished. However, for Form 1099-R, instructions similar to those on the back of the official Copy B and Copy C of Form 1099-R must be furnished to the recipient. For convenience, you may choose to provide both Copies B and C of Form 1099-R to the recipient.

You must provide appropriate instructions to the form recipient similar to those on the official IRS form, to aid in the proper reporting on the form recipient's income tax return. For payments reported on Forms 1099-B and 1099-CAP, the requirement to include instructions substantially similar to those on the official IRS form, may be satisfied by providing form recipients with a single set of instructions for all Forms 1099-B and 1099-CAP statements required to be furnished in a calendar year.

If you use carbonless sets to produce recipient statements, the quality of each copy in the set must meet the following standards.

1. All copies must be clearly legible.

2. All copies must be able to be photocopied.

3. Fading must not diminish legibility and the ability to photocopy.

In general, black chemical transfer inks are preferred, but other colors are permitted if the above standards are met. Hot wax and cold carbon spots are not permitted on any of the internal form plies. The back of a mailer top envelope ply may contain these spots.

For reporting state income tax withholding and state payments, you may add an additional box(es) to recipient copies, as appropriate. In addition, the state withholding information may be provided separately and apart from the other information in the event the recipient must attach a copy to the recipient's tax return. Note. You cannot make this change on Copy A.

On Copy C of Form 1099-LTC, you may reverse the location of the policyholder’s and the insured’s name, street address, city, state, and ZIP code for easier mailing.

If an institution insurer uses a third-party service provider to file Form 1098-T, then in addition to the institution or insurer’s name, address, and telephone number, the same information may be included for the third-party service provider in the space provided on the form.

22

4.1.4

Online Fillable Copies B, C, D, 1, and 2

Forms 1099-A and 1099-C transactions, if related, may be combined on Form 1099-C.

Copies B, C, D, 1, and 2, as applicable, to be furnished to recipients and kept in the filers’ records, have been made online fillable at IRS.gov/forms-instructions for many forms referenced in these instructions. See the separate instructions for Forms 1098, 1098-E & T, 1098-F, 1098-Q, 1099-A & C, 1099-B, 1099-DIV, 1099-G, 1099-INT & OID, 1099-K, 1099-LS, 1099-MISC, 1099-NEC, 1099-PATR, 1099-R & 5498, 1099-S, 1099-SB, and 3921.

Section 4.2 – Composite Statements

4.2.1

Composite

Substitute

Statements for

Certain Forms

1099-B, 1099-

DIV, 1099-INT,

1099-MISC,

1099-OID, 1099-

PATR, and 1099-

S

A composite recipient statement is permitted for reportable payments consisting of the proceeds of brokerage and barter transactions, dividends, interest, original issue discount, patronage dividends, and royalties. The following forms may be included on a composite substitute statement, when one payer is reporting more than one of these payments during a calendar year to the same form recipient.

Form 1099-B.

Form 1099-DIV (except for section 404(k) dividends).

Form 1099-INT (except for interest reportable under section 6041).

Form 1099-MISC (only for royalties or substitute payments in lieu of dividends and interest).

Form 1099-OID.

Form 1099-PATR.

Form 1099-S (only for royalties).

Generally, do not include any other Form 1099 information (for example, 1099-A or 1099-C) on a composite statement with the information required on the forms listed in the preceding sentence.

Although the composite recipient statement may be on one sheet, the format of the composite recipient statement must satisfy the following requirements in addition to the requirements listed earlier in Sections 4.1.2, 4.3, and 4.4, as applicable.

All information pertaining to a particular type of payment must be located and blocked together on the form and separate from any information covering other types of payments included on the form. For example, if you are reporting interest and dividends, the Form 1099-INT information must be presented separately from the Form 1099-DIV information.

The composite recipient statement must prominently display the form number and form name of the official IRS form together in one area at the beginning of each appropriate block of information. The tax year must only be placed on each block of information if it is not

23

4.2.2

Composite

Substitute

Statements to

Recipients for

Forms Specified

in Sections 4.1.2

and 4.1.3

prominently displayed elsewhere on the page on which the information appears.

Any information required by the official IRS forms that would otherwise be repeated in each information block is required to be listed only once in the first information block on the composite form. For example, there is no requirement to report the name of the filer in each information block. This rule does not apply to any money amounts (for example, federal income tax withheld) or to any other information that applies to money amounts.

A composite statement is an acceptable substitute only if the type of payment, and the recipient's tax obligation with respect to the payment, are as clear as if each required statement were furnished separately on an official form.

A composite recipient statement for the forms specified in Section 4.1.2 or 4.1.3 is permitted when one filer is reporting more than one type of payment during a calendar year to the same form recipient. A composite statement is not allowed for a combination of forms listed in Sections 4.1.2 and 4.1.3.

Exceptions:

Substitute payments in lieu of dividends or interest reported in box 8 of Form 1099-MISC may be reported on a composite substitute statement with Form 1099-DIV.

Form 1099-B information may be reported on a composite form with the forms specified in Section 4.1.2 as described in Section 4.2.1.

Royalties reported on Form 1099-MISC or 1099-S may be reported on a composite form only with the forms specified in Section 4.1.2.

Although the composite recipient statement may be on one sheet, the format of the composite recipient statement must satisfy the requirements listed in Section 4.2.1 as well as the requirements in Section 4.1.3. A composite statement of Forms 1098 and 1099-INT (for interest reportable under section 6049) is not allowed.

Section 4.3 – Additional Information for Substitute and Composite Forms 1099-B

4.3.1

General

Requirements

for Presenting

Additional Form

1099-B

Information

A filer may include Form 1099-B information on a composite form with the forms listed in Section 4.1.2. Therefore, supporting, explanatory, or comparable relevant information for covered and noncovered lots on the 1099-B portion of the composite statement can be included. This information includes display on the payee statement of data elements such as basis for noncovered lots, explanatory remarks on permissible basis adjustments for covered lots, descriptions of the type of transaction (merger, buy to close, redemption, etc.), identification of contingent payment debt obligations, and lot relief methods.

If you wish to provide additional information to the investor on the same substitute recipient Form 1099-B, the form must follow the rules set forth in this

24

4.3.2

Added Legend for Providing Additional 1099-B Information

Section 4.3 and should clearly delineate how the information is presented. Any information presented should make reference to its corresponding number on the official form, as appropriate. You should clearly categorize each type of information you are reporting.

An additional separate legend is required that explains exactly which pieces of information are and which are not reported to the IRS, to the extent, if any, the information is not already identified as not being reported to the IRS, as described in Section 4.1.2. It should clearly explain how the information is presented. You may present this legend in a way that is consistent with your design as long as it clearly indicates which information is being provided to the IRS. Additionally, a reminder to taxpayers that they are ultimately responsible for the accuracy of their tax returns is also required.

Section 4.4 – Required Legends

4.4.1

Required

Legends for

Forms 1098

Form 1098 recipient statements (Copy B) must contain the following legends:

Form 1098

1. “The information in boxes 1 through 9 and 11 is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if the IRS determines that an underpayment of tax results because you overstated a deduction for the mortgage interest or for these points, reported in boxes 1 and 6; or because you did not report the refund of interest (box 4); or because you claimed a nondeductible item.”

2. Caution. “The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person.”

Form 1098-C: Copy B - “In order to take a deduction of more than $500 for this contribution, you must attach this copy to your federal tax return. Unless box 5a or 5b is checked, your deduction cannot exceed the amount in box 4c.” Copy C - “This information is being furnished to the IRS unless box 7 is checked.”

Form 1098-E: “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if the IRS determines that an underpayment of tax results because you overstated a deduction for student loan interest.”

Forms 1098-F and 1098-MA: “This is important tax information and is being furnished to the IRS.”

Form 1098-Q: “This information is being furnished to the IRS.”

25

4.4.2

Required

Legends for

Forms 1099 and

W-2G

Form 1098-T: “This is important tax information and is being furnished to the IRS. This form must be used to complete Form 8863 to claim education credits. Give it to the tax preparer or use it to prepare the tax return.”

Forms 1099-A, 1099-C, 1099-CAP, and 1099-K: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if taxable income results from this transaction and the IRS determines that it has not been reported.”

Forms 1099-B, 1099-DIV, 1099-G, 1099-INT, 1099-MISC,

1099-NEC, 1099-OID, 1099-PATR, 1099-Q, and 1099-QA: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.”

Form 1099-LS: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been reported.” Copy C - “Copy C is provided to you for information only. Only the payment recipient is required to report this information on a tax return.”

Form 1099-LTC: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been reported.” Copy C - “Copy C is provided to you for information only. Only the policyholder is required to report this information on a tax return.”

Form 1099-R: Copy B - “Report this income on your federal tax return. If this form shows federal income tax withheld in box 4, attach this copy to your return.” Copy C - “This information is being furnished to the IRS.”

Forms 1099-S and 1099-SB: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been reported.”

Form 1099-SA: Copy B - “This information is being furnished to the IRS.”

Form W-2G: Copy B - “This information is being furnished to the IRS.

Report this income on your federal tax return. If this form shows federal income tax withheld in box 4, attach this copy to your return.” Copy C - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence

26

4.4.3

Required

Legends for

Forms 1097-

BTC, 3921, 3922,

and 5498

penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.”

Form 1097-BTC: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if an amount of tax credit exceeding the amount reported on this form is claimed on your income tax return.”

Form 3921: Copy B - “This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the IRS determines that it has not been reported.” Copy C - “This copy should be retained by the corporation whose stock has been transferred under Section 422(b).”

Form 3922: Copy B - “This is important tax information and is being furnished to the IRS.” Copy C - “This copy should be retained by the corporation.”

Form 5498: Copy B - “This information is being furnished to the IRS.” Note. If you do not provide another statement to the participant because no contributions were made for the year, the statement of the fair market value, and any required minimum distribution of the account, must contain this legend and a designation of which information is being provided to the IRS.

Forms 5498-ESA, 5498-QA, and 5498-SA: Copy B - “This information is being furnished to the IRS.”

Section 4.5 – Miscellaneous Instructions for Copies B, C, D, E, 1, and 2

4.5.1

Copies

4.5.2

Arrangement of

Assembly

Copies B, C, and in some cases D, E, 1, and 2 are included in the official assembly for the convenience of the filer. You are not legally required to include all these copies with the privately printed substitute forms. Furnishing Copy B, and in some cases Copy C, will satisfy the legal requirement to provide statements of information to form recipients.

Note. If an amount of federal income tax withheld is shown on Form 1099-R or W-2G, Copy B (to be attached to the tax return) and Copy C must be furnished to the recipient. Copy D (Forms 1099-R and W-2G) may be used for payer records. Only Copy A should be filed with the IRS.

Copy A (“For Internal Revenue Service Center”) of all forms must be on top.

The rest of the assembly must be arranged, from top to bottom, as follows.

27

Form	Title
1098	Copy B “For Payer/Borrower”; Copy C “For Recipient/Lender.”
1098-C	Copy B “For Donor”; Copy C “For Donor’s Records”; Copy D “For Donee.”
1098-E	Copy B “For Borrower”; Copy C “For Recipient.”
1098-F	Copy B “For Payer”; Copy C “For Filer.”
1098-MA	Copy B “For Homeowner”; Copy C “For Filer.”
1098-Q	Copy B “For Participant”; Copy C “For Issuer.”
1098-T	Copy B “For Student”; Copy C “For Filer.”
1099-A	Copy B “For Borrower”; Copy C “For Lender.”
1097-BTC,
1099-PATR,	Copy B “For Recipient”; Copy C “For Payer.”
1099-Q, and

1099-QA
1099-C	Copy B “For Debtor”; Copy C “For Creditor.”
1099-CAP	Copy B “For Shareholder”; Copy C “For Corporation.”
1099-B,
1099-DIV,
1099-G,	Copy 1 “For State Tax Department”; Copy B “For Recipient”; Copy 2 “To be
1099-INT,	filed with recipient's state income tax return, when required”; and Copy C
1099-MISC,	“For Payer.”
1099-NEC, and
1099-OID
	Copy 1 “For State Tax Department”; Copy B “For Payee”; Copy 2 “To be
1099-K	filed with the recipient's state income tax return, when required”; Copy C
	“For Filer.”
1099-LS	Copy B “For Payment Recipient”; Copy C “For Issuer”; Copy D “For
	Acquirer.”

1099-LTC	Copy B “For Policyholder”; Copy C “For Insured”; Copy D “For Payer.”
	Copy 1 “For State, City, or Local Tax Department”; Copy B “Report this
	income on your federal tax return. If this form shows federal income tax
1099-R	withheld in box 4, attach this copy to your return”; Copy C “For Recipient’s
	Records”; Copy 2 “File this copy with your state, city, or local income tax
	return, when required”; Copy D “For Payer.”
1099-S	Copy B “For Transferor”; Copy C “For Filer.”
1099-SA	Copy B “For Recipient”; Copy C “For Trustee/Payer.”
1099-SB	Copy B “For Seller”; Copy C “For Issuer.”
	Copy B “For Employee”; Copy C “For Corporation”; Copy D “For
3921	Transferor.”
3922	Copy B “For Employee”; Copy C “For Corporation.”
5498	Copy B “For Participant”; Copy C “For Trustee or Issuer.”
5498-ESA	Copy B “For Beneficiary”; Copy C “For Trustee.”
5498-QA	Copy B “For Beneficiary”; Copy C “For Issuer.”
5498-SA	Copy B “For Participant”; Copy C “For Trustee.”

28

Form	Title
	Copy 1 “For State, City, or Local Tax Department”; Copy B “Report this
	income on your federal tax return. If this form shows federal income tax
W-2G	withheld in box 2, attach this copy to your return”; Copy C “For Winner’s
	Records”; Copy 2 “Attach this copy to your state, city, or local income tax
	return, if required”; Copy D “For Payer.”
	Copy B “For Recipient”; Copy C “For Recipient” and “Attach to any federal
1042-S	tax return you file”; Copy D “For Recipient” and “Attach to any state tax
	return you file”; Copy E “For Withholding Agent.”

4.5.3
	Instructions for perforation of forms can be found in Section 2.1.9, earlier.
Perforations

Section 4.6 – Electronic Delivery of Recipient Statements

4.6.1

Electronic

Recipient

Statements

4.6.2

Consent

If you are required to furnish a written statement (Copy B or an acceptable substitute) to a recipient, then you may furnish the statement electronically instead of on paper. This includes furnishing the statement to recipients of Forms 1098, 1098-E, 1098-F, 1098-MA, 1098-Q, 1098-T, 1099-A, 1099-B, 1099-C, 1099-CAP, 1099-DIV, 1099-G, 1099-H, 1099-INT, 1099-K, 1099-LS, 1099-LTC, 1099-MISC, 1099-NEC, 1099-OID, 1099-PATR, 1099-Q, 1099-QA, 1099-R, 1099-S, 1099-SA, 1099-SB, 1042-S, 3921, 3922, 5498,

5498-ESA, 5498-QA, and 5498-SA. It also includes Form W-2G (except for horse and dog racing, jai alai, sweepstakes, wagering pools, and lotteries).

Note. Until further guidance is issued, you cannot furnish Form 1098-C electronically. Perforation (see Section 2.1.9, earlier) does not apply to printouts of copies of forms that are furnished electronically to recipients. However, recipients should be cautioned to carefully separate the copies.

If you meet the requirements listed in Sections 4.6.2 and 4.6.3, you are treated as furnishing the statement timely.

The recipient must consent in the affirmative to receiving the statement electronically and not have withdrawn the consent before the statement is furnished. The consent by the recipient must be made electronically in a way that shows that he or she can access the statement in the electronic format in which it will be furnished. You must notify the recipient of any hardware or software changes prior to furnishing the statement. A new consent to receive the statement electronically is required after the new hardware or software is put into service. Prior to furnishing the statements electronically, you must provide the recipient a statement with the following statements prominently displayed.

If the recipient does not consent to receive the statement electronically, a paper copy will be provided.

The scope and duration of the consent. For example, whether the consent applies to every year the statement is furnished or only for the January 31, 2022 (February 15 for Forms 1099-B, 1099-S, and

29

4.6.3

Format, Posting, and Notification

1099-MISC with payments reported in box 8 or 10) immediately following the date of the consent.

How to obtain a paper copy after giving consent.

How to withdraw the consent. The consent may be withdrawn at any time by furnishing the withdrawal in writing (electronically or on paper) to the person whose name appears on the statement. Confirmation of the withdrawal will also be in writing (electronically or on paper).

Notice of termination. The notice must state under what conditions the statements will no longer be furnished to the recipient.

Procedures to update the recipient's information.

A description of the hardware and software required to access, print, and retain a statement, and a date the statement will no longer be available on the website.

Additionally, you must:

Ensure the electronic format contains all the required information and complies with the guidelines in this document;

Post, on or before the January 31, 2023: (February 15 for Forms

1099-B, 1099-S, and 1099-MISC with payments reported in box 8 or 10) due date, the applicable statement on a website accessible to the recipient through October 17 of that year; and

Inform the recipient, electronically or by mail, of the posting and how to access and print the statement.

For more information, see Regulations section 31.6051-1(j).

For electronic furnishing of:

Forms 1098-E and 1098-T, see Regulations sections 1.6050S-2 and 1.6050S-4;

Form 1099-K, see Regulations section 1.6050W-2;

Forms 1099-QA and 5498-QA, see Regulations section 1.529A-7;

Forms 1099-R, 1099-SA, 1099-Q, 5498, 5498-ESA, and 5498-SA, see Notice 2004-10, 2004-1 C.B. 433; and

Form 1042-S, see Regulations section 1.1461-1(c)(1)(i).

30

Part 5

Additional Instructions for Substitute Forms 1097-

BTC, 1098, 1099, 5498, W-2G, and 1042-S

Section 5.1 – Paper Substitutes for Form 1042-S

5.1.1

Paper

Substitutes

5.1.2

Revisions

5.1.3

Obtaining

Copies

5.1.4

Instructions For

Withholding

Agents

Paper substitutes of Copies A, B, C, and D must be identical to the Form 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding, and may be privately printed without prior approval from the Internal Revenue Service.

Caution. On the bottom of Copy B, left align the following text: (keep for

your records) and right align the following text: Form 1042-S (2022).

Note. Copies A, B, C, and D of Form 1042-S may not contain multiple income types for the same recipient, that is, multiple rows of the top boxes 1–11 of the form. Only Copy E, retained by the withholding agent, can contain multiple income types.

Form 1042-S is subject to annual review and possible change. Withholding agents and form suppliers are cautioned against overstocking supplies of the privately printed substitutes.

Copies of the official form for the reporting year may be obtained from most IRS offices. The IRS provides only cut sheets of these forms. Continuous fan-fold/pin-fed forms are not provided.

Only original forms may be filed with the IRS. Photocopies are not acceptable.

The term “Recipient’s U.S. TIN” for an individual means the SSN, ITIN, or ATIN, consisting of nine digits separated by hyphens as follows: 000-00-0000. For all other recipients, the EIN or qualified intermediary employer identification number (QI-EIN). The QI-EIN designation includes a withholding foreign partnership employer identification number (WP-EIN), and a withholding foreign trust employer identification number (WT-EIN). The EIN, QI-EIN, WP-EIN, and WT-EIN consist of nine digits separated by a hyphen as follows: 00-0000000. The TIN must be in one of these formats. Note. Digits must be separated by hyphens on paper statements in the formats listed.

The term “Recipient's GIIN” means the global intermediary identification number assigned to a recipient that is a participating foreign financial institution (FFI) (including a reporting Model 2 FFI), registered deemed-compliant FFI (including a reporting Model 1 FFI), or other entity for chapter 4 purposes.

Note. A GIIN consists of nineteen characters as follows: XXXXXX.XXXXX.XX.XXX (6 characters followed by a period, 5

31

5.1.5

Substitute Form 1042-S Format Requirements

characters followed by a period, 2 characters followed by a period, and 3 final characters).

Withholding agents are requested to type or machine print whenever possible, provide quality data entries on the forms (that is, use black ink and insert data in the middle of blocks well separated from other printing and guidelines), and take other measures to guarantee a clear, sharp image. Withholding agents are not required, however, to acquire special equipment solely for the purpose of preparing these forms.

The “UNIQUE FORM IDENTIFIER,” “AMENDED,” and “AMENDMENT NO.” boxes must be printed at the top center of the form under the title.

Substitute forms prepared in continuous or strip form must be burst and stripped to conform to the size specified for a single form before they are filed with the IRS. The dimensions are found in Section 5.1.5, later. Computer cards are acceptable provided they meet all requirements regarding layout, content, and size.

The OMB number must be printed in the format “OMB No.

1545-XXXX.” Use the appropriate OMB number from the most recent revision of the original IRS form.

Property	Substitute Form 1042-S Format Requirements
	Privately printed substitute Forms 1042-S must be exact replicas of the
	official forms with respect to layout and content. The Government Printing
Printing	Office (GPO) symbol must be deleted. The exact dimensions are found
	below. The Cat. No. must be removed and replaced with the form printer’s
	EIN or the vendor code (preferred). See Section 2.1.10.
	Only one type of income may be represented on Copies A, B, C, and D
	submitted to the IRS or furnished to recipients. Multiple income types may
Box Entries	be shown on Copy E retained by withholding agents. All boxes on Copy A
	filed with the IRS, and Copies B, C, and D furnished to recipients on the
	substitute form must conform to the official IRS form.
Color and Quality of	All printing must be in high quality nongloss black ink.
Ink

	Type must be substantially identical in size and shape to corresponding
	type on the official form. All rules on the document are either 1 point
Typography	(0.015 inches) or 3 point (0.045 inches). Vertical rules must be parallel to
	the left edge of the document; horizontal rules must be parallel to the top
	edge.
	If all five parts are present, the parts of the assembly shall be arranged
Assembly	from top to bottom as follows: Copy A (Original) “for Internal Revenue
	Service,” Copies B, C, and D “for Recipient,” and Copy E “for

	Withholding Agent.”
	Paper for Copy A must be white chemical wood bond, or equivalent, 20
	pounds (basis 17 x 22–500), plus or minus 5% (0.05); or offset book paper,
Color Quality of	50 pounds (basis 25 x 38–500). No optical brighteners may be added to the
Paper	pulp or paper during manufacture. The paper must consist of principally
	bleached chemical wood pulp or recycled printed paper. It must also be
	suitably sized to accept ink without feathering.

32

Property		Substitute Form 1042-S Format Requirements
	•	The dimensions for substitute Copies A, B, C, and D must match the
		IRS Form 1042-S in size and format.
	•	The official form is 8 inches wide x 11 inches deep, exclusive of a 1/2
Dimensions		inch snap stub on the left side of the form. The snap feature is not
		required on substitutes.
	•	Copies A, B, C, and D must conform to the official IRS form. No size
		variations are permitted.
	Copies B, C, and D must be furnished for the convenience of payees who
Other Copies	must send a copy of the form with other federal and state returns they file.
	Copy E may be used as a withholding agent’s record/copy.

Section 5.2 – OMB Requirements for All Forms in This Revenue Procedure

5.2.1

OMB

Requirements

5.2.2

Substitute Form Requirements

The Paperwork Reduction Act (the Act) of 1995 (P. L. 104-13) requires that:

OMB approves all IRS tax forms that are subject to the Act. Each IRS form contains (in or near the upper right corner) the OMB approval number, if any. (The official OMB numbers may be found on the official IRS printed forms and are also shown on the forms in the exhibits in Part 6.);

Each IRS form (or its instructions) states:

1. Why the IRS needs the information,

2. How it will be used, and

3. Whether or not the information is required to be furnished to the IRS.

This information must be provided to any users of official or substitute IRS forms or instructions.

The OMB requirements for substitute IRS forms are:

Any substitute form or substitute statement to a recipient must show the OMB number as it appears on the official IRS form,

For Copy A, the OMB number must appear exactly as shown on the official IRS form.

5.2.3

Required

Explanation to

Users

For any copy other than Copy A, the OMB number must use one of the following formats.

1. OMB No. 1545-xxxx (preferred), or

2. OMB # 1545-xxxx (acceptable).

Caution. These requirements do not apply to substitute Forms 1042-S. See Section 5.1.4, earlier.

All substitute forms must state the Privacy Act and Paperwork Reduction Act Notice as listed in Section 2.1.10, earlier.

33

If no instructions are provided to users of your forms, you must furnish them with the exact text of the Privacy Act and Paperwork Reduction Act Notice.

Section 5.3 – Ordering Forms and Instructions

You can order official IRS Forms (Forms 1096, 1098, 1099, W-2G, 1042-S, and most other forms mentioned in this publication), instructions, and information copies of federal tax material by going to IRS.gov/OrderForms.

Note. Some forms on the Internet are intended as information only and may not be submitted as an official IRS form (for example, most Forms 1099, W-2, and W-3). Unless otherwise instructed, Form 1096 and Copy A of 1098 series, 1099 series, 5498 series, and Forms 3921 and 3922 cannot be used for filing with the IRS when printed from a conventional printer. These forms contain drop-out ink requirements as described in Part 2 of this publication.

Exception. Forms 1097-BTC, 1098-C, 1098-MA, 1099-CAP, 1099-LTC, 1099-Q, 1099-QA, 1099-SA, 3922, 5498-ESA, 5498-QA, 5498-SA, and 1042-S can be printed in black ink as specified in Sections 2.1.1 and 5.1.5, earlier.

Section 5.4 – Effect on Other Revenue Procedures
5.4.1
	Revenue Procedure 2021-27, 2021-26, I.R.B. 1,252, dated June 28, 2021, is
Other Revenue

	superseded by this revenue procedure.
Procedures

		Part 6
		Exhibits

Section 6.1 – Exhibits of Forms in This Revenue Procedure

6.1.1

Purpose

Exhibits A through CC illustrate some of the specifications that were discussed earlier in this revenue procedure. The dimensions apply to the actual size forms, but the exhibits have been reduced in size.

Generally, the illustrated dimensions apply to all like forms. For example, Exhibit E shows 11.00 inches from the top edge to the bottom edge of Form 1098-E and .85 inches between the bottom rule of the top form and the top rule of the second form on the page. These dimensions apply to all forms that are printed 3-to-a-page.

Exhibit B contains the general measurements for forms printed 2-to-a-page. All 2-to-a-page forms, except Form 1099-B, are 4.5 inches in height within the border lines. Form 1099-B is 4.67 inches in height within the border lines.

34

6.1.2

Guidelines

6.2

Exhibits

Exhibit E contains the general measurements for forms printed 3-to-a-page. All 3-to-a-page forms are 2.83 inches in height within the border lines.

The printed area of all forms is 7.3 inches wide.

All of the exhibits in this publication were updated to include all of the 2022 revisions for those forms that have been revised.

Keep in mind the following guidelines when printing substitute forms.

Closely follow the specifications to avoid delays in processing the forms.

Always use the specifications as outlined in this revenue procedure and illustrated in the exhibits.

Do not add the text line “Do Not Cut or Separate Forms on This Page” to the bottom form. This will be inconsistent with the specifications.

The following exhibits provide specifications for the forms listed in Section 1.1.2. Exhibits A, B, and E contain the general measurements for all of the forms. The remaining exhibits represent the images and may contain unique measurements as required by the form.

35

11.0 in

Exhibit A

Form 1096

		.50 in
Do Not Staple6969

Form 1096	Annual Summary and Transmittal of			OMB No. 1545-0108

				2022
Department of the Treasury		U.S. Information Returns
Internal Revenue Service

FILER’S name
Street address (including room or suite number)			2.14 in
		1.33 in

7.30 in

City or town, state or province, country, and ZIP or foreign postal code

Name of person to contact		Telephone number			For Official Use Only
4.50 in
Email address		Fax number
1 Employer identi cation number	2 Social security number	3 Total number of forms	4 Federal income tax withheld 5 Total amount reported with this Form 1096
1.40 in	1.40 in	1.20 in	$	1.40 in	$	1.90 in

6 Enter an “X” in only one box below to indicate the type of form being led.

W-2G1097-BTC

3250

1098

81

1098-C	1098-E	1098-F	1098-Q	1098-T
78	84	03	74	83

1099-A

80

1099-B	1099-C	1099-CAP 1099-DIV		1099-G
79	85	73	91	86

1099-INT1099-K1099-LS

921016

in .25

1099-LTC 1099-MISC 1099-NEC			1099-OID 1099-PATR		1099-Q	1099-QA		1099-R	1099-S	1099-SA 1099-SB		3921
93	95	71	96	97	31		1A	98	75	94	43	25

3922

26

54985498-ESA

2872

5498-QA5498-SA

2A27

Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.

Send this form, with the copies of the form checked in box 6, to the IRS in a flat mailer (not folded).

Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.

Signature	8.00 in	Title		Date
Instructions		Enter the ler’s name, address (including room, suite, or other unit
Future developments. For the latest information about developments		number), and taxpayer identi cation number (TIN) in the spaces
		provided on the form. The name, address, and TIN of the ler on this
related to Form 1096, such as legislation enacted after it was
		form must be the same as those you enter in the upper left area of
published, go to www.irs.gov/Form1096.
		Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.

Reminder. The only acceptable method of electronically ling		When to file. File Form 1096 as follows.
information returns listed on this form in box 6 with the IRS is through		• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, le by
the FIRE System. See Pub. 1220.
		February 28, 2023.
Purpose of form. Use this form to transmit paper Forms 1097, 1098,
		• With Forms 1099-NEC, le by January 31, 2023.
1099, 3921, 3922, 5498, and W-2G to the IRS.
		• With Forms 5498, le by May 31, 2023.
Caution: If you are required to le 250 or more information returns of

any one type (excluding Form 1098-F), you must le electronically. If		Where To File
you are required to le electronically but fail to do so, and you do not		Send all information returns led on paper with Form 1096 to the
have an approved waiver, you may be subject to a penalty. The
Taxpayer First Act of 2019, enacted July 1, 2019, authorized the		following.
Department of the Treasury and the IRS to issue regulations that		If your principal business, office
reduce the 250-return requirement for 2021 tax returns. If those				Use the following
		or agency, or legal residence in
regulations are issued and effective for 2022 tax returns required to be		the case of an individual, is		address
led in 2023, we will post an article at www.irs.gov/Form1099
		located in
explaining the change. Until regulations are issued, however, the

number remains at 250, as re ected in these instructions. For more
information, see part F in the 2022 General Instructions for Certain		Alabama, Arizona, Arkansas, Delaware,
Information Returns.		Florida, Georgia, Kentucky, Maine,		Internal Revenue Service
		Massachusetts, Mississippi, New
Forms 1099-QA and 5498-QA can be led on paper only, regardless				P.O. Box 149213
		Hampshire, New Jersey, New Mexico,
of the number of returns.		New York, North Carolina, Ohio, Texas,		Austin, TX 78714-9213
Who must file. Any person or entity who les any of the forms shown		Vermont, Virginia

in line 6 above must le Form 1096 to transmit those forms to the IRS.
Caution: Your name and TIN must match the name and TIN used on
your 94X series tax return(s) or you may be subject to information
return penalties. Do not use the name and/or TIN of your paying agent
or service bureau.

For more information and the Privacy Act and Paperwork Reduction Act Notice,			Cat. No. 14400O	Form 1096 (2022)
see the 2022 General Instructions for Certain Information Returns.

36

Exhibit B

Form 1097-BTC

			VOID	CORRECTED			6.25in
	5050
	FORM 1097-BTC ISSUER’S name, street address, city or town, state or				1	Total			OMB No. 1545-2197
	province, country, ZIP or foreign postal code, and telephone no.								Form 1097-BTC
					$					Bond

	4.50 in	1.33 in			2a Code				(Rev. December 2019)
										Tax
									For calendar year

									20	Credit

					2b Unique identi er
	FORM 1097-BTC ISSUER’S TIN		RECIPIENT’S TIN				2.80 in
					3	Bond type		4
	RECIPIENT’S name					1.40 in				Copy A

		3.40 in			5a January			5b February		For
					$			$		Internal Revenue

	Street address (including apt. no.)				5c March			5d	April	Service Center

					$			$		File with Form 1096.
					5e	May		5f	June
	City or town, state or province, country, and ZIP or foreign postal code				$			$
		7.30 in			5g July			5h August		For Privacy Act
					$			$
										and Paperwork
	Form 1097-BTC issuer is (check one):				5i	September		5j	October	Reduction Act
					$			$		Notice, see the
										current General
.15 in	Issuer of bond or its agent ling current year				5k	November		5l	December
										Instructions for
	Form 1097-BTC for credit being reported				$			$
.22 in										Certain Information
				1.17 in
	An entity or a person that received or should have received				6	Comments				Returns.
	a current year Form 1097-BTC and is distributing part or all
.35 in	of that credit to others

	Form 1097-BTC (Rev. 12-2019)		Cat. No. 54293T		www.irs.gov/Form1097BTC			Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

1 in

5050	VOID	CORRECTED
FORM 1097-BTC ISSUER’S name, street address, city or town, state or			1	Total		OMB No. 1545-2197
province, country, ZIP or foreign postal code, and telephone no.						Form 1097-BTC
			$				Bond

			2a Code			(Rev. December 2019)
							Tax

						For calendar year
						20	Credit


			2b Unique identi er

FORM 1097-BTC ISSUER’S TIN	RECIPIENT’S TIN

			3	Bond type	4
							Copy A

RECIPIENT’S name
			5a January		5b February		For
			$		$		Internal Revenue
							Service Center
Street address (including apt. no.)			5c March		5d April

			$		$		File with Form 1096.
			5e May		5f	June
			$		$
City or town, state or province, country, and ZIP or foreign postal code
			5g July		5h August		For Privacy Act
			$		$
							and Paperwork
Form 1097-BTC issuer is (check one):			5i	September	5j	October	Reduction Act
			$		$		Notice, see the
							current General
Issuer of bond or its agent ling current year			5k	November	5l	December
							Instructions for
Form 1097-BTC for credit being reported			$		$		Certain Information

An entity or a person that received or should have received			6	Comments			Returns.
a current year Form 1097-BTC and is distributing part or all
of that credit to others

Form 1097-BTC (Rev. 12-2019)	Cat. No. 54293T		www.irs.gov/Form1097BTC		Department of the Treasury - Internal Revenue Service

37

Exhibit C

Form 1098

8181	VOID	CORRECTED
RECIPIENT’S/LENDER’S name, street address, city or town, state or					OMB No. 1545-1380
province, country, ZIP or foreign postal code, and telephone no.					Form 1098		Mortgage

					(Rev. January 2022)		Interest
							Statement

					For calendar year
					20
			1 Mortgage interest received from payer(s)/borrower(s)				Copy A
			$
							For
RECIPIENT’S/LENDER’S TIN	PAYER’S/BORROWER’S TIN		2 Outstanding mortgage		3 Mortgage origination date	Internal Revenue
			principal				Service Center

			$

			4 Refund of overpaid		5 Mortgage insurance	File with Form 1096.

			interest		premiums

PAYER’S/BORROWER’S name			$		$
							For Privacy Act
			6 Points paid on purchase of principal residence
			$				and Paperwork
							Reduction Act
Street address (including apt. no.)			7	If address of property securing mortgage is the same			Notice, see the
			as PAYER’S/BORROWER’S address, check the box, or enter				current General
			the address or description in box 8.				Instructions for
							Certain
City or town, state or province, country, and ZIP or foreign postal code			8 Address or description of property securing mortgage (see				Information
			instructions)				Returns.

9 Number of properties securing the	10 Other
mortgage

						11 Mortgage
						acquisition date
Account number (see instructions)


Form 1098 (Rev. 1-2022)	Cat. No. 14402K			www.irs.gov/Form1098	Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page—Do Not Cut or Separate Forms on This Page

8181	VOID	CORRECTED
RECIPIENT’S/LENDER’S name, street address, city or town, state or					OMB No. 1545-1380
province, country, ZIP or foreign postal code, and telephone no.					Form 1098	Mortgage

					(Rev. January 2022)	Interest
						Statement

					For calendar year
					20
			1 Mortgage interest received from payer(s)/borrower(s)			Copy A
			$
						For
RECIPIENT’S/LENDER’S TIN	PAYER’S/BORROWER’S TIN		2 Outstanding mortgage		3 Mortgage origination date	Internal Revenue
			principal			Service Center

			$

			4 Refund of overpaid		5 Mortgage insurance	File with Form 1096.

			interest		premiums

PAYER’S/BORROWER’S name			$		$
						For Privacy Act
			6 Points paid on purchase of principal residence
			$			and Paperwork
						Reduction Act
Street address (including apt. no.)			7	If address of property securing mortgage is the same		Notice, see the
			as PAYER’S/BORROWER’S address, check the box, or enter			current General
			the address or description in box 8.			Instructions for
						Certain
City or town, state or province, country, and ZIP or foreign postal code			8 Address or description of property securing mortgage (see			Information
			instructions)			Returns.

9 Number of properties securing the	10 Other
mortgage

						11 Mortgage
						acquisition date
Account number (see instructions)


Form 1098 (Rev. 1-2022)	Cat. No. 14402K			www.irs.gov/Form1098	Department of the Treasury - Internal Revenue Service

in 1.13

38

Exhibit D

Form 1098-C

7878

VOID

CORRECTED

DONEE’S name, street address, city or town, state or province, country, ZIP

1 Date of contribution

OMB No. 1545-1959

Contributions of

or foreign postal code, and telephone no.

Form 1098-C

Motor Vehicles,

(Rev. November 2019)

Boats, and

2a Odometer mileage

Airplanes

For calendar year

7.16 in

20

2b Year

2c Make

2d Model

DONEE’S TIN

DONOR’S TIN

3 Vehicle or other identi cation number

2.80 in

DONOR’S name

4a

Donee certi es that vehicle was sold in arm’s

2.45 in

3.40 in

length transaction to unrelated party

Street address (including apt. no.)

4b Date of sale

Copy A

City or town, state or province, country, and ZIP or foreign postal code

4c Gross proceeds from sale (see instructions)

$

For

5a

Donee certi es that vehicle will not be transferred for money, other property, or services before completion of material

Internal Revenue

improvements or signi cant intervening use

Service Center

File with Form 1096.

5b

Donee certi es that vehicle is to be transferred to a needy individual for signi cantly below fair market value in furtherance of

donee’s charitable purpose

For Privacy Act

5c

Donee certi es the following detailed description of material improvements or signi cant intervening use and duration of use

and Paperwork

Reduction Act

Notice, see the

current General

Instructions for

Certain

6a Did you provide goods or services in exchange for the vehicle? . . .

........

. .

Yes

No

Information

.55 in

Returns.

6b Value of goods and services provided in exchange for the vehicle

$

6c Describe the goods and services, if any, that were provided. If this box is checked, donee certi es that the goods and services

.05 in

consisted solely of intangible religious bene ts . . . . . . .

..............

7.30 in

7

Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked . . . . .

Form 1098-C (Rev. 11-2019)

Cat. No. 39732R

www.irs.gov/Form1098C

Department of the Treasury - Internal Revenue Service

39

Exhibit E

Form 1098-E

.45 in

		.33 in		.50 in

8484	VOID	CORRECTED

RECIPIENT’S/LENDER’S name, street address, city or town, state or				OMB No. 1545-1576
province, country, ZIP or foreign postal code, and telephone number					Student
			2022
3.33 in		1 in			Loan Interest
					Statement

			Form 1098-E
RECIPIENT’S TIN	BORROWER’S TIN	1 Student loan interest received by lender		Copy A	in
1.70 in		$	2.80 in	For	25.
BORROWER’S name				Internal Revenue
			2.83 in	Service Center
	3.40 in			File with Form 1096.

Street address (including apt. no.)

For Privacy Act and

7.30 in

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

2022 General

Instructions for

Account number (see instructions)

2 Check if box 1 does not include loan origination fees

Certain Information

and/or capitalized interest, and the loan was made

Returns.

before September 1, 2004 . . . . . . .

Form 1098-E

Cat. No. 25088U

www.irs.gov/Form1098E

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

.85 in

8.00 in

8484

VOID

CORRECTED

4.75 in

RECIPIENT’S/LENDER’S name, street address, city or town, state or

OMB No. 1545-1576

province, country, ZIP or foreign postal code, and telephone number

Student

2022

11.0 in

Loan Interest

Statement

Form 1098-E

RECIPIENT’S TIN

BORROWER’S TIN

1 Student loan interest received by lender

Copy A

$

For

BORROWER’S name

Internal Revenue

Service Center

File with Form 1096.

Street address (including apt. no.)

For Privacy Act and

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

2022 General

Instructions for

Account number (see instructions)

2 Check if box 1 does not include loan origination fees

Certain Information

and/or capitalized interest, and the loan was made

Returns.

before September 1, 2004 . . . . . . .

Form 1098-E

Cat. No. 25088U

www.irs.gov/Form1098E

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

8484

VOID

CORRECTED

RECIPIENT’S/LENDER’S name, street address, city or town, state or

OMB No. 1545-1576

province, country, ZIP or foreign postal code, and telephone number

Student

2022

Loan Interest

Statement

Form 1098-E

RECIPIENT’S TIN

BORROWER’S TIN

1 Student loan interest received by lender

Copy A

$

For

BORROWER’S name

Internal Revenue

Service Center

File with Form 1096.

Street address (including apt. no.)

For Privacy Act and

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

2022 General

Instructions for

Account number (see instructions)

2 Check if box 1 does not include loan origination fees

Certain Information

and/or capitalized interest, and the loan was made

Returns.

before September 1, 2004 . . . . . . .

Form 1098-E

Cat. No. 25088U

www.irs.gov/Form1098E

Department of the Treasury - Internal Revenue Service

in 1.17

40

Exhibit F

Form 1098-F

0303	VOID	CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP			1 Total amount required to be paid		OMB No. 1545-2284
or foreign postal code, and telephone no.			$		Form 1098-F
						Fines, Penalties, and
			2	Amount to be paid for
				violation or potential violation	(Rev. January 2022)		Other Amounts
			$
					For calendar year
			3	Restitution/remediation
					20
				amount
			$
FILER’S TIN	PAYER’S TIN				5 Date of order/agreement		Copy A
			4	Compliance amount			For
			$
PAYER’S name							Internal Revenue
			6	Court or entity			Service Center

Street address (including apt. no.)							File with Form 1096.
			7	Case number			For Privacy Act and

City or town, state or province, country, and ZIP or foreign postal code							Paperwork Reduction
			8	Case name or names of parties to suit, order, or agreement			Act Notice, see the
							current General
							Instructions for
			9	Code			Certain Information
							Returns.
Form 1098-F (Rev. 1-2022)	Cat. No. 71382B	www.irs.gov/Form1098F			Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page—Do Not Cut or Separate Forms on This Page

0303	VOID	CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP			1 Total amount required to be paid		OMB No. 1545-2284
or foreign postal code, and telephone no.			$		Form 1098-F
						Fines, Penalties, and
			2	Amount to be paid for
				violation or potential violation	(Rev. January 2022)		Other Amounts
			$
					For calendar year
			3	Restitution/remediation
					20
				amount
			$
FILER’S TIN	PAYER’S TIN				5 Date of order/agreement		Copy A
			4	Compliance amount			For
			$
PAYER’S name							Internal Revenue
			6	Court or entity			Service Center

Street address (including apt. no.)							File with Form 1096.
			7	Case number			For Privacy Act and

City or town, state or province, country, and ZIP or foreign postal code							Paperwork Reduction
			8	Case name or names of parties to suit, order, or agreement			Act Notice, see the
							current General
							Instructions for
			9	Code			Certain Information
							Returns.
Form 1098-F (Rev. 1-2022)	Cat. No. 71382B	www.irs.gov/Form1098F			Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page—Do Not Cut or Separate Forms on This Page

0303	VOID	CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP			1 Total amount required to be paid		OMB No. 1545-2284
or foreign postal code, and telephone no.			$		Form 1098-F
						Fines, Penalties, and
			2	Amount to be paid for
				violation or potential violation	(Rev. January 2022)		Other Amounts
			$
					For calendar year
			3	Restitution/remediation
					20
				amount
			$
FILER’S TIN	PAYER’S TIN				5 Date of order/agreement		Copy A
			4	Compliance amount			For
			$
PAYER’S name							Internal Revenue
			6	Court or entity			Service Center

Street address (including apt. no.)							File with Form 1096.
			7	Case number			For Privacy Act and

City or town, state or province, country, and ZIP or foreign postal code							Paperwork Reduction
			8	Case name or names of parties to suit, order, or agreement			Act Notice, see the
							current General
							Instructions for
			9	Code			Certain Information
							Returns.
Form 1098-F (Rev. 1-2022)	Cat. No. 71382B	www.irs.gov/Form1098F			Department of the Treasury - Internal Revenue Service

41

Exhibit G

Form 1098-MA

	VOID	CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.					OMB No. 1545-2221	Mortgage
					Form 1098-MA
						Assistance
					(Rev. September 2019)
						Payments

					For calendar year
					20
FILER’S TIN	HOMEOWNER’S TIN			1. Total State HFA and homeowner mortgage payments		Copy A
				$		For
HOMEOWNER’S name				2. State HFA mortgage assistance payments		Internal Revenue
						Service Center
				$		For Privacy Act
Street address (including apt. no.) (optional)				3. Homeowner mortgage payments
						and Paperwork
				$		Reduction Act
						Notice, see
City, state, and ZIP code (optional)
						the current General

						Instructions for
Account number (optional)
						Certain Information
						Returns.
Form 1098-MA (Rev. 9-2019)	Cat. No. 58017D		www.irs.gov/Form1098MA		Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on		This	Page — Do Not Cut or Separate Forms			on This Page
	VOID	CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.					OMB No. 1545-2221	Mortgage
					Form 1098-MA
						Assistance
					(Rev. September 2019)
						Payments

					For calendar year
					20
FILER’S TIN	HOMEOWNER’S TIN			1. Total State HFA and homeowner mortgage payments		Copy A
				$		For
HOMEOWNER’S name				2. State HFA mortgage assistance payments		Internal Revenue
						Service Center
				$		For Privacy Act
Street address (including apt. no.) (optional)				3. Homeowner mortgage payments
						and Paperwork
				$		Reduction Act
						Notice, see
City, state, and ZIP code (optional)
						the current General

						Instructions for
Account number (optional)
						Certain Information
						Returns.
Form 1098-MA (Rev. 9-2019)	Cat. No. 58017D		www.irs.gov/Form1098MA		Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on		This	Page — Do Not Cut or Separate Forms			on This Page
	VOID	CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.					OMB No. 1545-2221	Mortgage
					Form 1098-MA
						Assistance
					(Rev. September 2019)
						Payments

					For calendar year
					20
FILER’S TIN	HOMEOWNER’S TIN			1. Total State HFA and homeowner mortgage payments		Copy A
				$		For
HOMEOWNER’S name				2. State HFA mortgage assistance payments		Internal Revenue
						Service Center
				$		For Privacy Act
Street address (including apt. no.) (optional)				3. Homeowner mortgage payments
						and Paperwork
				$		Reduction Act
						Notice, see
City, state, and ZIP code (optional)
						the current General

						Instructions for
Account number (optional)
						Certain Information
						Returns.
Form 1098-MA (Rev. 9-2019)	Cat. No. 58017D		www.irs.gov/Form1098MA		Department of the Treasury - Internal Revenue Service

42

Exhibit H

Form 1098-Q

7474

VOID

CORRECTED

ISSUER’S name, street address, city or town,

state or province, country, ZIP

ISSUER’S TIN

OMB No. 1545-2234

or foreign postal code, and telephone no.

Qualifying

Form 1098-Q

PARTICIPANT’S TIN

.50 in

Longevity Annuity

1.5 in

(Rev. December 2019)

Contract

Information

1a Annuity amount on start date

For calendar year

$

20

1b Annuity start date

2 Check if

start date may be

Copy A

accelerated

0.4 in

For

Internal Revenue

0.6 in

3 Total premiums

4

FMV of QLAC

0.4 in

Service Center

$

$

File with Form 1096.

PARTICIPANT’S name

5a January

dd

5b February

0.34 in

dd

0.5 in

$

$

For Privacy Act

5c March

dd

5d April

dd

and Paperwork

$

$

Street address (including apt. no.)

Reduction Act

0.6 in

5e May

dd

5f

June

dd

Notice, see the

$

$

current General

Instructions for

5g July

dd

5h August

dd

Certain Information

$

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

0.3 in

5i

September

dd

5j

October

dd

$

$

Account number (see instructions)

0.5 in

Plan number

5k

November

dd

5l

December

dd

$

1.0 in

0.4 in

$

Name of plan

0.5 in

Plan sponsor’s EIN

Form 1098-Q (Rev. 12-2019)

Cat. No. 67073Z

www.irs.gov/Form1098Q

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page—Do Not Cut or Separate Forms on This Page

7474

VOID

CORRECTED

ISSUER’S name, street address, city or town, state or province, country, ZIP

ISSUER’S TIN

OMB No. 1545-2234

or foreign postal code, and telephone no.

Qualifying

Form 1098-Q

PARTICIPANT’S TIN

Longevity Annuity

(Rev. December 2019)

Contract

Information

1a Annuity amount on start date

For calendar year

$

20

1b Annuity start date

2 Check if start date may be

Copy A

accelerated

For

Internal Revenue

3 Total premiums

4

FMV of QLAC

Service Center

$

$

File with Form 1096.

PARTICIPANT’S name

5a January

dd

5b February

dd

$

$

For Privacy Act

5c March

dd

5d April

dd

and Paperwork

$

$

Street address (including apt. no.)

Reduction Act

5e May

dd

5f

June

dd

Notice, see the

$

$

current General

Instructions for

5g July

dd

5h August

dd

Certain Information

$

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5i September

dd

5j

October

dd

$

$

Account number (see instructions)

Plan number

5k November

dd

5l

December

dd

$

$

Name of plan

Plan sponsor’s EIN

Form 1098-Q (Rev. 12-2019)

Cat. No. 67073Z

www.irs.gov/Form1098Q

Department of the Treasury - Internal Revenue Service

43

Exhibit I

Form 1098-T

8383

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP or

1 Payments received for

OMB No. 1545-1574

foreign postal code, and telephone number

quali ed tuition and related

expenses

2022

Statement

2

$

Tuition

Form 1098-T

FILER’S employer identi cation no.

STUDENT’S TIN

3

Copy A

For

STUDENT’S name

4 Adjustments made for a

5 Scholarships or grants

Internal Revenue

prior year

Service Center

$

$

File with Form 1096.

Street address (including apt. no.)

6 Adjustments to

7 Checked if the amount

For Privacy Act and

scholarships or grants

in box 1 includes

Paperwork Reduction

for a prior year

amounts for an

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

academic period

$

beginning January–

2022 General

March 2023

Instructions for

Service Provider/Acct. No. (see instr.)

8 Checked if at least

9 Checked if a graduate

10 Ins. contract reimb./refund

Certain Information

half-time student

student

$

Returns.

Form 1098-T

Cat. No. 25087J

www.irs.gov/Form1098T

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

8383

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP or

1

Payments received for

OMB No. 1545-1574

foreign postal code, and telephone number

quali ed tuition and related

2

expenses

2022

Statement

$

Tuition

Form 1098-T

FILER’S employer identi cation no.

STUDENT’S TIN

3

Copy A

For

STUDENT’S name

4

Adjustments made for a

5 Scholarships or grants

Internal Revenue

prior year

Service Center

$

$

File with Form 1096.

Street address (including apt. no.)

6

Adjustments to

7 Checked if the amount

For Privacy Act and

scholarships or grants

in box 1 includes

Paperwork Reduction

for a prior year

amounts for an

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

academic period

$

beginning January–

2022 General

March 2023

Instructions for

Service Provider/Acct. No. (see instr.)

8 Checked if at least

9

Checked if a graduate

10 Ins. contract reimb./refund

Certain Information

half-time student

student

$

Returns.

Form 1098-T

Cat. No. 25087J

www.irs.gov/Form1098T

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

8383

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP or

1

Payments received for

OMB No. 1545-1574

foreign postal code, and telephone number

quali ed tuition and related

2

expenses

2022

Statement

$

Tuition

Form 1098-T

FILER’S employer identi cation no.

STUDENT’S TIN

3

Copy A

For

STUDENT’S name

4

Adjustments made for a

5 Scholarships or grants

Internal Revenue

prior year

Service Center

$

$

File with Form 1096.

Street address (including apt. no.)

6

Adjustments to

7 Checked if the amount

For Privacy Act and

scholarships or grants

in box 1 includes

Paperwork Reduction

for a prior year

amounts for an

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

academic period

$

beginning January–

2022 General

March 2023

Instructions for

Service Provider/Acct. No. (see instr.)

8 Checked if at least

9

Checked if a graduate

10 Ins. contract reimb./refund

Certain Information

half-time student

student

$

Returns.

Form 1098-T

Cat. No. 25087J

www.irs.gov/Form1098T

Department of the Treasury - Internal Revenue Service

44

Exhibit J

Form 1099-A

8080

VOID

CORRECTED

LENDER’S name, street address, city or town, state or province, country, ZIP or

OMB No. 1545-0877

Acquisition or

foreign postal code, and telephone no.

Form 1099-A

(Rev. January 2022)

Abandonment of

For calendar year

Secured Property

20

1 Date of lender’s acquisition or

2 Balance of principal

Copy A

knowledge of abandonment

outstanding

LENDER’S TIN

BORROWER’S TIN

For

$

Internal Revenue

Service Center

BORROWER’S name

3

4 Fair market value of property

$

File with Form 1096.

For Privacy Act

Street address (including apt. no.)

5 Check if the borrower was personally liable for repayment of

and Paperwork

the debt . . . . . . . . . . . .

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

6 Description of property

current General

Instructions for

Certain

Account number (see instructions)

Information

Returns.

Form 1099-A (Rev. 1-2022)

Cat. No. 14412G

www.irs.gov/Form1099A

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

in 1.30

8080	VOID	CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or					OMB No. 1545-0877			Acquisition or
foreign postal code, and telephone no.					Form 1099-A

					(Rev. January 2022)		Abandonment of
					For calendar year		Secured Property
					20
			1 Date of lender’s acquisition or		2 Balance of principal			Copy A
				knowledge of abandonment	outstanding
LENDER’S TIN	BORROWER’S TIN							For
					$
								Internal Revenue
								Service Center
BORROWER’S name			3		4 Fair market value of property
					$			File with Form 1096.

								For Privacy Act
Street address (including apt. no.)			5 Check if the borrower was personally liable for repayment of					and Paperwork
				the debt . . . . . . . . . . . .				Reduction Act
								Notice, see the

City or town, state or province, country, and ZIP or foreign postal code			6 Description of property					current General
								Instructions for
								Certain
Account number (see instructions)								Information
								Returns.

Form 1099-A (Rev. 1-2022)	Cat. No. 14412G		www.irs.gov/Form1099A		Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on		This Page — Do Not Cut or Separate				Forms		on This Page
8080	VOID	CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or					OMB No. 1545-0877			Acquisition or
foreign postal code, and telephone no.					Form 1099-A

					(Rev. January 2022)		Abandonment of
					For calendar year		Secured Property
					20
			1 Date of lender’s acquisition or		2 Balance of principal			Copy A
				knowledge of abandonment	outstanding
LENDER’S TIN	BORROWER’S TIN							For
					$
								Internal Revenue
								Service Center
BORROWER’S name			3		4 Fair market value of property
					$			File with Form 1096.

								For Privacy Act
Street address (including apt. no.)			5 Check if the borrower was personally liable for repayment of					and Paperwork
				the debt . . . . . . . . . . . .				Reduction Act
								Notice, see the

City or town, state or province, country, and ZIP or foreign postal code			6 Description of property					current General
								Instructions for
								Certain
Account number (see instructions)								Information
								Returns.

Form 1099-A (Rev. 1-2022)	Cat. No. 14412G		www.irs.gov/Form1099A		Department of the Treasury - Internal Revenue Service

45

Exhibit K

Form 1099-B

7979	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949			OMB No. 1545-0715	Proceeds From
or foreign postal code, and telephone no.			2022	Broker and

				Barter Exchange
			Form 1099-B	Transactions

1a Description of property (Example: 100 sh. XYZ Co.)

1b Date acquired

1c Date sold or disposed

Copy A

PAYER’S TIN

RECIPIENT’S TIN

1d Proceeds

1e Cost or other basis

$

$

1f Accrued market discount

1g Wash sale loss disallowed

For

$

$

Internal Revenue

Service Center

RECIPIENT’S name

2 Short-term gain or loss

3 Check if proceeds from:

Long-term gain or loss

Collectibles

File with Form 1096.

Ordinary

QOF

1.27 in

Street address (including apt. no.)

4 Federal income tax withheld

5 Check if noncovered

$

security

6 Reported to IRS:

7 Check if loss is not allowed

For Privacy Act

based on amount in 1d

and Paperwork

City or town, state or province, country, and ZIP or foreign postal code

Gross proceeds

2.60 in

Net proceeds

Reduction Act

0.60 in

Notice, see the

8 Pro t or (loss) realized in

9 Unrealized pro t or (loss) on

2022 General

2022 on closed contracts

open contracts—12/31/2021

Account number (see instructions)

2nd TIN not.

$

$

Instructions for

Certain

CUSIP number

FATCA ling

10 Unrealized pro t or (loss) on

11 Aggregate pro t or (loss)

Information

requirement

open contracts—12/31/2022

on contracts

Returns.

4.20 in

14 State name

15 State identi cation no.

16 State tax withheld

$

$

$

12 Check if basis reported to

13 Bartering

$

IRS

$

1.56 in

Form 1099-B

Cat. No. 14411V

www.irs.gov/Form1099B

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

7979	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949			OMB No. 1545-0715	Proceeds From
or foreign postal code, and telephone no.			2022	Broker and

				Barter Exchange
			Form 1099-B	Transactions

1a Description of property (Example: 100 sh. XYZ Co.)

								1b Date acquired	1c Date sold or disposed
										Copy A
PAYER’S TIN			RECIPIENT’S TIN					1d Proceeds	1e Cost or other basis
							$		$
								1f Accrued market discount	1g Wash sale loss disallowed	For
							$		$	Internal Revenue
										Service Center
RECIPIENT’S name								2 Short-term gain or loss	3 Check if proceeds from:
								Long-term gain or loss	Collectibles	File with Form 1096.
								Ordinary	QOF
Street address (including apt. no.)								4 Federal income tax withheld	5 Check if noncovered
							$		security

								6 Reported to IRS:	7 Check if loss is not allowed	For Privacy Act
									based on amount in 1d	and Paperwork
City or town, state or province, country, and ZIP or foreign postal code								Gross proceeds

								Net proceeds		Reduction Act
										Notice, see the
								8 Pro t or (loss) realized in	9 Unrealized pro t or (loss) on
										2022 General
								2022 on closed contracts	open contracts—12/31/2021
Account number (see instructions)						2nd TIN not.	$		$	Instructions for
										Certain
CUSIP number					FATCA ling			10 Unrealized pro t or (loss) on	11 Aggregate pro t or (loss)	Information
					requirement			open contracts—12/31/2022	on contracts	Returns.
									$
14 State name	15 State identi cation no.			16 State tax withheld				$
				$				12 Check if basis reported to	13 Bartering
				$				IRS	$

Form 1099-B		Cat. No. 14411V						www.irs.gov/Form1099B	Department of the Treasury - Internal Revenue Service

46

Exhibit L

Form 1099-C

8585

VOID

CORRECTED

CREDITOR’S name, street address, city or town, state or province, country,

1 Date of identi able event

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

Form 1099-C

Cancellation

2 Amount of debt discharged

$

(Rev. January 2022)

of Debt

3 Interest, if included in box 2

For calendar year

$

20

CREDITOR’S TIN

DEBTOR’S TIN

4 Debt description

Copy A

For

DEBTOR’S name

Internal Revenue

Service Center

File with Form 1096.

Street address (including apt. no.)

5 Check here if the debtor was personally liable for

For Privacy Act and

repayment of the debt . . . . . . . .

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Account number (see instructions)

6 Identi able event code

7 Fair market value of property

Certain Information

$

Returns.

Form 1099-C (Rev. 1-2022)

Cat. No. 26280W

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on

This Page — Do Not Cut or Separate Forms

on This Page

8585

VOID

CORRECTED

CREDITOR’S name, street address, city or town, state or province, country,

1 Date of identi able event

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

Form 1099-C

Cancellation

2 Amount of debt discharged

$

(Rev. January 2022)

of Debt

3 Interest, if included in box 2

For calendar year

$

20

CREDITOR’S TIN

DEBTOR’S TIN

4 Debt description

Copy A

For

DEBTOR’S name

Internal Revenue

Service Center

File with Form 1096.

Street address (including apt. no.)

5 Check here if the debtor was personally liable for

For Privacy Act and

repayment of the debt . . . . . . . .

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Account number (see instructions)

6 Identi able event code

7 Fair market value of property

Certain Information

$

Returns.

Form 1099-C (Rev. 1-2022)

Cat. No. 26280W

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on

This Page — Do Not Cut or Separate Forms

on This Page

8585

VOID

CORRECTED

CREDITOR’S name, street address, city or town, state or province, country,

1 Date of identi able event

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

Form 1099-C

Cancellation

2 Amount of debt discharged

$

(Rev. January 2022)

of Debt

3 Interest, if included in box 2

For calendar year

$

20

CREDITOR’S TIN

DEBTOR’S TIN

4 Debt description

Copy A

For

DEBTOR’S name

Internal Revenue

Service Center

File with Form 1096.

Street address (including apt. no.)

5 Check here if the debtor was personally liable for

For Privacy Act and

repayment of the debt . . . . . . . .

Paperwork Reduction

Act Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Account number (see instructions)

6 Identi able event code

7 Fair market value of property

Certain Information

$

Returns.

Form 1099-C (Rev. 1-2022)

Cat. No. 26280W

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

in 1.3

47

Exhibit M

Form 1099-DIV

9191

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

1a Total ordinary dividends

OMB No. 1545-0110

or foreign postal code, and telephone no.

Form 1099-DIV

$

Dividends and

(Rev. January 2022)

Distributions

1b Quali ed dividends

For calendar year

$

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

Copy A

$

$

For

PAYER’S TIN

RECIPIENT’S TIN

2c Section 1202 gain

2d Collectibles (28%) gain

Internal Revenue

$

$

Service Center

2e Section 897 ordinary dividends

2f

Section 897 capital gain

File with Form 1096.

$

$

RECIPIENT’S name

3

Nondividend distributions

4 Federal income tax withheld

For Privacy Act

$

$

and Paperwork

5

Section 199A dividends

6

Investment expenses

Reduction Act

$

$

Street address (including apt. no.)

Notice, see the

7

Foreign tax paid

8 Foreign country or U.S. possession

current General

$

Instructions for

City or town, state or province, country, and ZIP or foreign postal code

Certain

9

Cash liquidation distributions

10

Noncash liquidation distributions

Information

$

$

Returns.

11 FATCA ling

12 Exempt-interest dividends

13 Speci ed private activity

requirement

bond interest dividends

$

$

Account number (see instructions)

2nd TIN not.

14 State

15 State identi cation no.

16 State tax withheld

$

$

Form 1099-DIV (Rev. 1-2022)

Cat. No. 14415N

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on

This Page —

Do Not Cut or Separate Forms on This Page

9191

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

1a Total ordinary dividends

OMB No. 1545-0110

or foreign postal code, and telephone no.

Form 1099-DIV

$

Dividends and

(Rev. January 2022)

Distributions

1b Quali ed dividends

For calendar year

$

20

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

Copy A

$

$

For

PAYER’S TIN

RECIPIENT’S TIN

2c Section 1202 gain

2d Collectibles (28%) gain

Internal Revenue

$

$

Service Center

2e Section 897 ordinary dividends

2f

Section 897 capital gain

File with Form 1096.

$

$

RECIPIENT’S name

3

Nondividend distributions

4 Federal income tax withheld

For Privacy Act

$

$

and Paperwork

5

Section 199A dividends

6

Investment expenses

Reduction Act

$

$

Street address (including apt. no.)

Notice, see the

7

Foreign tax paid

8 Foreign country or U.S. possession

current General

$

Instructions for

City or town, state or province, country, and ZIP or foreign postal code

Certain

9

Cash liquidation distributions

10

Noncash liquidation distributions

Information

$

$

Returns.

11 FATCA ling

12 Exempt-interest dividends

13 Speci ed private activity

requirement

bond interest dividends

$

$

Account number (see instructions)

2nd TIN not.

14 State

15 State identi cation no.

16 State tax withheld

$

$

Form 1099-DIV (Rev. 1-2022)

Cat. No. 14415N

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

48

Exhibit N

Form 1099-G

8686	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Unemployment compensation		OMB No. 1545-0120
or foreign postal code, and telephone no.					Form 1099-G		Certain
			$
							Government
			2 State or local income tax		(Rev. January 2022)
							Payments
			refunds, credits, or offsets
					For calendar year
			$		20

PAYER’S TIN	RECIPIENT’S TIN		3 Box 2 amount is for tax year		4 Federal income tax withheld		Copy A
					$		For
RECIPIENT’S name			5 RTAA payments		6 Taxable grants		Internal Revenue
			$		$		Service Center
			7 Agriculture payments		8 Check if box 2 is		File with Form 1096.
			$		trade or business		For Privacy Act
Street address (including apt. no.)
					income
							and Paperwork
			9 Market gain
							Reduction Act
			$
City or town, state or province, country, and ZIP or foreign postal code							Notice, see the
			10a State	10b State identi cation no.		11 State income tax withheld	current General
						$	Instructions for
Account number (see instructions)		2nd TIN not.
							Certain Information
						$
							Returns.
Form 1099-G (Rev. 1-2022)	Cat. No. 14438M		www.irs.gov/Form1099G		Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

8686	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Unemployment compensation		OMB No. 1545-0120
or foreign postal code, and telephone no.					Form 1099-G		Certain
			$
							Government
			2 State or local income tax		(Rev. January 2022)
							Payments
			refunds, credits, or offsets
					For calendar year
			$		20

PAYER’S TIN	RECIPIENT’S TIN		3 Box 2 amount is for tax year		4 Federal income tax withheld		Copy A
					$		For
RECIPIENT’S name			5 RTAA payments		6 Taxable grants		Internal Revenue
			$		$		Service Center
			7 Agriculture payments		8 Check if box 2 is		File with Form 1096.
			$		trade or business		For Privacy Act
Street address (including apt. no.)
					income
							and Paperwork
			9 Market gain
							Reduction Act
			$
City or town, state or province, country, and ZIP or foreign postal code							Notice, see the
			10a State	10b State identi cation no.		11 State income tax withheld	current General
						$	Instructions for
Account number (see instructions)		2nd TIN not.
							Certain Information
						$
							Returns.
Form 1099-G (Rev. 1-2022)	Cat. No. 14438M		www.irs.gov/Form1099G		Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

8686	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Unemployment compensation		OMB No. 1545-0120
or foreign postal code, and telephone no.					Form 1099-G		Certain
			$
							Government
			2 State or local income tax		(Rev. January 2022)
							Payments
			refunds, credits, or offsets
					For calendar year
			$		20

PAYER’S TIN	RECIPIENT’S TIN		3 Box 2 amount is for tax year		4 Federal income tax withheld		Copy A
					$		For
RECIPIENT’S name			5 RTAA payments		6 Taxable grants		Internal Revenue
			$		$		Service Center
			7 Agriculture payments		8 Check if box 2 is		File with Form 1096.
			$		trade or business		For Privacy Act
Street address (including apt. no.)
					income
							and Paperwork
			9 Market gain
							Reduction Act
			$
City or town, state or province, country, and ZIP or foreign postal code							Notice, see the
			10a State	10b State identi cation no.		11 State income tax withheld	current General
						$	Instructions for
Account number (see instructions)		2nd TIN not.
							Certain Information
						$
							Returns.
Form 1099-G (Rev. 1-2022)	Cat. No. 14438M		www.irs.gov/Form1099G		Department of the Treasury - Internal Revenue Service

49

Exhibit O

Form 1099-INT

9292	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			Payer’s RTN (optional)	OMB No. 1545-0112
or foreign postal code, and telephone no.				Form 1099-INT		Interest

				(Rev. January 2022)		Income
			1 Interest income


				For calendar year
			$	20

			2 Early withdrawal penalty			Copy A

			$
PAYER’S TIN	RECIPIENT’S TIN					For
			3 Interest on U.S. Savings Bonds and Treasury obligations
						Internal Revenue

			$			Service Center


RECIPIENT’S name			4 Federal income tax withheld	5 Investment expenses		File with Form 1096.
			$	$
			6 Foreign tax paid	7 Foreign country or U.S. possession		For Privacy Act
			$
Street address (including apt. no.)						and Paperwork

			8 Tax-exempt interest	9 Speci ed private activity bond		Reduction Act
				interest		Notice, see the

City or town, state or province, country, and ZIP or foreign postal code			$	$		current General
						Instructions for
			10 Market discount	11 Bond premium
						Certain
			$	$		Information
		FATCA ling
						Returns.
		requirement
			12 Bond premium on Treasury obligations	13 Bond premium on tax-exempt bond
			$	$
Account number (see instructions)		2nd TIN not.	14 Tax-exempt and tax credit	15 State	16 State identi cation no.	17 State tax withheld
			bond CUSIP no.			$

						$
Form 1099-INT (Rev. 1-2022)	Cat. No. 14410K		www.irs.gov/Form1099INT	Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

9292	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			Payer’s RTN (optional)	OMB No. 1545-0112
or foreign postal code, and telephone no.				Form 1099-INT		Interest

				(Rev. January 2022)		Income
			1 Interest income


				For calendar year
			$	20

			2 Early withdrawal penalty			Copy A

			$
PAYER’S TIN	RECIPIENT’S TIN					For
			3 Interest on U.S. Savings Bonds and Treasury obligations
						Internal Revenue

			$			Service Center


RECIPIENT’S name			4 Federal income tax withheld	5 Investment expenses		File with Form 1096.
			$	$
			6 Foreign tax paid	7 Foreign country or U.S. possession		For Privacy Act
			$
Street address (including apt. no.)						and Paperwork

			8 Tax-exempt interest	9 Speci ed private activity bond		Reduction Act
				interest		Notice, see the

City or town, state or province, country, and ZIP or foreign postal code			$	$		current General
						Instructions for
			10 Market discount	11 Bond premium
						Certain
			$	$		Information
		FATCA ling
						Returns.
		requirement
			12 Bond premium on Treasury obligations	13 Bond premium on tax-exempt bond
			$	$
Account number (see instructions)		2nd TIN not.	14 Tax-exempt and tax credit	15 State	16 State identi cation no.	17 State tax withheld
			bond CUSIP no.			$

						$
Form 1099-INT (Rev. 1-2022)	Cat. No. 14410K		www.irs.gov/Form1099INT	Department of the Treasury - Internal Revenue Service

50

Exhibit P

Form 1099-K

1010

VOID

CORRECTED

FILER’S name, street address, city or

town, state or province, country, ZIP

FILER’S TIN

0.33 in

OMB No. 1545-2205

or foreign postal code, and telephone no.

Form 1099-K

Payment Card and

PAYEE’S TIN

1.40 in

Third Party

(Rev. January 2022)

Network

1a Gross amount of

payment

Transactions

card/third party

network

For calendar year

transactions

0.50 in

$

20

1b Card Not Present

2

Merchant

category code

Copy A

transactions

0.42 in

$

For

Check to indicate if FILER is a (an):

Check to indicate transactions

reported are:

Internal Revenue

Payment settlement entity (PSE)

Payment card

0.09 in

3

Number of payment

4

Federal income tax

Service Center

Electronic Payment Facilitator

1.56 in

transactions

0.42 in

$

withheld

(EPF)/Other third party

Third party network

File with Form 1096.

PAYEE’S name

5a January

5b February

$

$

For Privacy Act

5c March

5d April

0.33 in

and Paperwork

$

$

Street address (including apt. no.)

Reduction Act

5e May

5f

June

Notice, see the

$

$

current General

Instructions for

5g July

5h August

Certain Information

$

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5i

September

5j

October

$

$

PSE’S name and telephone number

5k November

5l

December

$

$

Account number (see instructions)

2nd TIN not.

6

State

7

State identi cation no.

8 State income tax withheld

$

$

Form 1099-K (Rev. 1-2022)

Cat. No. 54118B

www.irs.gov/Form1099K

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page—Do Not Cut or Separate Forms on This Page

1010

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country, ZIP

FILER’S TIN

OMB No. 1545-2205

or foreign postal code, and telephone no.

Payment Card and

Form 1099-K

PAYEE’S TIN

Third Party

(Rev. January 2022)

Network

1a Gross amount of payment

For calendar year

Transactions

transactions

card/third party network

20

$

1b Card Not Present

2

Merchant category code

Copy A

transactions

Check to indicate if FILER is a (an):

Check to indicate transactions

$

For

reported are:

Internal Revenue

Payment settlement entity (PSE)

3 Number of payment

4

Federal income tax

Payment card

Service Center

Electronic Payment Facilitator

transactions

withheld

$

(EPF)/Other third party

Third party network

File with Form 1096.

PAYEE’S name

5a January

5b February

$

$

For Privacy Act

5c March

5d April

and Paperwork

$

$

Street address (including apt. no.)

Reduction Act

5e May

5f June

Notice, see the

$

$

current General

Instructions for

5g July

5h August

Certain Information

$

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5i September

5j

October

$

$

PSE’S name and telephone number

5k November

5l

December

$

$

Account number (see instructions)

2nd TIN not.

6 State

7

State identi cation no.

8 State income tax withheld

$

$

Form 1099-K (Rev. 1-2022)

Cat. No. 54118B

www.irs.gov/Form1099K

Department of the Treasury - Internal Revenue Service

51

Exhibit Q

Form 1099-LS

1616

VOID

CORRECTED

ACQUIRER’S name, street address, city or town, state or province, country,

1 Amount paid to payment

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

recipient

Form 1099-LS

$

Reportable Life

2 Date of sale

(Rev. December 2019)

Insurance Sale

For calendar year

20

ACQUIRER’S TIN

PAYMENT RECIPIENT’S TIN

Issuer’s name

Copy A

For

Internal Revenue

PAYMENT RECIPIENT’S name

Acquirer’s information contact name, street address, city or

Service Center

town, state or province, country, ZIP or foreign postal code,

File with Form 1096.

and telephone no. (if different from ACQUIRER)

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-LS (Rev. 12-2019)

Cat. No. 71383M

www.irs.gov/Form1099LS

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not

Cut or

Separate

Forms

on

This

Page

1616

VOID

CORRECTED

ACQUIRER’S name, street address, city or town, state or province, country,

1 Amount paid to payment

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

recipient

Form 1099-LS

$

Reportable Life

2 Date of sale

(Rev. December 2019)

Insurance Sale

For calendar year

20

ACQUIRER’S TIN

PAYMENT RECIPIENT’S TIN

Issuer’s name

Copy A

For

Internal Revenue

PAYMENT RECIPIENT’S name

Acquirer’s information contact name, street address, city or

Service Center

town, state or province, country, ZIP or foreign postal code,

File with Form 1096.

and telephone no. (if different from ACQUIRER)

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-LS (Rev. 12-2019)

Cat. No. 71383M

www.irs.gov/Form1099LS

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not

Cut or

Separate

Forms

on

This

Page

1616

VOID

CORRECTED

ACQUIRER’S name, street address, city or town, state or province, country,

1 Amount paid to payment

OMB No. 1545-2281

ZIP or foreign postal code, and telephone no.

recipient

Form 1099-LS

$

Reportable Life

2 Date of sale

(Rev. December 2019)

Insurance Sale

For calendar year

20

ACQUIRER’S TIN

PAYMENT RECIPIENT’S TIN

Issuer’s name

Copy A

For

Internal Revenue

PAYMENT RECIPIENT’S name

Acquirer’s information contact name, street address, city or

Service Center

town, state or province, country, ZIP or foreign postal code,

File with Form 1096.

and telephone no. (if different from ACQUIRER)

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-LS (Rev. 12-2019)

Cat. No. 71383M

www.irs.gov/Form1099LS

Department of the Treasury - Internal Revenue Service

52

Exhibit R

Form 1099-MISC

.45 in

9595

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

1 Rents

OMB No. 1545-0115

or foreign postal code, and telephone no.

$

Form 1099-MISC

Miscellaneous

(Rev. January 2022)

Information

2 Royalties

For calendar year

$

20

3 Other income

4 Federal income tax withheld

Copy A

$

$

For

PAYER’S TIN

RECIPIENT’S TIN

5 Fishing boat proceeds

6 Medical and health care

Internal Revenue

payments

Service Center

$

$

File with Form 1096.

RECIPIENT’S name

7 Payer made direct sales

8 Substitute payments in lieu

For Privacy Act

totaling $5,000 or more of

of dividends or interest

and Paperwork

consumer products to

$

Reduction Act

recipient for resale

Street address (including apt. no.)

9 Crop insurance proceeds

10 Gross proceeds paid to an

Notice, see the

.50 in

attorney

current General

$

$

Instructions for

Certain

City or town, state or province, country, and ZIP or foreign postal code

11 Fish purchased for resale

12 Section 409A deferrals

Information

$

$

Returns.

13 FATCA ling

14 Excess golden parachute

15 Nonquali ed deferred

requirement

payments

compensation

$

$

Account number (see instructions)

2nd TIN not.

16 State tax withheld

17 State/Payer’s state no.

18 State income

$

$

$

$

Form 1099-MISC (Rev. 1-2022)

Cat. No. 14425J

www.irs.gov/Form1099MISC

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

1.00 in

9595

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

1 Rents

OMB No. 1545-0115

or foreign postal code, and telephone no.

$

Form 1099-MISC

Miscellaneous

(Rev. January 2022)

Information

2 Royalties

For calendar year

$

20

3 Other income

4 Federal income tax withheld

Copy A

$

$

For

PAYER’S TIN

RECIPIENT’S TIN

5 Fishing boat proceeds

6 Medical and health care

Internal Revenue

payments

Service Center

$

$

File with Form 1096.

RECIPIENT’S name

7 Payer made direct sales

8 Substitute payments in lieu

For Privacy Act

totaling $5,000 or more of

of dividends or interest

and Paperwork

consumer products to

$

Reduction Act

recipient for resale

Street address (including apt. no.)

9 Crop insurance proceeds

10 Gross proceeds paid to an

Notice, see the

attorney

current General

$

$

Instructions for

Certain

City or town, state or province, country, and ZIP or foreign postal code

11 Fish purchased for resale

12 Section 409A deferrals

Information

$

$

Returns.

13 FATCA ling

14 Excess golden parachute

15 Nonquali ed deferred

requirement

payments

compensation

$

$

Account number (see instructions)

2nd TIN not.

16 State tax withheld

17 State/Payer’s state no.

18 State income

$

$

$

$

Form 1099-MISC (Rev. 1-2022)

Cat. No. 14425J

www.irs.gov/Form1099MISC

Department of the Treasury - Internal Revenue Service

53

Exhibit S

Form 1099-NEC

7171

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

OMB No. 1545-0116

or foreign postal code, and telephone no.

Form 1099-NEC

Nonemployee

(Rev. January 2022)

Compensation

For calendar year

20

PAYER’S TIN

RECIPIENT’S TIN

1

Nonemployee compensation

Copy A

$

For Internal Revenue

RECIPIENT’S name

2

Payer made direct sales totaling $5,000 or more of

Service Center

consumer products to recipient for resale

File with Form 1096.

3

For Privacy Act and

Paperwork Reduction Act

Street address (including apt. no.)

Notice, see the current

4

Federal income tax withheld

General Instructions for

Certain Information

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5

State tax withheld

6 State/Payer’s state no.

7 State income

$

$

Account number (see instructions)

2nd TIN not.

$

$

Form 1099-NEC (Rev. 1-2022)

Cat. No. 72590N

www.irs.gov/Form1099NEC

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

7171

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

OMB No. 1545-0116

or foreign postal code, and telephone no.

Form 1099-NEC

Nonemployee

(Rev. January 2022)

Compensation

For calendar year

20

PAYER’S TIN

RECIPIENT’S TIN

1

Nonemployee compensation

Copy A

$

For Internal Revenue

RECIPIENT’S name

2

Payer made direct sales totaling $5,000 or more of

Service Center

consumer products to recipient for resale

File with Form 1096.

3

For Privacy Act and

Paperwork Reduction Act

Street address (including apt. no.)

Notice, see the current

4

Federal income tax withheld

General Instructions for

Certain Information

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5

State tax withheld

6 State/Payer’s state no.

7 State income

$

$

Account number (see instructions)

2nd TIN not.

$

$

Form 1099-NEC (Rev. 1-2022)

Cat. No. 72590N

www.irs.gov/Form1099NEC

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

7171

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP

OMB No. 1545-0116

or foreign postal code, and telephone no.

Form 1099-NEC

Nonemployee

(Rev. January 2022)

Compensation

For calendar year

20

PAYER’S TIN

RECIPIENT’S TIN

1 Nonemployee compensation

Copy A

$

For Internal Revenue

RECIPIENT’S name

2 Payer made direct sales totaling $5,000 or more of

Service Center

consumer products to recipient for resale

File with Form 1096.

3

For Privacy Act and

Paperwork Reduction Act

Street address (including apt. no.)

Notice, see the current

4 Federal income tax withheld

General Instructions for

Certain Information

$

City or town, state or province, country, and ZIP or foreign postal code

Returns.

5 State tax withheld

6 State/Payer’s state no.

7 State income

$

$

Account number (see instructions)

2nd TIN not.

$

$

Form 1099-NEC (Rev. 1-2022)

Cat. No. 72590N

www.irs.gov/Form1099NEC

Department of the Treasury - Internal Revenue Service

54

Exhibit T

Form 1099-OID

9696

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country,

1 Original issue discount for

OMB No. 1545-0117

ZIP or foreign postal code, and telephone no.

the year

$

Form 1099-OID

Original Issue

(Rev. October 2019)

Discount

2 Other periodic interest

For calendar year

$

20

PAYER’S TIN

RECIPIENT’S TIN

3 Early withdrawal penalty

4 Federal income tax withheld

Copy A

$

$

5 Market discount

6 Acquisition premium

For

Internal Revenue

RECIPIENT’S name

$

$

Service Center

7 Description

File with Form 1096.

Street address (including apt. no.)

For Privacy Act

and Paperwork

City or town, state or province, country, and ZIP or foreign postal code

8 Original issue discount on

9 Investment expenses

Reduction Act

U.S. Treasury obligations

Notice, see the

$

$

current General

FATCA ling

10 Bond premium

11 Tax-exempt OID

Instructions for

requirement

Certain

$

$

Information

Account number (see instructions)

2nd TIN not.

12 State

13 State identi cation no.

14 State tax withheld

Returns.

$

$

Form 1099-OID (Rev. 10-2019)

Cat. No. 14421R

www.irs.gov/Form1099OID

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

9696

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province, country,

1 Original issue discount for

OMB No. 1545-0117

ZIP or foreign postal code, and telephone no.

the year

$

Form 1099-OID

Original Issue

(Rev. October 2019)

Discount

2 Other periodic interest

For calendar year

$

20

PAYER’S TIN

RECIPIENT’S TIN

3 Early withdrawal penalty

4 Federal income tax withheld

Copy A

$

$

5 Market discount

6 Acquisition premium

For

Internal Revenue

RECIPIENT’S name

$

$

Service Center

7 Description

File with Form 1096.

Street address (including apt. no.)

For Privacy Act

and Paperwork

City or town, state or province, country, and ZIP or foreign postal code

8 Original issue discount on

9 Investment expenses

Reduction Act

U.S. Treasury obligations

Notice, see the

$

$

current General

FATCA ling

10 Bond premium

11

Tax-exempt OID

Instructions for

requirement

Certain

$

$

Information

Account number (see instructions)

2nd TIN not.

12 State

13 State identi cation no.

14 State tax withheld

Returns.

$

$

Form 1099-OID (Rev. 10-2019)

Cat. No. 14421R

www.irs.gov/Form1099OID

Department of the Treasury - Internal Revenue Service

55

Exhibit U

Form 1099-PATR

9797	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Patronage dividends		OMB No. 1545-0118			Taxable
or foreign postal code, and telephone no.			$

					2022			Distributions
			2 Nonpatronage distributions
			$				Received From
								Cooperatives
			3 Per-unit retain allocations
			$	Form 1099-PATR
PAYER’S TIN	RECIPIENT’S TIN		4 Federal income tax withheld		5 Redeemed nonquali ed notices			Copy A
			$		$			For
								Internal Revenue
RECIPIENT’S name			6 Section 199A(g) deduction		7 Quali ed payments
					(Section 199A(b)(7))			Service Center

								File with Form 1096.
			$		$
								For Privacy Act
Street address (including apt. no.)			8 Section 199A(a) qual. items		9 Section 199A(a) SSTB items
			$		$			and Paperwork
								Reduction Act
City or town, state or province, country, and ZIP or foreign postal code			10 Investment credit	11 Work opportunity credit				Notice, see the
			$		$			2022 General
								Instructions for
Account number (see instructions)		2nd TIN not.	12 Other credits and deductions			13 Speci ed Coop		Certain Information
			$					Returns.
Form 1099-PATR	Cat. No. 14435F		www.irs.gov/Form1099PATR		Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

9797	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Patronage dividends		OMB No. 1545-0118			Taxable
or foreign postal code, and telephone no.			$

					2022			Distributions
			2 Nonpatronage distributions
			$				Received From
								Cooperatives
			3 Per-unit retain allocations
			$	Form 1099-PATR
PAYER’S TIN	RECIPIENT’S TIN		4 Federal income tax withheld		5 Redeemed nonquali ed notices			Copy A
			$		$			For
								Internal Revenue
RECIPIENT’S name			6 Section 199A(g) deduction		7 Quali ed payments
					(Section 199A(b)(7))			Service Center

								File with Form 1096.
			$		$
								For Privacy Act
Street address (including apt. no.)			8 Section 199A(a) qual. items		9 Section 199A(a) SSTB items
			$		$			and Paperwork
								Reduction Act
City or town, state or province, country, and ZIP or foreign postal code			10 Investment credit	11 Work opportunity credit				Notice, see the
			$		$			2022 General
								Instructions for
Account number (see instructions)		2nd TIN not.	12 Other credits and deductions			13 Speci ed Coop		Certain Information
			$					Returns.
Form 1099-PATR	Cat. No. 14435F		www.irs.gov/Form1099PATR		Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

9797	VOID	CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP			1 Patronage dividends		OMB No. 1545-0118			Taxable
or foreign postal code, and telephone no.			$

					2022			Distributions
			2 Nonpatronage distributions
			$				Received From
								Cooperatives
			3 Per-unit retain allocations
			$	Form 1099-PATR
PAYER’S TIN	RECIPIENT’S TIN		4 Federal income tax withheld		5 Redeemed nonquali ed notices			Copy A
			$		$			For
								Internal Revenue
RECIPIENT’S name			6 Section 199A(g) deduction		7 Quali ed payments
					(Section 199A(b)(7))			Service Center

								File with Form 1096.
			$		$
								For Privacy Act
Street address (including apt. no.)			8 Section 199A(a) qual. items		9 Section 199A(a) SSTB items
			$		$			and Paperwork
								Reduction Act
City or town, state or province, country, and ZIP or foreign postal code			10 Investment credit	11 Work opportunity credit				Notice, see the
			$		$			2022 General
								Instructions for
Account number (see instructions)		2nd TIN not.	12 Other credits and deductions			13 Speci ed Coop		Certain Information
			$					Returns.
Form 1099-PATR	Cat. No. 14435F		www.irs.gov/Form1099PATR		Department of the Treasury - Internal Revenue Service

56

Exhibit V

Form 1099-Q

3131

VOID

CORRECTED

PAYER’S/TRUSTEE’S name, street address, city or town, state or province,

1 Gross distribution

OMB No. 1545-1760

Payments From

country, ZIP or foreign postal code, and telephone no.

Form 1099-Q

Qualified

$

Education

(Rev. November 2019)

Programs

2 Earnings

(Under Sections

For calendar year

529 and 530)

$

20

transfer

1.17 in ^{Copy A}

PAYER’S/TRUSTEE’S TIN

RECIPIENT’S TIN

3 Basis

4 Trustee-to-trustee

$

For

RECIPIENT’S name

5 Distribution is from:

6 Check if the recipient is

Internal Revenue

• Quali ed tuition program—

not the designated

Service Center

bene ciary _{3.30 in}

Private

or State

File with Form 1096.

2.55 in

For Privacy Act

Street address (including apt. no.)

• Coverdell ESA

and Paperwork

Reduction Act

City or town, state or province, country, and ZIP or foreign postal code

Notice, see the

current General

Instructions for

Account number (see instructions)

Certain Information

Returns.

Form 1099-Q (Rev. 11-2019)

Cat. No. 32223J

www.irs.gov/Form1099Q

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

3131	VOID	CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province,			1 Gross distribution		OMB No. 1545-1760	Payments From
country, ZIP or foreign postal code, and telephone no.					Form 1099-Q
						Qualified

			$			Education
					(Rev. November 2019)	Programs
			2 Earnings
						(Under Sections
					For calendar year
						529 and 530)
			$		20


PAYER’S/TRUSTEE’S TIN	RECIPIENT’S TIN		3 Basis		4 Trustee-to-trustee	Copy A
			$		transfer	For

RECIPIENT’S name			5 Distribution is from:		6 Check if the recipient is	Internal Revenue
			• Quali ed tuition program—		not the designated	Service Center
					bene ciary
						File with Form 1096.
			Private	or State
						For Privacy Act
Street address (including apt. no.)			• Coverdell ESA
						and Paperwork

						Reduction Act
City or town, state or province, country, and ZIP or foreign postal code						Notice, see the
						current General
						Instructions for
Account number (see instructions)
						Certain Information

						Returns.
Form 1099-Q (Rev. 11-2019)	Cat. No. 32223J		www.irs.gov/Form1099Q		Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

3131	VOID	CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province,			1 Gross distribution		OMB No. 1545-1760	Payments From
country, ZIP or foreign postal code, and telephone no.					Form 1099-Q
						Qualified

			$			Education
					(Rev. November 2019)	Programs
			2 Earnings
						(Under Sections
					For calendar year
						529 and 530)
			$		20


PAYER’S/TRUSTEE’S TIN	RECIPIENT’S TIN		3 Basis		4 Trustee-to-trustee	Copy A
			$		transfer	For

RECIPIENT’S name			5 Distribution is from:		6 Check if the recipient is	Internal Revenue
			• Quali ed tuition program—		not the designated	Service Center
					bene ciary
						File with Form 1096.
			Private	or State
						For Privacy Act
Street address (including apt. no.)			• Coverdell ESA
						and Paperwork

						Reduction Act
City or town, state or province, country, and ZIP or foreign postal code						Notice, see the
						current General
						Instructions for
Account number (see instructions)
						Certain Information

						Returns.
Form 1099-Q (Rev. 11-2019)	Cat. No. 32223J		www.irs.gov/Form1099Q		Department of the Treasury - Internal Revenue Service

57

Exhibit W

Form 1099-R

9898

VOID

CORRECTED

Distributions From

PAYER’S name, street address, city or town, state or province,

1 Gross distribution

OMB No. 1545-0119

country, ZIP or foreign postal code, and telephone no.

Pensions, Annuities,

$

2022

Retirement or

Profit-Sharing Plans,

2a Taxable amount

IRAs, Insurance

$

Form 1099-R

Contracts, etc.

2b Taxable amount

Total

Copy A

not determined

distribution

For

PAYER’S TIN

RECIPIENT’S TIN

3 Capital gain (included in

4 Federal income tax

Internal Revenue

box 2a)

withheld

Service Center

$

$

File with Form 1096.

RECIPIENT’S name

5 Employee contributions/

6 Net unrealized

For Privacy Act

Designated Roth

appreciation in

contributions or

employer’s securities

and Paperwork

insurance premiums

Reduction Act

$

$

Notice, see the

Street address (including apt. no.)

7 Distribution

IRA/

8 Other

2022 General

code(s)

SEP/

Instructions for

SIMPLE

$

Certain

%

Information

City or town, state or province, country, and ZIP or foreign postal code

9a Your percentage of total

9b Total employee contributions

Returns.

distribution

%

$

10 Amount allocable to IRR

11 1st year of desig.

12 FATCA ling

14 State tax withheld

15 State/Payer’s state no.

16 State distribution

within 5 years

Roth contrib.

requirement

$

$

$

$

$

Account number (see instructions)

13 Date of

17 Local tax withheld

18 Name of locality

19 Local distribution

payment

$

$

$

$

Form 1099-R

Cat. No. 14436Q

www.irs.gov/Form1099R

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on

This Page —

Do Not Cut or Separate Forms on This Page

9898

VOID

CORRECTED

Distributions From

PAYER’S name, street address, city or town, state or province,

1 Gross distribution

OMB No. 1545-0119

country, ZIP or foreign postal code, and telephone no.

Pensions, Annuities,

$

2022

Retirement or

Profit-Sharing Plans,

2a Taxable amount

IRAs, Insurance

$

Form 1099-R

Contracts, etc.

2b Taxable amount

Total

Copy A

not determined

distribution

For

PAYER’S TIN

RECIPIENT’S TIN

3 Capital gain (included in

4 Federal income tax

Internal Revenue

box 2a)

withheld

Service Center

$

$

File with Form 1096.

RECIPIENT’S name

5 Employee contributions/

6 Net unrealized

For Privacy Act

Designated Roth

appreciation in

contributions or

employer’s securities

and Paperwork

insurance premiums

Reduction Act

$

$

Notice, see the

Street address (including apt. no.)

7 Distribution

IRA/

8 Other

2022 General

code(s)

SEP/

Instructions for

SIMPLE

$

Certain

%

Information

City or town, state or province, country, and ZIP or foreign postal code

9a Your percentage of total

9b Total employee contributions

Returns.

distribution

%

$

10 Amount allocable to IRR

11 1st year of desig.

12 FATCA ling

14 State tax withheld

15 State/Payer’s state no.

16 State distribution

within 5 years

Roth contrib.

requirement

$

$

$

$

$

Account number (see instructions)

13 Date of

17 Local tax withheld

18 Name of locality

19 Local distribution

payment

$

$

$

$

Form 1099-R

Cat. No. 14436Q

www.irs.gov/Form1099R

Department of the Treasury - Internal Revenue Service

58

Exhibit X

Form 1099-S

7575

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country,

1 Date of closing

OMB No. 1545-0997

ZIP or foreign postal code, and telephone number

Form 1099-S

Proceeds From Real

(Rev. January 2022)

Estate Transactions

2 Gross proceeds

For calendar year

$

20

FILER’S TIN

TRANSFEROR’S TIN

3 Address (including city, state, and ZIP code) or legal description

Copy A

For

Internal Revenue

TRANSFEROR’S name

Service Center

File with Form 1096.

4 Check here if the transferor received or will receive

For Privacy Act

property or services as part of the consideration

Street address (including apt. no.)

and Paperwork

5 Check here if the transferor

is a foreign person

Reduction Act

City or town, state or province, country, and ZIP or foreign postal code

(nonresident alien, foreign partnership, foreign estate,

Notice, see the

or foreign trust) . . . .

.....

current General

Instructions for

Account number (see instructions)

6 Buyer’s part of real estate tax

Certain Information

$

Returns.

Form 1099-S (Rev. 1-2022)

Cat. No. 64292E

www.irs.gov/Form1099S

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This

Page — Do Not Cut or

Separate

Forms

on

This

Page

7575

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country,

1 Date of closing

OMB No. 1545-0997

ZIP or foreign postal code, and telephone number

Form 1099-S

Proceeds From Real

(Rev. January 2022)

Estate Transactions

2 Gross proceeds

For calendar year

$

20

FILER’S TIN

TRANSFEROR’S TIN

3 Address (including city, state, and ZIP code) or legal description

Copy A

For

Internal Revenue

TRANSFEROR’S name

Service Center

File with Form 1096.

4 Check here if the transferor received or will receive

For Privacy Act

property or services as part of the consideration

Street address (including apt. no.)

and Paperwork

5 Check here if the transferor

is a foreign person

Reduction Act

City or town, state or province, country, and ZIP or foreign postal code

(nonresident alien, foreign partnership, foreign estate,

Notice, see the

or foreign trust) . . . .

.....

current General

Instructions for

Account number (see instructions)

6 Buyer’s part of real estate tax

Certain Information

$

Returns.

Form 1099-S (Rev. 1-2022)

Cat. No. 64292E

www.irs.gov/Form1099S

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This

Page — Do Not Cut or Separate

Forms

on

This

Page

7575

VOID

CORRECTED

FILER’S name, street address, city or town, state or province, country,

1 Date of closing

OMB No. 1545-0997

ZIP or foreign postal code, and telephone number

Form 1099-S

Proceeds From Real

(Rev. January 2022)

Estate Transactions

2 Gross proceeds

For calendar year

$

20

FILER’S TIN

TRANSFEROR’S TIN

3 Address (including city, state, and ZIP code) or legal description

Copy A

For

Internal Revenue

TRANSFEROR’S name

Service Center

File with Form 1096.

4 Check here if the transferor received or will receive

For Privacy Act

property or services as part of the consideration

Street address (including apt. no.)

and Paperwork

5 Check here if the transferor

is a foreign person

Reduction Act

City or town, state or province, country, and ZIP or foreign postal code

(nonresident alien, foreign partnership, foreign estate,

Notice, see the

or foreign trust) . . . .

.....

current General

Instructions for

Account number (see instructions)

6 Buyer’s part of real estate tax

Certain Information

$

Returns.

Form 1099-S (Rev. 1-2022)

Cat. No. 64292E

www.irs.gov/Form1099S

Department of the Treasury - Internal Revenue Service

59

Exhibit Y

Form 1099-SB

4343

VOID

CORRECTED

ISSUER’S name, street address, city or town, state or province, country, ZIP

1 Investment in contract

OMB No. 1545-2281

or foreign postal code, and telephone no.

Form 1099-SB

Seller’s Investment in

$

Life Insurance

2 Surrender amount

(Rev. December 2019)

Contract

For calendar year

$

20

ISSUER’S TIN

SELLER’S TIN

Issuer’s information contact name, street address, city or

Copy A

town, state or province, country, ZIP or foreign postal code,

For

and telephone no. (if different from ISSUER)

Internal Revenue

SELLER’S name

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-SB (Rev. 12-2019)

Cat. No. 71384X

www.irs.gov/Form1099SB

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not

Cut or Separate

Forms

on

This

Page

4343

VOID

CORRECTED

ISSUER’S name, street address, city or town, state or province, country, ZIP

1 Investment in contract

OMB No. 1545-2281

or foreign postal code, and telephone no.

Form 1099-SB

Seller’s Investment in

$

Life Insurance

2 Surrender amount

(Rev. December 2019)

Contract

For calendar year

$

20

ISSUER’S TIN

SELLER’S TIN

Issuer’s information contact name, street address, city or

Copy A

town, state or province, country, ZIP or foreign postal code,

For

and telephone no. (if different from ISSUER)

Internal Revenue

SELLER’S name

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-SB (Rev. 12-2019)

Cat. No. 71384X

www.irs.gov/Form1099SB

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not

Cut or Separate

Forms

on

This

Page

4343

VOID

CORRECTED

ISSUER’S name, street address, city or town, state or province, country, ZIP

1 Investment in contract

OMB No. 1545-2281

or foreign postal code, and telephone no.

Form 1099-SB

Seller’s Investment in

$

Life Insurance

2 Surrender amount

(Rev. December 2019)

Contract

For calendar year

$

20

ISSUER’S TIN

SELLER’S TIN

Issuer’s information contact name, street address, city or

Copy A

town, state or province, country, ZIP or foreign postal code,

For

and telephone no. (if different from ISSUER)

Internal Revenue

SELLER’S name

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

current General

Instructions for

Certain

Policy number

Information

Returns.

Form 1099-SB (Rev. 12-2019)

Cat. No. 71384X

www.irs.gov/Form1099SB

Department of the Treasury - Internal Revenue Service

60

Exhibit Z

Form 3921

2525	VOID	CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,			1 Date option granted	OMB No. 1545-2129	Exercise of an
country, and ZIP or foreign postal code				Form 3921
					Incentive Stock
					Option Under
			2 Date option exercised
				(Rev. October 2017)	Section 422(b)


TRANSFEROR’S TIN	EMPLOYEE’S TIN		3 Exercise price per share	4 Fair market value per share	Copy A
				on exercise date	For

EMPLOYEE’S name			$	$	Internal Revenue
					Service Center
			5 No. of shares transferred

					File with Form 1096.
Street address (including apt. no.)			6 If other than TRANSFEROR, name, address, and TIN of		For Privacy Act and
			corporation whose stock is being transferred		Paperwork
					Reduction Act

					Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
					current version of
					the General
					Instructions for
Account number (see instructions)
					Certain Information
					Returns.
Form 3921 (Rev. October 2017)	Cat. No. 41179O		www.irs.gov/Form3921	Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

2525	VOID	CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,			1 Date option granted	OMB No. 1545-2129	Exercise of an
country, and ZIP or foreign postal code				Form 3921
					Incentive Stock
					Option Under
			2 Date option exercised
				(Rev. October 2017)	Section 422(b)


TRANSFEROR’S TIN	EMPLOYEE’S TIN		3 Exercise price per share	4 Fair market value per share	Copy A
				on exercise date	For

EMPLOYEE’S name			$	$	Internal Revenue
					Service Center
			5 No. of shares transferred

					File with Form 1096.
Street address (including apt. no.)			6 If other than TRANSFEROR, name, address, and TIN of		For Privacy Act and
			corporation whose stock is being transferred		Paperwork
					Reduction Act

					Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
					current version of
					the General
					Instructions for
Account number (see instructions)
					Certain Information
					Returns.
Form 3921 (Rev. October 2017)	Cat. No. 41179O		www.irs.gov/Form3921	Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

2525	VOID	CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,			1 Date option granted	OMB No. 1545-2129	Exercise of an
country, and ZIP or foreign postal code				Form 3921
					Incentive Stock
					Option Under
			2 Date option exercised
				(Rev. October 2017)	Section 422(b)


TRANSFEROR’S TIN	EMPLOYEE’S TIN		3 Exercise price per share	4 Fair market value per share	Copy A
				on exercise date	For

EMPLOYEE’S name			$	$	Internal Revenue
					Service Center
			5 No. of shares transferred

					File with Form 1096.
Street address (including apt. no.)			6 If other than TRANSFEROR, name, address, and EIN of		For Privacy Act and
					Paperwork
			corporation whose stock is being transferred
					Reduction Act

					Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
					current version of

					the General
					Instructions for
Account number (see instructions)
					Certain Information

					Returns.
Form 3921 (Rev. October 2017)	Cat. No. 41179O		www.irs.gov/Form3921	Department of the Treasury - Internal Revenue Service

61

Exhibit AA

Form 5498

2828

VOID

CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city or town, state or

1

IRA contributions (other

OMB No. 1545-0747

province, country, and ZIP or foreign postal code

than amounts in boxes

IRA

2–4, 8–10, 13a, and 14a)

2022

$

Contribution

Information

2

Rollover contributions

$

Form 5498

3

Roth IRA conversion

4

Recharacterized

Copy A

amount

contributions

0.50 in

TRUSTEE’S or ISSUER’S TIN

PARTICIPANT’S TIN

$

$

For

5

FMV of account

6 Life insurance cost included in

Internal Revenue

0.66 in

1.70 in

box 1

Service Center

$

$

File with Form 1096.

PARTICIPANT’S name

7

IRA

SEP

SIMPLE

Roth IRA

8

SEP contributions

9

SIMPLE

contributions

For Privacy Act

$

$

0.33 in

and Paperwork

Street address (including apt. no.)

10

Roth IRA contributions

11 Check if RMD for 2023

0.50 in

$

Reduction Act

Notice, see the

12a RMD date

12b RMD amount

2022 General

$

City or town, state or province, country, and ZIP or foreign postal code

Instructions for

13a Postponed/late contrib.

13b Year

13c Code

Certain

$

Information

14a Repayments

14b Code

Returns.

$

Account number (see instructions)

15a FMV of certain speci ed

15b Code(s)

$

assets

Form 5498

Cat. No. 50010C

www.irs.gov/Form5498

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

2828

VOID

CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city or town, state or

1

IRA contributions (other

OMB No. 1545-0747

province, country, and ZIP or foreign postal code

than amounts in boxes

IRA

2–4, 8–10, 13a, and 14a)

2022

$

Contribution

Information

2

Rollover contributions

$

Form 5498

3

Roth IRA conversion

4 Recharacterized

Copy A

amount

contributions

$

$

For

TRUSTEE’S or ISSUER’S TIN

PARTICIPANT’S TIN

5

FMV of account

6 Life insurance cost included in

Internal Revenue

box 1

Service Center

$

$

File with Form 1096.

PARTICIPANT’S name

7

IRA

SEP

SIMPLE

Roth IRA

8

SEP contributions

9 SIMPLE contributions

For Privacy Act

$

$

and Paperwork

Street address (including apt. no.)

10

Roth IRA contributions

11 Check if RMD for 2023

Reduction Act

$

Notice, see the

12a RMD date

12b RMD amount

2022 General

$

City or town, state or province, country, and ZIP or foreign postal code

Instructions for

13a Postponed/late contrib.

13b Year

13c Code

Certain

$

Information

14a Repayments

14b Code

Returns.

$

Account number (see instructions)

15a FMV of certain speci ed

15b Code(s)

$

assets

Form 5498

Cat. No. 50010C

www.irs.gov/Form5498

Department of the Treasury - Internal Revenue Service

62

Exhibit BB

Form W-2G

3232

VOID

CORRECTED

PAYER’S name, street address, city or town, province or state, country,

1

Reportable winnings

2 Date won

and ZIP or foreign postal code

0.50 in

$

3

Type of wager

4 Federal income tax withheld

$

5

Transaction

6 Race

0.33 in

7

Winnings from identical wagers

8 Cashier

PAYER’S federal identi cation number

PAYER’S telephone number

$

0.67 in

9

Winner’s taxpayer identi cation no.

10

Window

WINNER’S name

11 First identi cation

12

Second identi cation

0.50 in

Street address (including apt. no.)

13 State/Payer’s state identi cation no.

14

State winnings

$

City or town, province or state, country, and ZIP or foreign postal code

15 State income tax withheld

16

Local winnings

$

$

17 Local income tax withheld

18

Name of locality

$

OMB No. 1545-0238

Form W-2G

Certain

Gambling

Winnings

(Rev. January 2021)

For calendar year 20

For Privacy Act

and Paperwork

Reduction Act Notice, see the current General

Instructions for Certain Information Returns.

File with Form 1096

Copy A

For Internal Revenue Service Center

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identi cation number that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature

Date

Form W-2G (Rev. 1-2021)

Cat. No. 10138V

www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page – Do Not Cut or Separate Forms on This Page

3232

VOID

CORRECTED

OMB No. 1545-0238

PAYER’S name, street address, city or town, province or state, country,

1 Reportable winnings

2 Date won

and ZIP or foreign postal code

Form W-2G

$

Certain

3 Type of wager

4 Federal income tax withheld

Gambling

$

Winnings

5 Transaction

6 Race

(Rev. January 2021)

For calendar year

7 Winnings from identical wagers

8 Cashier

20

PAYER’S federal identi cation number

PAYER’S telephone number

$

9 Winner’s taxpayer identi cation no.

10 Window

For Privacy Act

and Paperwork

Reduction Act

WINNER’S name

11 First identi cation

12 Second identi cation

Notice, see the

current General

Instructions for

Certain Information

Street address (including apt. no.)

13 State/Payer’s state identi cation no.

14 State winnings

Returns.

$

City or town, province or state, country, and ZIP or foreign postal code

15 State income tax withheld

16 Local winnings

File with Form 1096

$

$

17 Local income tax withheld

18 Name of locality

Copy A

For Internal Revenue

$

Service Center

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identi cation number that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature			Date

Form W-2G (Rev. 1-2021)	Cat. No. 10138V	www.irs.gov/FormW2G	Department of the Treasury - Internal Revenue Service

63

Exhibit CC

Form 1042-S

0.35 in

Form 1042-S

Foreign Person’s U.S. Source Income Subject to Withholding

2022

OMB No. 1545-0096

Go to www.irs.gov/Form1042S for instructions and the latest information.

Copy A for

Department of the Treasury

Internal Revenue Service

UNIQUE FORM IDENTIFIER

AMENDED

AMENDMENT NO.

Internal Revenue Service

1 Income 2 Gross income

3 Chapter indicator. Enter “3” or “4”

13e Recipient’s U.S. TIN, if any

13f Ch. 3 status code

code

3a Exemption code

4a Exemption code

13g Ch. 4 status code

	3b Tax rate	.	4b Tax rate	.	13h	Recipient’s GIIN	13i Recipient’s foreign tax identi cation	13j LOB code
5	Withholding allowance						number, if any

6	Net income
7a Federal tax withheld					13k	Recipient’s account number

7b Check if federal tax withheld was not deposited with the IRS because

escrow procedures were applied (see instructions) . . . . . .

13l Recipient’s date of birth (YYYYMMDD)

7c Check if withholding occurred in subsequent year with respect to a

partnership interest . . . . . . . . . . . . . .

8 Tax withheld by other agents

14a Primary Withholding Agent’s Name (if applicable)

9. Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)

(	)	14b Primary Withholding Agent’s EIN	15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)


		15a Intermediary or ow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

11. Tax paid by withholding agent (amounts not withheld) (see instructions)

15d Intermediary or ow-through entity’s name

12a

Withholding agent’s EIN

12b Ch. 3 status code

12c Ch. 4 status code

15e

Intermediary or ow-through entity’s GIIN

12d Withholding agent’s name

15f Country code

15g Foreign tax identi cation number, if any

12e

Withholding agent’s Global Intermediary Identi cation Number (GIIN)

15h

Address (number and street)

5.30 in

12f

Country code

12g

Foreign tax identi cation number, if any

15i

City or town, state or province, country, ZIP or foreign postal code

12h

Address (number and street)

16a

Payer’s name

16b Payer’s TIN

12i City or town, state or province, country, ZIP or foreign postal code

16c

Payer’s GIIN

16d Ch. 3 status code

16e Ch. 4 status code

13a

Recipient’s name

13b Recipient’s country code

17a

State income tax withheld

17b Payer’s state tax no.

17c Name of state

7.30 in

13c

Address (number and street)

13d City or town, state or province, country, ZIP or foreign postal code

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Cat. No. 11386R

Form 1042-S (2022)

0.35 in

64

IRS Releases Publication 1179 (7/2022), General Rules and Specifications for Substitute Forms 1096, 1098, 1099, 5498, and Certain Other Information Returns