3131 VOID CORRECTED

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number Payments From

Qualified

Education

Programs

(Under Sections

529 and 530)

PAYER’S/TRUSTEE’S federal identification no. RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-Q Cat. No. 32223J Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

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

Basis

Earnings

1 Gross distribution

$

$

$

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2011 General

Instructions for

Certain Information

Returns.

Check if the recipient is

not the designated

beneficiary

6

4 Trustee-to-trustee

transfer

5

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

2011
CORRECTED (if checked)

RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-Q Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

5

Copy B

(keep for your records)

This is important tax

information and is

being furnished to the

Internal Revenue

Service. 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.

For Recipient 6 If this box is checked,

the recipient is not

the designated

beneficiary

4 Trustee-to-trustee

transfer

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number Payments From

Qualified

Education

Programs

(Under Sections

529 and 530)

PAYER’S/TRUSTEE’S federal identification no.

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

If the fair market value (FMV) is shown below, see Pub. 970,

Tax Benefits for Education, for how to figure earnings.

2011
Instructions for Recipient

Box 1. Shows the gross distribution (including in-kind distributions) paid to you

this year from a qualified tuition program (QTP), under section 529, or a

Coverdell ESA (CESA), under section 530. This amount is the total of the

amounts shown in box 2 and box 3. See Pub. 970 for more information.

Box 2. Shows the earnings part of the gross distribution shown in box 1.

Generally, amounts distributed are included in income unless they are used to

pay for qualified education expenses, transferred between trustees, or rolled

over to another qualified education program within 60 days. Report taxable

amounts as “Other Income” on Form 1040.

Box 4. This box is checked if a trustee-to-trustee transfer was made from one

QTP to another QTP, from one CESA to another CESA, or from a CESA to a

QTP. However, in certain transfers from a CESA, the box will be blank.

Box 5. Shows whether the gross distribution was from a QTP (private or state)

or from a CESA.

Box 3. Shows your basis in the gross distribution reported in box 1.

Under a CESA, the amount in box 2 is included in income if there has been

a change in the designated beneficiary and the new designated beneficiary is

not a family member or is over age 30 (except for beneficiaries with special

needs).

Also, an additional 10% tax may apply to part or all of any amount included

in income from the CESA or QTP. See Form 5329 and your tax return

instructions for more information.

If a final (total) distribution is made from your account and you have not

recovered your contributions, see Pub. 970 to determine if you have a

deductible loss and how to claim it.

Under a QTP, the amount in box 2 is included in income if there has been

(a) more than one transfer or rollover within any 12-month period with respect

to the same beneficiary, or (b) a change in the designated beneficiary and the

new designated beneficiary is not a family member.

Caution: For CESA distributions (other than earnings on excess contributions)

made during 2011, the payer/trustee is not required to report amounts in boxes

2 and 3. Instead, the payer/trustee may report the fair market value of the CESA

as of December 31, 2011, in the blank box below boxes 5 and 6. To figure your

earnings and basis, use the Coverdell ESA—Taxable Distributions and Basis

worksheet in Pub. 970.

Distribution codes. For 2011, the payer/trustee may, but is not required to,

report (in the box below boxes 5 and 6) one of the following codes to identify

the distribution you received: 1—Distributions (including transfers); 2—Excess

contributions plus earnings taxable in 2011; 3—Excess contributions plus

earnings taxable in 2010; 4—Disability; 5—Death; 

6—Prohibited transaction. Note: Nontaxable distributions from CESAs and

QTPs, including rollovers, are not required to be reported on your income tax

return. See Pub. 970 for more information.

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

has assigned to distinguish your account.
For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2011 General

Instructions for

Certain

Information

Returns.

Copy C

VOID CORRECTED

RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-Q Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

6 Check if the recipient is

not the designated

beneficiary

4 Trustee-to-trustee

transfer

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number Payments From

Qualified

Education

Programs

(Under Sections

529 and 530)

PAYER’S/TRUSTEE’S federal identification no.

5

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

2011
Instructions for Payer/Trustee

General and specific form instructions are provided

as separate products. The products you should use

to complete Form 1099-Q are the 2011 General

Instructions for Certain Information Returns and the

2011 Instructions for Form 1099-Q. A chart in the

general instructions gives a quick guide to which form

must be filed to report a particular payment. To order

these instructions and additional forms, visit IRS.gov

or call 1-800-TAX-FORM (1-800-829-3676).

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2012.

File Copy A of this form with the IRS by

February 28, 2012. If you file electronically, the due

date is April 2, 2012. To file electronically, you must

have software that generates a file according to the

specifications in Pub. 1220, Specifications for Filing

Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and

W-2G Electronically. IRS does not provide a fill-in form

option.

Caution: Because paper forms are scanned during

processing, you cannot file with the IRS Forms 1096,

1097, 1098, 1099, 3921, 3922, or 5498 that you

download from the IRS website.

Need help? If you have questions about reporting on

Form 1099-Q, call the information reporting customer

service site toll free at 1-866-455-7438 or

304-263-8700 (not toll free). For TTY/TDD equipment,

call 304-579-4827 (not toll free). The hours of

operation are Monday through Friday from 8:30 a.m.

to 4:30 p.m., Eastern time.