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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 nonqualified notices

$

6 Section 199A(g) deduction

$

7 Qualified 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 Specified 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)

Taxable 

Distributions 

Received From 

Cooperatives

Copy B

For Recipient

Department of the Treasury - Internal Revenue Service

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.

OMB No. 1545-0118

For calendar year 

20

CORRECTED (if checked)

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 Patronage dividends

$

2 Nonpatronage distributions

$

3 Per-unit retain allocations

$

4 Federal income tax withheld

$

5 Redeemed nonqualified notices

$

6 Section 199A(g) deduction

$

7 Qualified 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 Specified Coop

Form 1099-PATR (Rev. 1-2023) (keep for your records) www.irs.gov/Form1099PATR
Instructions for Recipient

Distributions you received from a cooperative may be includible in your income. 

Generally, if you are an individual, report any amounts shown in boxes 1, 2, 3, and 5 

as ordinary income, unless nontaxable, on your income tax return. You must report 

any redemptions in boxes 2 and 5 as ordinary income to the extent of the stated 

dollar value because they were not taxable when issued to you. Amounts shown in 

boxes 7, 8, and 9 are information needed to compute your section 199A(a) 

deduction. See the instructions for Form 8995 or 8995-A for more information.

Recipient’s taxpayer identification number (TIN). For your protection, this 

form may show only the last four digits of your TIN. However, the issuer has 

reported your complete TIN to the IRS.

Account number. May show an account or other unique number the payer

assigned to distinguish your account.

Box 1. Shows patronage dividends paid to you during the year in cash, qualified 

written notices of allocation (at stated dollar value), or other property (not including 

nonqualified allocations). Any dividends paid on (1) property bought for personal 

use or (2) capital assets or depreciable property used in your business are not 

taxable. However, if (2) applies, reduce the basis of the assets by this amount.

Box 2. Shows nonpatronage distributions paid to you during the year in cash,

qualified written notices of allocation, or other property, and amounts you 

received in redemption of nonqualified written notices of allocation from 

nonpatronage sources.

Box 3. Shows patronage per-unit retain allocations paid to you during the year 

in cash, qualified per-unit retain certificates, or other property.

Box 4. Shows backup withholding. Generally, a payer must backup withhold if

you didn’t furnish your TIN. See Form W-9 and Pub. 505 for more information. 

Report this amount on your income tax return as tax withheld.

Box 5. Shows amounts you received when you redeemed nonqualified written notices 

of allocation and nonqualified per-unit retain allocations from patronage sources.

Box 6. Shows your share of the cooperative’s section 199A(g) deduction passed 

through to you. The amount must have been designated in a written notice sent 

to you from the cooperative during the section 1382(d) payment period. To claim 

the deduction, you must not be a C corporation.

Box 7. Shows the amount of qualified payments paid to you on which the 

cooperative computed its section 199A(g) deduction. If there is an amount in 

this box and the amount is related to a trade or business for which you are 

claiming a section 199A(a) deduction, you are required to compute a reduction 

to your deduction per section 199A(b)(7). 

Box 8. Shows items received and reported in boxes 1, 2, 3, and 5 that may 

qualify as qualified items from trades or businesses that are not a specified 

service trade or business (SSTB) for purposes of the section 199A(a) deduction. 

Items relating to SSTBs are reported separately in box 9. 

Box 9. Shows amounts received and reported in boxes 1, 2, 3, and 5 from an 

SSTB that may qualify as qualified items for purposes of the section 199A(a) 

deduction. Use Form 8995 or 8995-A to determine your section 199A(a) deduction.

Box 10. Shows investment credits passed through to you by the cooperative. 

Use Form 3468 to compute your allowable credit.

Box 11. Shows work opportunity credits passed through to you. Use Form 5884 

or 3800 to compute your allowable credit.

Box 12. Shows other credits and deductions passed through to you. For information 

on how to report credits, see the instructions for the specific credit form.

Box 13. If this box is checked, the information reported to you is from a specified 

agricultural or horticultural cooperative, as defined in section 199A(g)(4)(A).

Future developments. For the latest information about developments related to 

Form 1099-PATR and its instructions, such as legislation enacted after they 

were published, go to www.irs.gov/Form1099PATR.

Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost 

online federal tax preparation, e-filing, and direct deposit or payment options.
 

Form 1099-PATR

(Rev. January 2023)

Taxable 

Distributions 

Received From 

Cooperatives

Copy C

For Payer

Department of the Treasury - Internal Revenue Service

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

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 nonqualified notices

$

6 Section 199A(g) deduction

$

7 Qualified 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 Specified Coop

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

To complete Form 1099-PATR, use:

• The current General Instructions for Certain Information 

Returns, and 

• The current Instructions for Form 1099-PATR.

To get and to order these instructions and additional 

forms, go to www.irs.gov/EmployerForms.

Caution: Because paper forms are scanned during

processing, you cannot file certain Forms 1096, 1097, 

1098, 1099, 3921, or 5498 that you print from the IRS

website.

Filing and furnishing. For filing and furnishing instructions, 

including due dates, and requesting filing or furnishing 

extensions, see the current General Instructions for Certain 

Information Returns.

Foreign recipient. If the recipient is a nonresident alien, 

you may have to withhold federal income tax and file 

Form 1042-S. See the Instructions for Form 1042-S and 

Pub. 515.

Need help? If you have questions about reporting on Form 

1099-PATR, call the Technical Services Operation (TSO) 

toll free at 866-455-7438 or 304-263-8700 (not toll free). 

Deaf or hard of hearing customers may call any of our 

toll-free numbers using their choice of relay service.