Revenue 

Procedure 

2024-29

Reprinted from IR Bulletin 2024-30

Dated July 22, 2024

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. 07-2024)

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, and 1.6050Y-3.)

Rev. Proc. 2024-29

TABLE OF CONTENTS

Part 1 – GENERAL INFORMATION

Section 1.1 – Overview of Revenue Procedure 2024-29 / 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 ............. 5

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, 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 .......................... 30

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

Section 5.3 – Ordering Forms and Instructions ............................ 33

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 2024-29 / What's New

.

The purpose of this revenue procedure is to set forth the 2024 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 the following 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

1.1.1

Purpose

1.1.2

Which Forms 

Are Covered?

1
Form Title

1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)

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 10 or more information returns during a calendar year must file 

those returns electronically. See Electronic filing of returns, later, for more 

information.

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 10 information returns 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 current General Instructions for Certain Information Returns and the current 

Instructions for Form 1042-S. In addition, see the current revision of Pub. 1220, 

1.1.3

Scope

2
Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 

5498, and W-2G, for electronic filing through the IRS Filing Information 

Returns Electronically (FIRE) system.

.

The IRS prints and provides the forms on which various payments must be 

reported. See Section 5.3 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/Technical Service Operation (IRS/TSO) 

maintains a centralized customer service call site to answer questions 

related to information returns (Forms W-2, W-3, W-2c, W-3c, 1099, 

1096, etc.). You can reach the call site at 866-455-7438 (toll free) or outside the 

United States at 304-263-8700 (not a toll-free number). Deaf or hard-of-hearing 

customers may call any of our toll-free numbers using their choice of relay 

service.

Questions regarding the filing of information returns and comments/

suggestions regarding this publication can be emailed to fire@irs.gov. 

When you send emails concerning specific file information, include 

the company name and the electronic file name or Transmitter Control Code 

(TCC). Do not include taxpayer identification numbers (TINs) or attachments in 

email correspondence because electronic mail is not secure.

The IRS/TSO does not process information returns which are filed on 

paper forms. See Pub. 1220 for information on waivers and extensions 

of time.

For other tax information related to business returns or accounts, call 

800-829-4933. Deaf or hard-of-hearing customers may call any of our 

toll-free numbers using their choice of relay service.

Further information impacting Pub. 1179, such as issues 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.

Removal of filer copy. In an ongoing process to reduce filer burden, we are 

removing the filer copy and instructions for the filer on forms.

Form 1099-H. The Health Coverage Tax Credit expired on December 31, 

2021. The form is listed for reference purposes only.

Exhibits. All of the exhibits in this publication were updated to include all of 

the 2024 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.

CAUTION

!

TIP

1.1.4

For More 

Information

1.1.5

What’s New

3
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.

• 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 going to their information pages at IRS.gov. See the 

separate instructions for each form on the webpage via the link.

4
Section 1.2 – Definitions

.

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. A filer may be a payer, creditor, payment settlement 

entity, recipient of mortgage or student loan interest payments, educational 

institution, broker, barter exchange, or 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.

.

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

.

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.

1.2.1

Form Recipient

1.2.2

Filer

1.2.3

Substitute Form

1.2.4

Substitute Form 

Recipient 

Statement 

(Recipient 

Statement)

1.2.5

Composite 

Substitute 

Statement

1.3.1

Introduction

5
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:

Internal Revenue Service

Attn: Substitute Forms Program

C:DC:TS:CAR:MP:P:TP:TP

ATSC

4800 Buford Highway

Mail Stop 061-N

Chamblee, GA 30341

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.

Note. Do not send completed forms to the Substitute Forms Program via email 

or mail as they are unable to process those forms. Any examples/samples of 

substitute forms sent to the Substitute Forms Program should not contain 

taxpayer information.

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 

allowed on the payee copies of the above forms, on Copy A filed with the IRS, 

or on Form 1096, or on an envelope or enclosed in an envelope containing any 

of those documents, 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.

1.3.2

Logos, Slogans, 

and 

Advertisements

6
• Logos and slogans may be used on permissible enclosures, such as a 

check or account statement, other than information returns and payee 

copies.

The information return and payee copies must clearly identify the payer’s name 

associated with its employer identification number (EIN).

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

C:DC:TS:CAR:MP:P:TP:TP

ATSC

4800 Buford Highway

Mail Stop 061-N

Chamblee, GA 30341

or email them to substituteforms@irs.gov.

Note. Do not send completed forms to the Substitute Forms Program via email 

or mail as they are unable to process those forms. Any examples/samples of 

substitute forms sent to the Substitute Forms Program should not contain 

taxpayer information.

.

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 2024 is 

shown under Penalties in part O of the 2024 General Instructions for Certain 

Information Returns.

.

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, the form number, the 

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

1.3.3

Copy A 

Specifications

1.3.4

Copy B and 

Copy C 

Specifications

7
Form Recipient

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; 

1097-BTC; 1042-S For Recipient

3921; 3922 For Employee 

5498; 5498-SA For Participant

5498-QA; 5498-ESA For Beneficiary

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

Form Recipient

1097-BTC For Payer

1098 For Recipient/Lender

1098-C For Donor’s Records 

1042-S For Recipient

1098-F; 1098-MA For Filer

1098-Q For Issuer

1099-CAP; 3921; 3922 For Corporation 

1099-LTC For Insured

1099-QA For Payer

1099-R For Recipient’s Records

All other Forms 1099 See Section 4.5.2.

W-2G For Winner’s Records

Note. On Copy C of 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.

8
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

.

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 available in a fillable 

online format, are found separately in Part 5.

These forms in their fillable formats 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 81⁄2 inch by 11 inch 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 

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 with no scaling.

2.1.1

Online Fillable 

Forms

9
.

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 Publishing 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

For information only, the Sheffield equivalent-units 170-100

Dirt: Average, each side, not to exceed-parts per million 8

2.1.2

General 

Requirements

2.1.3

Color and Paper 

Quality

10
.

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, and 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 2.1.6 through 2.1.10.

.

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.

Density readings on the solid Flint 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 

2.1.4

Chemical 

Transfer Paper

2.1.5

Printing

2.1.6

OCR 

Specifications

11
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 

0.01 minimum to 0.06 maximum.

• Kidder 082A. The tested PCS values when using the Kidder 082A 

tester on the Infra Red (IR) scale must range from 0.12 minimum to 

0.21 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.

Internal Revenue Service

Attn: Substitute Forms Program

C:DC:TS:CAR:MP:P:TP:TP

ATSC

4800 Buford Highway

Mail Stop 061-N

Chamblee, GA 30341

.

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. 

2.1.7

Typography

2.1.8

Dimensions

12
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 32/3 

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 51/2 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) 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 (Copy B, and 

Copies 1 and 2 of Forms 1099-B, 1099-DIV, 1099-G, 1099-INT, 1099-K, 

1099-MISC, 1099-NEC, and 1099-OID; and Copy C of Form 1099-R; and 

Copy D of 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 for information on electronically furnishing statements to 

recipients.

.

You must include the Office of Management and Budget (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 or D of the form retained by the filer, if applicable.

• “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 2024 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 2024 

General Instructions for Certain Information Returns” must be 

printed on all other forms listed in Section 1.1.2.

2.1.9

Perforation

2.1.10

Required 

Inclusions/ 

Exclusions

13
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 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 companies 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

.

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 TIN 

shown on the form. Place the other form recipients’ names on the 

second name line (only 2 name lines are allowable).

2.2.1

Recipient 

Information

14
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 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 TIN on payee statements. Where permitted, filers may 

truncate a payee's TIN (social security number (SSN), individual taxpayer 

identification number (ITIN), adoption taxpayer identification number (ATIN), 

or 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 

are filed with the IRS. The size specified does not include pinfeed 

holes. Pinfeed holes must not be present on forms filed with the IRS.

2.2.2

Account Number 

Box

2.2.3

Specifications 

and Restrictions

15
• 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 these types 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 2024 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 2024 

General Instructions for Certain Information Returns.

Part 3

Specifications for Substitute Form W-2G (Filed 

With the IRS)

Section 3.1 – General

.

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.

2.2.4

Where To File

3.1.1

Purpose

16
Section 3.2 – Specifications for Copy A of Form W-2G

.

You must follow these specifications when printing substitute Copy A of the 

Form W-2G.

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 Color and 

Quality

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). The paper must 

consist substantially of bleached chemical wood pulp. It must be free 

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. 

Typography

The type must be substantially identical in size and shape to the official 

form. All rules on the document are either 1/2 point (0.007 inch), 1 point 

(0.015 inch), or 3 point (0.045 inch). Vertical rules must be parallel to 

the left edge of the document; horizontal rules to the top edge.

Dimensions

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. 

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 

Carbon Spots

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. 

Printer’s Symbol

The GPO symbol must not be printed on substitute Forms W-2G. 

Instead, the 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.

Cat. No. The 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

3.2.1

Substitute Form 

W-2G (Copy A)

17
Section 4.1 – Specifications

.

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 

Form 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 the 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 the date 

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

18
acquired is known. For 2024 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 they would be shown for short-term dispositions where 

basis was reported to the IRS.

For 2024 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 Form 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 OMB number as shown on the 

official IRS form. See Section 5.2.

• The recipient statement must contain the tax year (for example, 2024), 

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 are 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). 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
.

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 acceptable substitutes.

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 on 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.

4.1.3

Substitute 

Statements to 

Recipients for 

Certain Forms 

1098, 1099, 5498, 

and W-2G

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’s 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
• 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 & NEC, 1099-PATR, 

1099-R & 5498, 1099-S, 1099-SB, and 3921.

Section 4.2 – Composite Statements

.

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, Form 

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 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 

prominently displayed elsewhere on the page on which the information 

appears.

4.1.4

Online Fillable 

Copies B, C, D, 

1, and 2

4.2.1

Composite 

Substitute 

Statements for 

Certain Forms 

1099-B, 1099-

DIV, 1099-INT, 

1099-MISC, 

1099-OID, 1099-

PATR, and 1099-

S

23
• 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, 

is 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

.

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 

Section 4.3 and should clearly delineate how the information is presented. Any 

information presented should make reference to its corresponding number on the 

4.2.2

Composite 

Substitute 

Statements to 

Recipients for 

Forms Specified 

in Sections 4.1.2 

and 4.1.3

4.3.1

General 

Requirements 

for Presenting 

Additional Form 

1099-B 

Information

24
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 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

.

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.”

• 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 

4.3.2

Added Legend 

for Providing 

Additional Form 

1099-B 

Information

4.4.1

Required 

Legends for 

Forms 1098

25
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 

4.4.2

Required 

Legends for 

Forms 1099 and 

W-2G

26
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 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, 1, and 2

.

Copies B, C, and in some cases D, 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 (Form 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.

4.4.3

Required 

Legends for 

Forms 1097-

BTC, 3921, 3922, 

and 5498

4.5.1

Copies

4.5.2

Arrangement of 

Assembly

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-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.”

1099-A Copy B “For Borrower”; Copy C “For Lender.”

1097-BTC, 

1099-PATR, 

1099-Q, and 

1099-QA 

Copy B “For Recipient”; Copy C “For Payer.”

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, 

1099-INT, 

1099-MISC, 

1099-NEC, and 

1099-OID

Copy 1 “For State Tax Department”; Copy B “For Recipient”; Copy 2 “To be 

filed with recipient's state income tax return, when required.”

1099-K Copy 1 “For State Tax Department”; Copy B “For Payee”; Copy 2 “To be 

filed with the recipient's state income tax return, when required.”

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.”

1099-R

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 

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.”

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.”

3921

Copy B “For Employee”; Copy C “For Corporation”; Copy D “For 

Transferor.”

3922 Copy B “For Employee”; Copy C “For Corporation.”

W-2G

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 

withheld in box 4, 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.”

1042-S

Copy B “For Recipient”; Copy C “For Recipient” and “Attach to any federal 

tax return you file”; Copy D “For Recipient” and “Attach to any state tax 

return you file”

.

Instructions for perforation of forms can be found in Section 2.1.9.

4.5.3

Perforations

28
Section 4.6 – Electronic Delivery of Recipient Statements

.

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) 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 the recipient 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, 2025 (February 15 for Forms 1099-B, 1099-S, and 

1099-MISC with payments reported in box 8 or 10), due date 

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.

4.6.1

Electronic 

Recipient 

Statements

4.6.2

Consent

29
• 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, 2025 (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).

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

.

Paper substitutes of Copies A, B, C, and D must be identical to the Form 

1042-S and may be privately printed without prior approval from the IRS.

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 (2024).

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.

.

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.

4.6.3

Format, Posting, 

and Notification

5.1.1

Paper 

Substitutes

5.1.2

Revisions

30
.

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, it means 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 (GIIN) 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 

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. 

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.

5.1.3

Obtaining 

Copies

5.1.4

Instructions for 

Withholding 

Agents

31
.

Property Substitute Form 1042-S Format Requirements

Printing

Privately printed substitute Forms 1042-S must be exact replicas of the 

official forms with respect to layout and content. The 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.

Box Entries

Only one type of income may be represented on Copies A, B, C, and D 

submitted to the IRS or furnished to recipients. 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 

Ink All printing must be in high quality nongloss black ink. 

Typography

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 

(0.015 inch) or 3 point (0.045 inch). Vertical rules must be parallel to the 

left edge of the document; horizontal rules must be parallel to the top edge.

Assembly

If all four parts are present, the parts of the assembly shall be arranged 

from top to bottom as follows: Copy A (Original) “for Internal Revenue 

Service”; and Copies B, C, and D “for Recipient.”

Color Quality of 

Paper

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 of principally 

bleached chemical wood pulp or recycled printed paper. It must also be 

suitably sized to accept ink without feathering.

Dimensions

• 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-

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.

Other Copies Copies B, C, and D must be furnished for the convenience of payees who 

must send a copy of the form with other federal and state returns they file.

5.1.5

Substitute Form 

1042-S Format 

Requirements

32
Section 5.2 – OMB Requirements for All Forms in This Revenue Procedure

.

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

following.

• 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; and

• For Copy A, the OMB number must appear exactly as shown on the 

official IRS form.

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

following formats.

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

2. OMB # 1545-xxxx (acceptable).

Caution. These requirements do not apply to substitute Forms 1042-S. See 

Section 5.1.4.

.

All substitute forms must state the Privacy Act and Paperwork Reduction Act 

Notice as listed in Section 2.1.10.

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 

5.2.1

OMB 

Requirements

5.2.2

Substitute Form 

Requirements

5.2.3

Required 

Explanation to 

Users

33
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.

Section 5.4 – Effect on Other Revenue Procedures

.

Revenue Procedure 2023-30, 2023-40 I.R.B. 995, dated October 2, 2023, is 

superseded by this revenue procedure.

Part 6

Exhibits

Section 6.1 – Exhibits of Forms in This Revenue Procedure

.

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 0.85 inch 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.

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 2024 

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.

5.4.1

Other Revenue 

Procedures

6.1.1

Purpose

6.1.2

Guidelines

34
• 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 forms.

6.2

Exhibits

35
For Official Use Only

0.25 in

1.33 in

2.17 in

0.67 in

7.30 in

Exhibit A Form 1096

Do Not Staple 6969

Form 1096

2024

Annual Summary and Transmittal of 

Department of the Treasury U.S. Information Returns

Internal Revenue Service

OMB No. 1545-0108

FILER’S name

Street address (including room or suite number)

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

Name of person to contact Telephone number

Email address Fax number

For Official Use Only

1 Employer identication number 2 Social security number 3 Total number of forms 4 Federal income tax withheld

$

5 Total amount reported with this Form 1096

$

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

W-2G 

32

1097-BTC 

50

1098 

81

1098-C 

78

1098-E 

84

1098-F 

03

1098-Q 

74

1098-T 

83

1099-A 

80

1099-B 

79

1099-C 

85

1099-CAP 

73

1099-DIV 

91

1099-G 

86

1099-INT 

92

1099-K 

10

1099-LS 

16

1099-LTC 

93

1099-MISC

95

1099-NEC 

71

1099-OID 

96

1099-PATR

97

1099-Q 

31

1099-QA 

1A

1099-R 

98

1099-S 

75

1099-SA 

94

1099-SB 

43

3921 

25

3922 

26

5498 

28

5498-ESA 

72

5498-QA 

2A

5498-SA 

27

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 Title Date

Instructions

Future developments. For the latest information about developments 

related to Form 1096, such as legislation enacted after it was published, go 

to www.irs.gov/Form1096.

Reminder. You may be required to electronically le (e-le) information 

returns. Go to www.irs.gov/inforeturn for e-le options. Also, see part F in 

the 2024 General Instructions for Certain Information Returns.

Purpose of form. Use this form to transmit paper Forms 1097, 1098, 

1099, 3921, 3922, 5498, and W-2G to the IRS. 

Caution: Form 5498-QA can only be led on paper, regardless of the 

number of returns.

Who must file. Any person or entity who les any form checked in box 6 

above must le Form 1096 to transmit those forms to the IRS. 

Caution: Your name and taxpayer identication number (TIN) (employer 

identication number (EIN) or social security number (SSN)) 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.

Enter the ler’s name, address (including room, suite, or other unit 

number), and TIN in the spaces provided on the form. The name, address, 

and TIN of the ler on this form must be the same as those you enter in the 

upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.

When to file. If any date shown falls on a Saturday, Sunday, or legal 

holiday in the District of Columbia or where the return is to be led, 

the due date is the next business day. File Form 1096 in the calendar 

year following the year for which the information is being reported, as 

follows.

• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, le by February 28.*

• With Forms 1099-NEC, le by January 31.

• With Forms 5498, le by May 31.

* Leap years do not impact the due date. See Announcement 91-179, 

1991-49 I.R.B. 78, for more information. 

Where To File

Send all information returns led on paper with Form 1096 to the following.

If your principal business, office or 

agency, or legal residence in the 

case of an individual, is located in:

Use the following 

address:

Alabama, Arizona, Arkansas, Delaware, 

Florida, Georgia, Kentucky, Maine, 

Massachusetts, Mississippi, New 

Hampshire, New Jersey, New Mexico, 

New York, North Carolina, Ohio, Texas, 

Vermont, Virginia

Internal Revenue Service

P.O. Box 149213 

Austin, TX 78714-9213

Alaska, Colorado, Hawaii, Idaho, 

Illinois, Indiana, Iowa, Kansas, 

Michigan, Minnesota, Missouri, 

Montana, Nebraska, Nevada, North 

Dakota, Oklahoma, Oregon, South 

Carolina, South Dakota, Tennessee,

Utah, Washington, Wisconsin, Wyoming

Internal Revenue Service Center 

P.O. Box 219256 

 Kansas City, MO 64121-9256

For more information and the Privacy Act and Paperwork Reduction Act Notice, 

see the 2024 General Instructions for Certain Information Returns.

Cat. No. 14400O Form 1096 (2024)

4.92 in

8.00 in

11.00 in

1.40 in 1.40 in 1.20 in 1.40 in 1.90 in

36
Exhibit B Form 1097-BTC

 

Form 1097-BTC

(Rev. December 2019)

Cat. No. 54293T

Bond 

Tax 

Credit

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-2197

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year

20

5050 VOID CORRECTED

FORM 1097-BTC ISSUER’S name, street address, city or town, state or 

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

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

RECIPIENT’S name

Street address (including apt. no.)

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

 Form 1097-BTC issuer is (check one):

Issuer of bond or its agent ling current year 

Form 1097-BTC for credit being reported

An entity or a person that received or should have received 

a current year Form 1097-BTC and is distributing part or all 

of that credit to others

1 Total 

$

2a Code

2b Unique identier

3 Bond type 4

5a January 

$ 

5b February

$ 

5c March

$ 

5d April

$ 

5e May

$ 

5f June

$ 

5g July 

$ 

5h August

$ 

5i September

$ 

5j October

$ 

5k November

$ 

5l December

$ 

6 Comments

Form 1097-BTC (Rev. 12-2019) www.irs.gov/Form1097BTC

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

 

Form 1097-BTC

(Rev. December 2019)

Cat. No. 54293T

Bond 

Tax 

Credit

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-2197

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year

20

5050 VOID CORRECTED

FORM 1097-BTC ISSUER’S name, street address, city or town, state or 

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

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

RECIPIENT’S name

Street address (including apt. no.)

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

 Form 1097-BTC issuer is (check one):

Issuer of bond or its agent ling current year 

Form 1097-BTC for credit being reported

An entity or a person that received or should have received 

a current year Form 1097-BTC and is distributing part or all 

of that credit to others

1 Total 

$

2a Code

2b Unique identier

3 Bond type 4

5a January 

$ 

5b February

$ 

5c March

$ 

5d April

$ 

5e May

$ 

5f June

$ 

5g July 

$ 

5h August

$ 

5i September

$ 

5j October

$ 

5k November

$ 

5l December

$ 

6 Comments

Form 1097-BTC (Rev. 12-2019) www.irs.gov/Form1097BTC

1.40 in

2.80 in

7.30 in

1.17 in

4.50 in 1.33 in

6.25in

3.40 in

.15 in

.35 in

1 in

.22 in

37
 8181 VOID CORRECTED 

OMB No. 1545-1380

Form 1098

(Rev. January 2022)

For calendar year 

20

Mortgage 

Interest 

Statement

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

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

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

RECIPIENT’S/LENDER’S TIN PAYER’S/BORROWER’S TIN

PAYER’S/BORROWER’S name 

Street address (including apt. no.) 

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

Account number (see instructions)

1 Mortgage interest received from payer(s)/borrower(s)

$ 

2 Outstanding mortgage 

principal

$ 

3 Mortgage origination date

4 Refund of overpaid 

interest

$ 

5 Mortgage insurance 

premiums

$

6 Points paid on purchase of principal residence

$

7 If address of property securing mortgage is the same 

as PAYER’S/BORROWER’S address, check the box, or enter 

the address or description in box 8.

8 Address or description of property securing mortgage (see 

instructions)

9 Number of properties securing the 

mortgage

10 Other

11 Mortgage 

acquisition date

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 

OMB No. 1545-1380

Form 1098

(Rev. January 2022)

For calendar year 

20

Mortgage 

Interest 

Statement

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

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

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

RECIPIENT’S/LENDER’S TIN PAYER’S/BORROWER’S TIN

PAYER’S/BORROWER’S name 

Street address (including apt. no.) 

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

Account number (see instructions)

1 Mortgage interest received from payer(s)/borrower(s)

$ 

2 Outstanding mortgage 

principal

$ 

3 Mortgage origination date

4 Refund of overpaid 

interest

$ 

5 Mortgage insurance 

premiums

$

6 Points paid on purchase of principal residence

$

7 If address of property securing mortgage is the same 

as PAYER’S/BORROWER’S address, check the box, or enter 

the address or description in box 8.

8 Address or description of property securing mortgage (see 

instructions)

9 Number of properties securing the 

mortgage

10 Other

11 Mortgage 

acquisition date

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

Exhibit C Form 10981.13 in

38
 

Form 1098-C 

(Rev. November 2019)

Cat. No. 39732R

Contributions of 

Motor Vehicles, 

Boats, and 

Airplanes

Copy A 

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service 

File with Form 1096.

OMB No. 1545-1959 

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns. 

For calendar year

20

7878 VOID CORRECTED 

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

or foreign postal code, and telephone no. 

DONEE’S TIN DONOR’S TIN

DONOR’S name 

Street address (including apt. no.) 

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

1 Date of contribution 

2a Odometer mileage

2b Year 2c Make 2d Model

3 Vehicle or other identication number 

4a Donee certies that vehicle was sold in arm’s 

length transaction to unrelated party 

4b Date of sale 

4c Gross proceeds from sale (see instructions) 

$ 

5a Donee certies that vehicle will not be transferred for money, other property, or services before completion of material 

improvements or signicant intervening use 

5b Donee certies that vehicle is to be transferred to a needy individual for signicantly below fair market value in furtherance of 

donee’s charitable purpose 

5c Donee certies the following detailed description of material improvements or signicant intervening use and duration of use 

6a Did you provide goods or services in exchange for the vehicle? . . . . . . . . . . . . . ▶ Yes No 

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 certies that the goods and services 

consisted solely of intangible religious benets . . . . . . . . . . . . . . . . . . . . . ▶

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) www.irs.gov/Form1098C

Exhibit D Form 1098-C

2.80 in

3.40 in

7.30 in

7.16 in

2.45 in

.55 in

.05 in

39
Exhibit E Form 1098-E

Form 1098-E

2024

Cat. No. 25088U

Student 

Loan Interest 

Statement

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-1576

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8484 VOID CORRECTED

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

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

RECIPIENT’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Student loan interest received by lender

$

2 Check if box 1 does not include loan origination fees 

and/or capitalized interest, and the loan was made 

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

Form 1098-E www.irs.gov/Form1098E

Form 1098-E

2024

Cat. No. 25088U

Student 

Loan Interest 

Statement

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-1576

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8484 VOID CORRECTED

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

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

RECIPIENT’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Student loan interest received by lender

$

2 Check if box 1 does not include loan origination fees 

and/or capitalized interest, and the loan was made 

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

Form 1098-E www.irs.gov/Form1098E

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

Form 1098-E

2024

Cat. No. 25088U

Student 

Loan Interest 

Statement

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-1576

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8484 VOID CORRECTED

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

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

RECIPIENT’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Student loan interest received by lender

$

2 Check if box 1 does not include loan origination fees 

and/or capitalized interest, and the loan was made 

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

Form 1098-E www.irs.gov/Form1098E

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

0.50 in 0.33 in

3.33 in

1.70 in

3.40 in

7.30 in

2.80 in

2.83 in

11.00 in

1.17 in

0.25 in

0.45 in

1.00 in

0.85 in

4.75 in

8.00 in

40
Exhibit F Form 1098-F

 

Form 1098-F

(Rev. January 2022)

Cat. No. 71382B

Fines, Penalties, and 

Other Amounts

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-2284

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General

Instructions for

Certain Information

Returns.

0303

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be paid

$

2 Amount to be paid for

violation or potential violation

$

3 Restitution/remediation 

amount

$

4 Compliance amount

$

5 Date of order/agreement

6 Court or entity

7 Case number

8 Case name or names of parties to suit, order, or agreement

9 Code

Form 1098-F (Rev. 1-2022) www.irs.gov/Form1098F

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

 

Form 1098-F

(Rev. January 2022)

Cat. No. 71382B

Fines, Penalties, and 

Other Amounts

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-2284

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General

Instructions for

Certain Information

Returns.

0303

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be paid

$

2 Amount to be paid for

violation or potential violation

$

3 Restitution/remediation 

amount

$

4 Compliance amount

$

5 Date of order/agreement

6 Court or entity

7 Case number

8 Case name or names of parties to suit, order, or agreement

9 Code

Form 1098-F (Rev. 1-2022) www.irs.gov/Form1098F

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

 

Form 1098-F

(Rev. January 2022)

Cat. No. 71382B

Fines, Penalties, and 

Other Amounts

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-2284

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General

Instructions for

Certain Information

Returns.

0303

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

FILER’S TIN PAYER’S TIN

PAYER’S name

Street address (including apt. no.)

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

1 Total amount required to be paid

$

2 Amount to be paid for

violation or potential violation

$

3 Restitution/remediation 

amount

$

4 Compliance amount

$

5 Date of order/agreement

6 Court or entity

7 Case number

8 Case name or names of parties to suit, order, or agreement

9 Code

Form 1098-F (Rev. 1-2022) www.irs.gov/Form1098F

41
Exhibit G Form 1098-MA

 

Form 1098-MA

(Rev. September 2019)

Cat. No. 58017D

Mortgage 

Assistance 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service 

OMB No. 1545-2221

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see

the current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

VOID CORRECTED 

FILER’S name, street address, city, state, ZIP code, and telephone no. 

FILER’S TIN HOMEOWNER’S TIN

HOMEOWNER’S name 

Street address (including apt. no.) (optional) 

City, state, and ZIP code (optional) 

Account number (optional)

1. Total State HFA and homeowner mortgage payments

$ 

2. State HFA mortgage assistance payments

$ 

3. Homeowner mortgage payments

$ 

Form 1098-MA (Rev. 9-2019) www.irs.gov/Form1098MA

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

 

Form 1098-MA

(Rev. September 2019)

Cat. No. 58017D

Mortgage 

Assistance 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service 

OMB No. 1545-2221

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see

the current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

VOID CORRECTED 

FILER’S name, street address, city, state, ZIP code, and telephone no. 

FILER’S TIN HOMEOWNER’S TIN

HOMEOWNER’S name 

Street address (including apt. no.) (optional) 

City, state, and ZIP code (optional) 

Account number (optional)

1. Total State HFA and homeowner mortgage payments

$ 

2. State HFA mortgage assistance payments

$ 

3. Homeowner mortgage payments

$ 

Form 1098-MA (Rev. 9-2019) www.irs.gov/Form1098MA

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

 

Form 1098-MA

(Rev. September 2019)

Cat. No. 58017D

Mortgage 

Assistance 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service 

OMB No. 1545-2221

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see

the current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

VOID CORRECTED 

FILER’S name, street address, city, state, ZIP code, and telephone no. 

FILER’S TIN HOMEOWNER’S TIN

HOMEOWNER’S name 

Street address (including apt. no.) (optional) 

City, state, and ZIP code (optional) 

Account number (optional)

1. Total State HFA and homeowner mortgage payments

$ 

2. State HFA mortgage assistance payments

$ 

3. Homeowner mortgage payments

$ 

Form 1098-MA (Rev. 9-2019) www.irs.gov/Form1098MA

42
 

Form 1098-Q

(Rev. December 2019)

Cat. No. 67073Z

Qualifying 

Longevity Annuity 

Contract 

Information

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2234

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns. 

7474

For calendar year 

20

VOID CORRECTED 

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

or foreign postal code, and telephone no.

PARTICIPANT’S name 

Street address (including apt. no.) 

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

Account number (see instructions) Plan number

Name of plan Plan sponsor’s EIN

ISSUER’S TIN 

PARTICIPANT’S TIN

1a Annuity amount on start date

$ 

1b Annuity start date 2 Check if start date may be 

accelerated

3 Total premiums

$ 

4 FMV of QLAC

$

5a January

$

dd 5b February

$

dd

5c March

$

dd 5d April

$

dd

5e May

$

dd 5f June

$

dd

5g July 

$ 

dd 5h August

$ 

dd

5i September

$ 

dd 5j October

$ 

dd

5k November

$ 

dd 5l December

$ 

dd

Form 1098-Q (Rev. 12-2019) www.irs.gov/Form1098Q

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

 

Form 1098-Q

(Rev. December 2019)

Cat. No. 67073Z

Qualifying 

Longevity Annuity 

Contract 

Information

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2234

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns. 

7474

For calendar year 

20

VOID CORRECTED 

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

or foreign postal code, and telephone no.

PARTICIPANT’S name 

Street address (including apt. no.) 

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

Account number (see instructions) Plan number

Name of plan Plan sponsor’s EIN

ISSUER’S TIN 

PARTICIPANT’S TIN

1a Annuity amount on start date

$ 

1b Annuity start date 2 Check if start date may be 

accelerated

3 Total premiums

$ 

4 FMV of QLAC

$

5a January

$

dd 5b February

$

dd

5c March

$

dd 5d April

$

dd

5e May

$

dd 5f June

$

dd

5g July 

$ 

dd 5h August

$ 

dd

5i September

$ 

dd 5j October

$ 

dd

5k November

$ 

dd 5l December

$ 

dd

Form 1098-Q (Rev. 12-2019) www.irs.gov/Form1098Q

Exhibit H Form 1098-Q

1.5 in

0.5 in

0.5 in

0.5 in

.50 in

0.6 in 0.4 in

0.3 in

0.4 in

1.0 in 0.4 in

0.34 in

0.6 in

43
Exhibit I Form 1098-T

Form 1098-T

2024

Cat. No. 25087J

Tuition 

Statement

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-1574

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8383 VOID CORRECTED

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

foreign postal code, and telephone number

FILER’S employer identication no. STUDENT’S TIN

STUDENT’S name

Street address (including apt. no.)

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

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

1 Payments received for 

qualied tuition and related 

expenses

$

2 

3

4 Adjustments made for a 

prior year

$

5 Scholarships or grants

$

6 Adjustments to 

scholarships or grants 

for a prior year

$

7 Checked if the amount 

in box 1 includes 

amounts for an 

academic period 

beginning January–

March 2025

8 Checked if at least 

half-time student

9 Checked if a graduate

student 

10 Ins. contract reimb./refund

$

Form 1098-T www.irs.gov/Form1098T

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

Form 1098-T

2024

Cat. No. 25087J

Tuition 

Statement

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-1574

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8383 VOID CORRECTED

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

foreign postal code, and telephone number

FILER’S employer identication no. STUDENT’S TIN

STUDENT’S name

Street address (including apt. no.)

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

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

1 Payments received for 

qualied tuition and related 

expenses

$

2 

3

4 Adjustments made for a 

prior year

$

5 Scholarships or grants

$

6 Adjustments to 

scholarships or grants 

for a prior year

$

7 Checked if the amount 

in box 1 includes 

amounts for an 

academic period 

beginning January–

March 2025

8 Checked if at least 

half-time student

9 Checked if a graduate

student 

10 Ins. contract reimb./refund

$

Form 1098-T www.irs.gov/Form1098T

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

Form 1098-T

2024

Cat. No. 25087J

Tuition 

Statement

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center

File with Form 1096.

OMB No. 1545-1574

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2024 General

Instructions for

Certain Information

Returns.

8383 VOID CORRECTED

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

foreign postal code, and telephone number

FILER’S employer identication no. STUDENT’S TIN

STUDENT’S name

Street address (including apt. no.)

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

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

1 Payments received for 

qualied tuition and related 

expenses

$

2 

3

4 Adjustments made for a 

prior year

$

5 Scholarships or grants

$

6 Adjustments to 

scholarships or grants 

for a prior year

$

7 Checked if the amount 

in box 1 includes 

amounts for an 

academic period 

beginning January–

March 2025

8 Checked if at least 

half-time student

9 Checked if a graduate

student 

10 Ins. contract reimb./refund

$

Form 1098-T www.irs.gov/Form1098T

44
Exhibit J Form 1099-A

 

Form 1099-A

(Rev. January 2022)

Cat. No. 14412G

Acquisition or 

Abandonment of 

Secured Property

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0877

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain

Information 

Returns.

For calendar year 

20

8080 VOID CORRECTED

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

foreign postal code, and telephone no.

LENDER’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of lender’s acquisition or 

knowledge of abandonment

2 Balance of principal 

outstanding

$

3 4 Fair market value of property

$

5 Check if the borrower was personally liable for repayment of 

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

6 Description of property

Form 1099-A (Rev. 1-2022) www.irs.gov/Form1099A

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

 

Form 1099-A

(Rev. January 2022)

Cat. No. 14412G

Acquisition or 

Abandonment of 

Secured Property

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0877

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain

Information 

Returns.

For calendar year 

20

8080 VOID CORRECTED

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

foreign postal code, and telephone no.

LENDER’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of lender’s acquisition or 

knowledge of abandonment

2 Balance of principal 

outstanding

$

3 4 Fair market value of property

$

5 Check if the borrower was personally liable for repayment of 

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

6 Description of property

Form 1099-A (Rev. 1-2022) www.irs.gov/Form1099A

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

 

Form 1099-A

(Rev. January 2022)

Cat. No. 14412G

Acquisition or 

Abandonment of 

Secured Property

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0877

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain

Information 

Returns.

For calendar year 

20

8080 VOID CORRECTED

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

foreign postal code, and telephone no.

LENDER’S TIN BORROWER’S TIN

BORROWER’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of lender’s acquisition or 

knowledge of abandonment

2 Balance of principal 

outstanding

$

3 4 Fair market value of property

$

5 Check if the borrower was personally liable for repayment of 

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

6 Description of property

Form 1099-A (Rev. 1-2022) www.irs.gov/Form1099A

1.30 in

45
Form 1099-B

2024

Cat. No. 14411V

Proceeds From 

Broker and 

Barter Exchange 

Transactions

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center 

File with Form 1096.

OMB No. 1545-0715

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General

Instructions for

Certain 

Information

Returns.

7979 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

CUSIP number FATCA ling 

requirement

Applicable checkbox on Form 8949

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

1b Date acquired 1c Date sold or disposed

1d Proceeds

$

1e Cost or other basis

$

1f Accrued market discount

$

1g Wash sale loss disallowed

$

2 Short-term gain or loss

Long-term gain or loss

Ordinary

3 Check if proceeds from:

Collectibles

QOF

4 Federal income tax withheld

$

5 Check if noncovered 

security

6 Reported to IRS:

Gross proceeds

Net proceeds

7 Check if loss is not allowed 

based on amount in 1d

8 Prot or (loss) realized in 

2024 on closed contracts

$

9 Unrealized prot or (loss) on 

open contracts—12/31/2023

$

10 Unrealized prot or (loss) on 

open contracts—12/31/2024

$

11 Aggregate prot or (loss) 

on contracts

$

12 Check if basis reported to 

IRS

13 Bartering

$

14 State name 15 State identication no. 16 State tax withheld

$

$

Form 1099-B www.irs.gov/Form1099B

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

Form 1099-B

2024

Cat. No. 14411V

Proceeds From 

Broker and 

Barter Exchange 

Transactions

Department of the Treasury - Internal Revenue Service

Copy A

For 

Internal Revenue 

Service Center 

File with Form 1096.

OMB No. 1545-0715

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General

Instructions for

Certain 

Information

Returns.

7979 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

CUSIP number FATCA ling 

requirement

Applicable checkbox on Form 8949

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

1b Date acquired 1c Date sold or disposed

1d Proceeds

$

1e Cost or other basis

$

1f Accrued market discount

$

1g Wash sale loss disallowed

$

2 Short-term gain or loss

Long-term gain or loss

Ordinary

3 Check if proceeds from:

Collectibles

QOF

4 Federal income tax withheld

$

5 Check if noncovered 

security

6 Reported to IRS:

Gross proceeds

Net proceeds

7 Check if loss is not allowed 

based on amount in 1d

8 Prot or (loss) realized in 

2024 on closed contracts

$

9 Unrealized prot or (loss) on 

open contracts—12/31/2023

$

10 Unrealized prot or (loss) on 

open contracts—12/31/2024

$

11 Aggregate prot or (loss) 

on contracts

$

12 Check if basis reported to 

IRS

13 Bartering

$

14 State name 15 State identication no. 16 State tax withheld

$

$

Form 1099-B www.irs.gov/Form1099B

Exhibit K Form 1099-B

1.20 in

2.60 in

0.60 in

1.56 in

4.06 in

46
 

Form 1099-C

(Rev. January 2022)

Cat. No. 26280W

Cancellation 

of Debt

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

8585 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

CREDITOR’S TIN DEBTOR’S TIN

DEBTOR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of identiable event

2 Amount of debt discharged

$

3 Interest, if included in box 2

$

4 Debt description

5 Check here if the debtor was personally liable for 

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

6 Identiable event code 7 Fair market value of property

$

Form 1099-C (Rev. 1-2022) www.irs.gov/Form1099C

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

 

Form 1099-C

(Rev. January 2022)

Cat. No. 26280W

Cancellation 

of Debt

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

8585 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

CREDITOR’S TIN DEBTOR’S TIN

DEBTOR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of identiable event

2 Amount of debt discharged

$

3 Interest, if included in box 2

$

4 Debt description

5 Check here if the debtor was personally liable for 

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

6 Identiable event code 7 Fair market value of property

$

Form 1099-C (Rev. 1-2022) www.irs.gov/Form1099C

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

 

Form 1099-C

(Rev. January 2022)

Cat. No. 26280W

Cancellation 

of Debt

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

20

8585 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

CREDITOR’S TIN DEBTOR’S TIN

DEBTOR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of identiable event

2 Amount of debt discharged

$

3 Interest, if included in box 2

$

4 Debt description

5 Check here if the debtor was personally liable for 

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

6 Identiable event code 7 Fair market value of property

$

Form 1099-C (Rev. 1-2022) www.irs.gov/Form1099C

Exhibit L Form 1099-C1.3 in

47
Form 1099-DIV 

(Rev. January 2024)

Cat. No. 14415N 

Dividends and 

Distributions 

Copy A

For 

Internal Revenue 

Service Center 

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0110 

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns. 

9191

For calendar year

VOID CORRECTED

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

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

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

Account number (see instructions) 2nd TIN not. 

1a Total ordinary dividends 

$ 

1b Qualied dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

2e Section 897 ordinary dividends

$ 

2f Section 897 capital gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 FATCA ling 

requirement

12 Exempt-interest dividends

$ 

13 Specied private activity 

bond interest dividends

$ 

14 State 15 State identication no. 16 State tax withheld

$ 

$ 

Form 1099-DIV (Rev. 1-2024) www.irs.gov/Form1099DIV

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

Form 1099-DIV 

(Rev. January 2024)

Cat. No. 14415N 

Dividends and 

Distributions 

Copy A

For 

Internal Revenue 

Service Center 

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0110 

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns. 

9191

For calendar year

VOID CORRECTED

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

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

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

Account number (see instructions) 2nd TIN not. 

1a Total ordinary dividends 

$ 

1b Qualied dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

2e Section 897 ordinary dividends

$ 

2f Section 897 capital gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 FATCA ling 

requirement

12 Exempt-interest dividends

$ 

13 Specied private activity 

bond interest dividends

$ 

14 State 15 State identication no. 16 State tax withheld

$ 

$ 

Form 1099-DIV (Rev. 1-2024) www.irs.gov/Form1099DIV

Exhibit M Form 1099-DIV

48
Form 1099-G

(Rev. March 2024)

Cat. No. 14438M

Certain 

Government 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0120

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

8686 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

3 Box 2 amount is for tax year 4 Federal income tax withheld

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income

9 Market gain

$

10a State 10b State identication no. 11 State income tax withheld

$

$

Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G

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

Form 1099-G

(Rev. March 2024)

Cat. No. 14438M

Certain 

Government 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0120

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

8686 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

3 Box 2 amount is for tax year 4 Federal income tax withheld

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income

9 Market gain

$

10a State 10b State identication no. 11 State income tax withheld

$

$

Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G

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

Form 1099-G

(Rev. March 2024)

Cat. No. 14438M

Certain 

Government 

Payments

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0120

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

8686 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

3 Box 2 amount is for tax year 4 Federal income tax withheld

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 Check if box 2 is 

trade or business 

income

9 Market gain

$

10a State 10b State identication no. 11 State income tax withheld

$

$

Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G

Exhibit N Form 1099-G

49
Form 1099-INT

(Rev. January 2024)

Cat. No. 14410K

Interest 

Income

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0112

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain 

Information

Returns.

For calendar year

9292 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN 

RECIPIENT’S name

Street address (including apt. no.)

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

FATCA ling 

requirement

Account number (see instructions) 2nd TIN not.

Payer’s RTN (optional)

2 Early withdrawal penalty

$

1 Interest income

$

3 Interest on U.S. Savings Bonds and Treasury obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. territory

8 Tax-exempt interest

$

9 Specied private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identication no. 17 State tax withheld

$

$

Form 1099-INT (Rev. 1-2024) www.irs.gov/Form1099INT

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

Form 1099-INT

(Rev. January 2024)

Cat. No. 14410K

Interest 

Income

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0112

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain 

Information

Returns.

For calendar year

9292 VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN 

RECIPIENT’S name

Street address (including apt. no.)

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

FATCA ling 

requirement

Account number (see instructions) 2nd TIN not.

Payer’s RTN (optional)

2 Early withdrawal penalty

$

1 Interest income

$

3 Interest on U.S. Savings Bonds and Treasury obligations

$

4 Federal income tax withheld

$

5 Investment expenses

$

6 Foreign tax paid

$

7 Foreign country or U.S. territory

8 Tax-exempt interest

$

9 Specied private activity bond 

interest

$

10 Market discount

$

11 Bond premium

$

12 Bond premium on Treasury obligations

$

13 Bond premium on tax-exempt bond

$

14 Tax-exempt and tax credit 

bond CUSIP no.

15 State 16 State identication no. 17 State tax withheld

$

$

Form 1099-INT (Rev. 1-2024) www.irs.gov/Form1099INT

Exhibit O Form 1099-INT

50
Form 1099-K

(Rev. March 2024)

Cat. No. 54118B

Payment Card and 

Third Party 

Network 

Transactions

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2205

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

1010 VOID CORRECTED 

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

or foreign postal code, and telephone no.

Check to indicate if FILER is a (an): 

Payment settlement entity (PSE)

Electronic Payment Facilitator 

(EPF)/Other third party

Check to indicate transactions 

reported are:

Payment card 

Third party network 

PAYEE’S name 

Street address (including apt. no.) 

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

PSE’S name and telephone number

Account number (see instructions) 2nd TIN not.

FILER’S TIN

PAYEE’S TIN

1a Gross amount of payment 

card/third party network 

transactions 

$ 

1b Card Not Present 

transactions 

$ 

2 Merchant category code

3 Number of payment 

transactions

4 Federal income tax 

withheld

$

5a January 

$ 

5b February

$ 

5c March

$ 

5d April

$ 

5e May

$ 

5f June

$ 

5g July 

$ 

5h August

$ 

5i September

$ 

5j October

$ 

5k November

$ 

5l December

$ 

6 State 7 State identication no. 8 State income tax withheld

$

$

Form 1099-K (Rev. 3-2024) www.irs.gov/Form1099K

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

Form 1099-K

(Rev. March 2024)

Cat. No. 54118B

Payment Card and 

Third Party 

Network 

Transactions

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-2205

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year 

1010 VOID CORRECTED 

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

or foreign postal code, and telephone no.

Check to indicate if FILER is a (an): 

Payment settlement entity (PSE)

Electronic Payment Facilitator 

(EPF)/Other third party

Check to indicate transactions 

reported are:

Payment card 

Third party network 

PAYEE’S name 

Street address (including apt. no.) 

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

PSE’S name and telephone number

Account number (see instructions) 2nd TIN not.

FILER’S TIN

PAYEE’S TIN

1a Gross amount of payment 

card/third party network 

transactions 

$ 

1b Card Not Present 

transactions 

$ 

2 Merchant category code

3 Number of payment 

transactions

4 Federal income tax 

withheld

$

5a January 

$ 

5b February

$ 

5c March

$ 

5d April

$ 

5e May

$ 

5f June

$ 

5g July 

$ 

5h August

$ 

5i September

$ 

5j October

$ 

5k November

$ 

5l December

$ 

6 State 7 State identication no. 8 State income tax withheld

$

$

Form 1099-K (Rev. 3-2024) www.irs.gov/Form1099K

Exhibit P Form 1099-K

1.42 in

0.33 in

0.50 in

0.42 in

0.42 in

1.56 in

0.09 in

0.33 in

51
Exhibit Q Form 1099-LS

 

Form 1099-LS

(Rev. December 2019)

Cat. No. 71383M

Reportable Life 

Insurance Sale

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

For calendar year 

20

1616 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

ACQUIRER’S TIN PAYMENT RECIPIENT’S TIN

PAYMENT RECIPIENT’S name

Street address (including apt. no.)

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

Policy number

1 Amount paid to payment 

recipient

$

2 Date of sale

Issuer’s name

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

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

and telephone no. (if different from ACQUIRER)

Form 1099-LS (Rev. 12-2019) www.irs.gov/Form1099LS

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

 

Form 1099-LS

(Rev. December 2019)

Cat. No. 71383M

Reportable Life 

Insurance Sale

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

For calendar year 

20

1616 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

ACQUIRER’S TIN PAYMENT RECIPIENT’S TIN

PAYMENT RECIPIENT’S name

Street address (including apt. no.)

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

Policy number

1 Amount paid to payment 

recipient

$

2 Date of sale

Issuer’s name

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

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

and telephone no. (if different from ACQUIRER)

Form 1099-LS (Rev. 12-2019) www.irs.gov/Form1099LS

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

 

Form 1099-LS

(Rev. December 2019)

Cat. No. 71383M

Reportable Life 

Insurance Sale

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

For calendar year 

20

1616 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

ACQUIRER’S TIN PAYMENT RECIPIENT’S TIN

PAYMENT RECIPIENT’S name

Street address (including apt. no.)

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

Policy number

1 Amount paid to payment 

recipient

$

2 Date of sale

Issuer’s name

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

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

and telephone no. (if different from ACQUIRER)

Form 1099-LS (Rev. 12-2019) www.irs.gov/Form1099LS

52
Form 1099-MISC

(Rev. January 2024)

Cat. No. 14425J

Miscellaneous 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0115

For calendar year 

9595 VOID CORRECTED

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the

current General

Instructions for

Certain

Information

Returns.

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Rents

$

2 Royalties

$

3 Other income

$

4 Federal income tax withheld

$

5 Fishing boat proceeds

$

6 Medical and health care 

payments

$

7 Payer made direct sales 

totaling $5,000 or more of 

consumer products to 

recipient for resale

8 Substitute payments in lieu 

of dividends or interest

$

9 Crop insurance proceeds

$

10 Gross proceeds paid to an 

attorney

$

11 Fish purchased for resale

$

12 Section 409A deferrals

$

13 FATCA ling 

requirement

14 Excess golden parachute 

payments

$

15 Nonqualied deferred 

compensation

$

16 State tax withheld

$

$

17 State/Payer’s state no. 18 State income

$

$

Form 1099-MISC (Rev. 1-2024) www.irs.gov/Form1099MISC

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

Form 1099-MISC

(Rev. January 2024)

Cat. No. 14425J

Miscellaneous 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0115

For calendar year 

9595 VOID CORRECTED

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the

current General

Instructions for

Certain

Information

Returns.

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Rents

$

2 Royalties

$

3 Other income

$

4 Federal income tax withheld

$

5 Fishing boat proceeds

$

6 Medical and health care 

payments

$

7 Payer made direct sales 

totaling $5,000 or more of 

consumer products to 

recipient for resale

8 Substitute payments in lieu 

of dividends or interest

$

9 Crop insurance proceeds

$

10 Gross proceeds paid to an 

attorney

$

11 Fish purchased for resale

$

12 Section 409A deferrals

$

13 FATCA ling 

requirement

14 Excess golden parachute 

payments

$

15 Nonqualied deferred 

compensation

$

16 State tax withheld

$

$

17 State/Payer’s state no. 18 State income

$

$

Form 1099-MISC (Rev. 1-2024) www.irs.gov/Form1099MISC

Exhibit R Form 1099-MISC

0.50 in

0.45 in

1.00 in

53
Exhibit S Form 1099-NEC

Form 1099-NEC

(Rev. January 2024)

Cat. No. 72590N

Nonemployee 

Compensation

Copy A

For Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0116

For Privacy Act and 

Paperwork Reduction Act 

Notice, see the current General Instructions for

Certain Information

Returns.

7171

For calendar year

VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Nonemployee compensation

$

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

consumer products to recipient for resale

3

4 Federal income tax withheld

$

5 State tax withheld

$

$

6 State/Payer’s state no. 7 State income

$

$

Form 1099-NEC (Rev. 1-2024) www.irs.gov/Form1099NEC

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

Form 1099-NEC

(Rev. January 2024)

Cat. No. 72590N

Nonemployee 

Compensation

Copy A

For Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0116

For Privacy Act and 

Paperwork Reduction Act 

Notice, see the current General Instructions for

Certain Information

Returns.

7171

For calendar year

VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Nonemployee compensation

$

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

consumer products to recipient for resale

3

4 Federal income tax withheld

$

5 State tax withheld

$

$

6 State/Payer’s state no. 7 State income

$

$

Form 1099-NEC (Rev. 1-2024) www.irs.gov/Form1099NEC

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

Form 1099-NEC

(Rev. January 2024)

Cat. No. 72590N

Nonemployee 

Compensation

Copy A

For Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0116

For Privacy Act and 

Paperwork Reduction Act 

Notice, see the current General Instructions for

Certain Information

Returns.

7171

For calendar year

VOID CORRECTED

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

or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Nonemployee compensation

$

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

consumer products to recipient for resale

3

4 Federal income tax withheld

$

5 State tax withheld

$

$

6 State/Payer’s state no. 7 State income

$

$

Form 1099-NEC (Rev. 1-2024) www.irs.gov/Form1099NEC

54
Exhibit T Form 1099-OID

Form 1099-OID

Cat. No. 14421R

(Rev. January 2024)

Original Issue 

Discount

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0117

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information

Returns.

For calendar year 

9696 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

FATCA ling 

requirement

Account number (see instructions) 2nd TIN not.

1 Original issue discount for 

the year

$

2 Other periodic interest

$

3 Early withdrawal penalty

$

4 Federal income tax withheld

$

5 Market discount 

$

6 Acquisition premium

$ 

7 Description

8 Original issue discount on 

U.S. Treasury obligations

$

9 Investment expenses

$

10 Bond premium

$

11 Tax-exempt OID

$

12 State 13 State identication no. 14 State tax withheld

$

$

Form 1099-OID (Rev. 1-2024) www.irs.gov/Form1099OID

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

Form 1099-OID

Cat. No. 14421R

(Rev. January 2024)

Original Issue 

Discount

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0117

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information

Returns.

For calendar year 

9696 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

FATCA ling 

requirement

Account number (see instructions) 2nd TIN not.

1 Original issue discount for 

the year

$

2 Other periodic interest

$

3 Early withdrawal penalty

$

4 Federal income tax withheld

$

5 Market discount 

$

6 Acquisition premium

$ 

7 Description

8 Original issue discount on 

U.S. Treasury obligations

$

9 Investment expenses

$

10 Bond premium

$

11 Tax-exempt OID

$

12 State 13 State identication no. 14 State tax withheld

$

$

Form 1099-OID (Rev. 1-2024) www.irs.gov/Form1099OID

55
Exhibit U Form 1099-PATR

Form 1099-PATR

(Rev. January 2023)

Cat. No. 14435F

Taxable 

Distributions 

Received From 

Cooperatives

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0118

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

20

9797 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Patronage dividends

$

2 Nonpatronage distributions

$

3 Per-unit retain allocations

$

4 Federal income tax withheld

$

5 Redeemed nonqualied notices

$

6 Section 199A(g) deduction

$

7 Qualied payments 

(Section 199A(b)(7))

$

8 Section 199A(a) qual. items

$

9 Section 199A(a) SSTB items

$

10 Investment credit

$

11 Work opportunity credit

$

12 Other credits and deductions

$

13 Specied Coop

Form 1099-PATR (Rev. 1-2023) www.irs.gov/Form1099PATR

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

Form 1099-PATR

(Rev. January 2023)

Cat. No. 14435F

Taxable 

Distributions 

Received From 

Cooperatives

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0118

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

20

9797 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Patronage dividends

$

2 Nonpatronage distributions

$

3 Per-unit retain allocations

$

4 Federal income tax withheld

$

5 Redeemed nonqualied notices

$

6 Section 199A(g) deduction

$

7 Qualied payments 

(Section 199A(b)(7))

$

8 Section 199A(a) qual. items

$

9 Section 199A(a) SSTB items

$

10 Investment credit

$

11 Work opportunity credit

$

12 Other credits and deductions

$

13 Specied Coop

Form 1099-PATR (Rev. 1-2023) www.irs.gov/Form1099PATR

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

Form 1099-PATR

(Rev. January 2023)

Cat. No. 14435F

Taxable 

Distributions 

Received From 

Cooperatives

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0118

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

For calendar year 

20

9797 VOID CORRECTED

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

ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions) 2nd TIN not.

1 Patronage dividends

$

2 Nonpatronage distributions

$

3 Per-unit retain allocations

$

4 Federal income tax withheld

$

5 Redeemed nonqualied notices

$

6 Section 199A(g) deduction

$

7 Qualied payments 

(Section 199A(b)(7))

$

8 Section 199A(a) qual. items

$

9 Section 199A(a) SSTB items

$

10 Investment credit

$

11 Work opportunity credit

$

12 Other credits and deductions

$

13 Specied Coop

Form 1099-PATR (Rev. 1-2023) www.irs.gov/Form1099PATR

56
 

Form 1099-Q

(Rev. November 2019)

For calendar year 

20

Cat. No. 32223J

Payments From 

Qualified 

Education 

Programs 

(Under Sections 

529 and 530)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

OMB No. 1545-1760

File with Form 1096.

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

3131 VOID CORRECTED

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

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

PAYER’S/TRUSTEE’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Gross distribution

$

2 Earnings

$

3 Basis

$

4 Trustee-to-trustee 

transfer

5 Distribution is from:

• Qualied tuition program—

Private or State

• Coverdell ESA

6 Check if the recipient is 

not the designated 

beneciary

Form 1099-Q (Rev. 11-2019) www.irs.gov/Form1099Q

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

 

Form 1099-Q

(Rev. November 2019)

For calendar year 

20

Cat. No. 32223J

Payments From 

Qualified 

Education 

Programs 

(Under Sections 

529 and 530)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

OMB No. 1545-1760

File with Form 1096.

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

3131 VOID CORRECTED

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

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

PAYER’S/TRUSTEE’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Gross distribution

$

2 Earnings

$

3 Basis

$

4 Trustee-to-trustee 

transfer

5 Distribution is from:

• Qualied tuition program—

Private or State

• Coverdell ESA

6 Check if the recipient is 

not the designated 

beneciary

Form 1099-Q (Rev. 11-2019) www.irs.gov/Form1099Q

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

 

Form 1099-Q

(Rev. November 2019)

For calendar year 

20

Cat. No. 32223J

Payments From 

Qualified 

Education 

Programs 

(Under Sections 

529 and 530)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

OMB No. 1545-1760

File with Form 1096.

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General

Instructions for

Certain Information

Returns.

3131 VOID CORRECTED

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

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

PAYER’S/TRUSTEE’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Gross distribution

$

2 Earnings

$

3 Basis

$

4 Trustee-to-trustee 

transfer

5 Distribution is from:

• Qualied tuition program—

Private or State

• Coverdell ESA

6 Check if the recipient is 

not the designated 

beneciary

Form 1099-Q (Rev. 11-2019) www.irs.gov/Form1099Q

Exhibit V Form 1099-Q

3.30 in

2.55 in

1.17 in

57
Exhibit W Form 1099-R

Form 1099-R

2024

Cat. No. 14436Q

Distributions From 

Pensions, Annuities, 

Retirement or 

Profit-Sharing Plans, 

IRAs, Insurance 

Contracts, etc.

Department of the Treasury - Internal Revenue Service

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

OMB No. 1545-0119

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General 

Instructions for 

Certain 

Information 

Returns.

9898 VOID CORRECTED

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

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

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Gross distribution

$

2a Taxable amount

$

2b Taxable amount

not determined

Total 

distribution

3 Capital gain (included in 

box 2a)

$

4 Federal income tax 

withheld

$

5 Employee contributions/

Designated Roth

contributions or 

insurance premiums

$

6 Net unrealized

appreciation in

employer’s securities

$

7 Distribution 

code(s)

IRA/

SEP/

SIMPLE

8 Other

$ %

9a Your percentage of total

distribution %

9b Total employee contributions

$

10 Amount allocable to IRR 

within 5 years

$

11 1st year of desig. 

Roth contrib.

12 FATCA ling

requirement

13 Date of 

payment 

14 State tax withheld

$

$

15 State/Payer’s state no. 16 State distribution

$

$

17 Local tax withheld

$

$

18 Name of locality 19 Local distribution

$

$

Form 1099-R www.irs.gov/Form1099R

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

Form 1099-R

2024

Cat. No. 14436Q

Distributions From 

Pensions, Annuities, 

Retirement or 

Profit-Sharing Plans, 

IRAs, Insurance 

Contracts, etc.

Department of the Treasury - Internal Revenue Service

Copy A 

For 

Internal Revenue 

Service Center 

File with Form 1096.

OMB No. 1545-0119

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General 

Instructions for 

Certain 

Information 

Returns.

9898 VOID CORRECTED

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

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

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Gross distribution

$

2a Taxable amount

$

2b Taxable amount

not determined

Total 

distribution

3 Capital gain (included in 

box 2a)

$

4 Federal income tax 

withheld

$

5 Employee contributions/

Designated Roth

contributions or 

insurance premiums

$

6 Net unrealized

appreciation in

employer’s securities

$

7 Distribution 

code(s)

IRA/

SEP/

SIMPLE

8 Other

$ %

9a Your percentage of total

distribution %

9b Total employee contributions

$

10 Amount allocable to IRR 

within 5 years

$

11 1st year of desig. 

Roth contrib.

12 FATCA ling

requirement

13 Date of 

payment 

14 State tax withheld

$

$

15 State/Payer’s state no. 16 State distribution

$

$

17 Local tax withheld

$

$

18 Name of locality 19 Local distribution

$

$

Form 1099-R www.irs.gov/Form1099R

58
 

Form 1099-S

(Rev. January 2022)

Cat. No. 64292E

Proceeds From Real 

Estate Transactions

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0997

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year

20

7575 VOID CORRECTED

Form 1099-S (Rev. 1-2022)

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

ZIP or foreign postal code, and telephone number

FILER’S TIN TRANSFEROR’S TIN

TRANSFEROR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of closing

2 Gross proceeds

$

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

4 Check here if the transferor received or will receive 

property or services as part of the consideration 

5 Check here if the transferor is a foreign person 

(nonresident alien, foreign partnership, foreign estate, 

or foreign trust) .........

6 Buyer’s part of real estate tax

$

www.irs.gov/Form1099S

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

 

Form 1099-S

(Rev. January 2022)

Cat. No. 64292E

Proceeds From Real 

Estate Transactions

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0997

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year

20

7575 VOID CORRECTED

Form 1099-S (Rev. 1-2022)

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

ZIP or foreign postal code, and telephone number

FILER’S TIN TRANSFEROR’S TIN

TRANSFEROR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of closing

2 Gross proceeds

$

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

4 Check here if the transferor received or will receive 

property or services as part of the consideration 

5 Check here if the transferor is a foreign person 

(nonresident alien, foreign partnership, foreign estate, 

or foreign trust) .........

6 Buyer’s part of real estate tax

$

www.irs.gov/Form1099S

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

 

Form 1099-S

(Rev. January 2022)

Cat. No. 64292E

Proceeds From Real 

Estate Transactions

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-0997

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year

20

7575 VOID CORRECTED

Form 1099-S (Rev. 1-2022)

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

ZIP or foreign postal code, and telephone number

FILER’S TIN TRANSFEROR’S TIN

TRANSFEROR’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date of closing

2 Gross proceeds

$

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

4 Check here if the transferor received or will receive 

property or services as part of the consideration 

5 Check here if the transferor is a foreign person 

(nonresident alien, foreign partnership, foreign estate, 

or foreign trust) .........

6 Buyer’s part of real estate tax

$

www.irs.gov/Form1099S

Exhibit X Form 1099-S

59
 

Form 1099-SB

(Rev. December 2019)

Cat. No. 71384X

Seller’s Investment in 

Life Insurance 

Contract

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

4343

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

ISSUER’S TIN SELLER’S TIN

SELLER’S name

Street address (including apt. no.)

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

Policy number

1 Investment in contract

$

2 Surrender amount

$

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

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

and telephone no. (if different from ISSUER)

Form 1099-SB (Rev. 12-2019) www.irs.gov/Form1099SB

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

 

Form 1099-SB

(Rev. December 2019)

Cat. No. 71384X

Seller’s Investment in 

Life Insurance 

Contract

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

4343

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

ISSUER’S TIN SELLER’S TIN

SELLER’S name

Street address (including apt. no.)

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

Policy number

1 Investment in contract

$

2 Surrender amount

$

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

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

and telephone no. (if different from ISSUER)

Form 1099-SB (Rev. 12-2019) www.irs.gov/Form1099SB

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

 

Form 1099-SB

(Rev. December 2019)

Cat. No. 71384X

Seller’s Investment in 

Life Insurance 

Contract

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-2281

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain 

Information 

Returns.

4343

For calendar year 

20

VOID CORRECTED

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

or foreign postal code, and telephone no.

ISSUER’S TIN SELLER’S TIN

SELLER’S name

Street address (including apt. no.)

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

Policy number

1 Investment in contract

$

2 Surrender amount

$

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

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

and telephone no. (if different from ISSUER)

Form 1099-SB (Rev. 12-2019) www.irs.gov/Form1099SB

Exhibit Y Form 1099-SB

60
Form 3921

(Rev. October 2017)

Cat. No. 41179O

Exercise of an 

Incentive Stock 

Option Under 

Section 422(b)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2129

For Privacy Act and 

Paperwork 

Reduction Act 

Notice, see the 

current version of

the General

Instructions for

Certain Information

Returns.

2525 VOID CORRECTED

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

country, and ZIP or foreign postal code

TRANSFEROR’S TIN EMPLOYEE’S TIN

EMPLOYEE’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date option granted

2 Date option exercised

3 Exercise price per share

$

4 Fair market value per share 

on exercise date

$

5 No. of shares transferred

6 If other than TRANSFEROR, name, address, and TIN of 

corporation whose stock is being transferred

Form 3921 (Rev. October 2017) www.irs.gov/Form3921

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

Form 3921

(Rev. October 2017)

Cat. No. 41179O

Exercise of an 

Incentive Stock 

Option Under 

Section 422(b)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2129

For Privacy Act and 

Paperwork 

Reduction Act 

Notice, see the 

current version of

the General

Instructions for

Certain Information

Returns.

2525 VOID CORRECTED

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

country, and ZIP or foreign postal code

TRANSFEROR’S TIN EMPLOYEE’S TIN

EMPLOYEE’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date option granted

2 Date option exercised

3 Exercise price per share

$

4 Fair market value per share 

on exercise date

$

5 No. of shares transferred

6 If other than TRANSFEROR, name, address, and TIN of 

corporation whose stock is being transferred

Form 3921 (Rev. October 2017) www.irs.gov/Form3921

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

Form 3921

(Rev. October 2017)

Cat. No. 41179O

Exercise of an 

Incentive Stock 

Option Under 

Section 422(b)

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2129

For Privacy Act and 

Paperwork 

Reduction Act 

Notice, see the 

current version of

the General

Instructions for

Certain Information

Returns.

2525 VOID CORRECTED

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

country, and ZIP or foreign postal code

TRANSFEROR’S TIN EMPLOYEE’S TIN

EMPLOYEE’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 Date option granted

2 Date option exercised

3 Exercise price per share

$

4 Fair market value per share 

on exercise date

$

5 No. of shares transferred

6 If other than TRANSFEROR, name, address, and TIN of 

corporation whose stock is being transferred

Form 3921 (Rev. October 2017) www.irs.gov/Form3921

Exhibit Z Form 3921

61
Form 5498

2024

Cat. No. 50010C

IRA 

Contribution 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0747

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General

Instructions for

Certain

Information

Returns.

2828 VOID CORRECTED

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

province, country, and ZIP or foreign postal code

TRUSTEE’S or ISSUER’S TIN PARTICIPANT’S TIN

PARTICIPANT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 IRA contributions (other 

than amounts in boxes 

2–4, 8–10, 13a, and 14a)

$

2 Rollover contributions

$

3 Roth IRA conversion 

amount

$

4 Recharacterized 

contributions

$

5 FMV of account

$

6 Life insurance cost included in 

box 1

$

7 IRA SEP SIMPLE Roth IRA

8 SEP contributions

$

9 SIMPLE contributions

$

10 Roth IRA contributions

$

11 Check if RMD for 2025

12a RMD date 12b RMD amount

$

13a Postponed/late contrib.

$

13b Year 13c Code

14a Repayments

$

14b Code

15a FMV of certain specied 

assets

$

15b Code(s)

Form 5498 www.irs.gov/Form5498

Form 5498

2024

Cat. No. 50010C

IRA 

Contribution 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0747

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2024 General

Instructions for

Certain

Information

Returns.

2828 VOID CORRECTED

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

province, country, and ZIP or foreign postal code

TRUSTEE’S or ISSUER’S TIN PARTICIPANT’S TIN

PARTICIPANT’S name

Street address (including apt. no.)

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

Account number (see instructions)

1 IRA contributions (other 

than amounts in boxes 

2–4, 8–10, 13a, and 14a)

$

2 Rollover contributions

$

3 Roth IRA conversion 

amount

$

4 Recharacterized 

contributions

$

5 FMV of account

$

6 Life insurance cost included in 

box 1

$

7 IRA SEP SIMPLE Roth IRA

8 SEP contributions

$

9 SIMPLE contributions

$

10 Roth IRA contributions

$

11 Check if RMD for 2025

12a RMD date 12b RMD amount

$

13a Postponed/late contrib.

$

13b Year 13c Code

14a Repayments

$

14b Code

15a FMV of certain specied 

assets

$

15b Code(s)

Form 5498 www.irs.gov/Form5498

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

Exhibit AA Form 5498

0.50 in

0.33 in

0.50 in

0.67 in 1.70 in

62
Form W-2G

(Rev. December 2023)

Cat. No. 10138V

Certain 

Gambling 

Winnings

Department of the Treasury - Internal Revenue Service

Copy A 

For Internal Revenue 

Service Center

File with Form 1096

OMB No. 1545-0238

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year

20

3232 VOID CORRECTED

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

and ZIP or foreign postal code

PAYER’S TIN PAYER’S telephone no.

WINNER’S name

Street address (including apt. no.)

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

1 Reportable winnings

$

2 Date won

3 Type of wager 4 Federal income tax withheld

$

5 Transaction 6 Race

7 Winnings from identical wagers

$

8 Cashier

9 WINNER’S TIN 10 Window

11 First identication no. 12 Second identication no.

13 State/Payer’s state identication no. 14 State winnings

$

15 State income tax withheld

$

16 Local winnings

$

17 Local income tax withheld

$

18 Name of locality

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identication 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. 12-2023) www.irs.gov/FormW2G

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

Form W-2G

(Rev. December 2023)

Cat. No. 10138V

Certain 

Gambling 

Winnings

Department of the Treasury - Internal Revenue Service

Copy A 

For Internal Revenue 

Service Center

File with Form 1096

OMB No. 1545-0238

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

current General 

Instructions for 

Certain Information 

Returns.

For calendar year

20

3232 VOID CORRECTED

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

and ZIP or foreign postal code

PAYER’S TIN PAYER’S telephone no.

WINNER’S name

Street address (including apt. no.)

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

1 Reportable winnings

$

2 Date won

3 Type of wager 4 Federal income tax withheld

$

5 Transaction 6 Race

7 Winnings from identical wagers

$

8 Cashier

9 WINNER’S TIN 10 Window

11 First identication no. 12 Second identication no.

13 State/Payer’s state identication no. 14 State winnings

$

15 State income tax withheld

$

16 Local winnings

$

17 Local income tax withheld

$

18 Name of locality

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identication 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. 12-2023) www.irs.gov/FormW2G

Exhibit BB Form W-2G

0.50 in

0.33 in

0.50 in

0.67 in

63
Exhibit CC Form 1042-S

Form 1042-S

Department of the Treasury 

Internal Revenue Service

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

Go to www.irs.gov/Form1042S for instructions and the latest information. 2024

UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.

OMB No. 1545-0096

Copy A for

Internal Revenue Service

1 Income 

code

2 Gross income 3 Chapter indicator. Enter “3” or “4”

3a Exemption code

3b Tax rate .

4a Exemption code

4b Tax rate .

5 Withholding allowance

6 Net income

7a Federal tax withheld

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

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

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

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

8 Tax withheld by other agents 

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

( )

10 Total withholding credit (combine boxes 7a, 8, and 9)

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

12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code

12d Withholding agent’s name

12e Withholding agent’s Global Intermediary Identication Number (GIIN)

12f Country code 12g Foreign tax identication number, if any

12h Address (number and street)

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

13a Recipient’s name 13b Recipient’s country code

13c Address (number and street)

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

13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code

13g Ch. 4 status code

13h Recipient’s GIIN 13i Recipient’s foreign tax identication 

number, if any

13j LOB code 

13k Recipient’s account number

13l Recipient’s date of birth (YYYYMMDD)

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

14b Primary Withholding Agent’s EIN

15 Check if pro-rata basis reporting 

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

15d Intermediary or ow-through entity’s name

15e Intermediary or ow-through entity’s GIIN

15f Country code 15g Foreign tax identication number, if any

15h Address (number and street)

15i City or town, state or province, country, ZIP or foreign postal code

16a Payer’s name 16b Payer’s TIN

16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code

17a State income tax withheld 17b Payer’s state tax no. 17c Name of state

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11386R Form 1042-S (2024)

0.35 in5.33 in

7.30 in

0.35 in

64